Nephrology nursing and the wearable artificial kidney

LOUISVILLE––Victor Gura is a nephrologist turned inventor. He can give you a fascinating review of progress on his project, the wearable artificial kidney. But equally of interest is the story about the patients who tested the device––and the nurse who patiently lead them through it.

Last week, Gura gave his second talk in the past two years at the American Nephrology Nurses Association 47th National Symposium. It was on the last morning of the five-day meeting––a tough assignment for any speaker. But the ballroom was filled. Gura made some general comments about innovation in the dialysis community, noting some research efforts regarding new machines, most of them for home use. He expressed support for the implantable artificial kidney undergoing development at the University of California San Francisco. “There is a lot of work being done,” he said.

The wearable artificial kidney: why do we need it?

No matter how you do it, Gura believes slow, gentle dialysis 24/7 is the best way to mimic the natural kidney and its functions––constantly cleansing the blood of toxins. But kidney research has spent little time on this because the industry has been happy with the status quo. Quoting Belding Scribner from 1999: “The renal community has convinced itself that it is providing adequate dialysis, but it is in fact woefully inadequate.”

But even Scribner, who shared the prestigious Albert Lasker Award for Clinical Medical Research with fellow inventor Dr. Willem J. Kolff in 2002, may not have seen the practicality of doing dialysis 24/7. Maybe more home dialysis to help lengthen therapy? Gura said he likes the value of home dialysis, but questioned whether patients had the desire to store supplies, spend the time to set up the dialysis machine, and do the work to produce better outcomes. Longer and more frequent dialysis in-center is not feasible because “society cannot afford to build more clinics: and many of them are trying to resolve nursing shortages.”

Trial of a different color

Nancy Colobong Smith, MN ANP-BC CNN ARNP, of the University of Washington Med Center, brought Gura’s quest for a working wearable artificial kidney to the nursing level. Colobong Smith worked side by side with 14 patients who underwent use of the WAK prototype: a group of six patients who lived on the WAK for up to six hours, and a second group of eight that lasted up to 8 hours.

Key points of what she gleaned from the two trials:

The wearable kidney was safe, and walking and even dancing could be done with little side effects

Dialysate is regenerated in the artificial kidney, but it’s clear this process needs to be finetuned

CO₂ bubble traps related to kinked tubing developed through the therapy need to be fixed

But putting patients on the wearable artificial kidney was more involved than what you might see in an in-center dialysis clinic. Checklists, diagrams, tools for the process were used (patients in the study had been on dialysis a mean of 15 months); to keep track of the project’s caseload, some of the blood samples were parsed out to three different labs.

None of the patients had restrictions on their diet. That couldn’t have pleased Chuck Lee more. He was the study’s first patient and a diabetic for 40 years. He had previously dialyzed three days a week, four hours a day. “I thought it worked well for me…it was heavy and cumbersome. But it gave me so much more freedom” away from the commitment of in-center dialysis treatment, said the 70-year-old in a video played for attendees.

“He was so happy to eat everything, drink everything, but his tests always came back normal,” his wife added.

Colobong Smith and Gura want to see the wearable kidney start its next trial with a new smaller, lighter prototype. They want to prove that 24/7 dialysis can keep hypertension in check, eliminate the need for phosphate binders, and reduce the need for anemia drugs.

Stay tuned. -by Mark Neumann