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Portable hemodialysis devices with vascular access may provide solutions for patients with ESRD
With adequate vascular access, portable hemodialysis devices, like the wearable artificial kidney and wearable ultrafiltration device, may provide patients with ESRD a cost-effective solution that also allows them to safely carry out activities of daily living, according to a study published in the Clinical Kidney Journal.
“Although renal transplantation is considered the best option for ESRD patients, there are still several limitations to its wider use,” Ana Coutinho Castro, MD, of the department of nephrology, dialysis and transplantation at Centro Hospitalar do Porto in Portugal, and colleagues wrote. “Portable [hemodialysis] HD devices can be acceptable options to address several unmet clinical needs of HD patients. However, their implementation depends primarily on the development of innovative [vascular access]VA systems.”
To determine what type of vascular access would allow for the most beneficial implementation of Wearable Artificial Kidney and Wearable Ultrafiltration, researchers first reviewed the related literature, finding that the biggest challenge has been the development of a vascular access with a mean blood flow of 100 mL/min. Other technological prerequisites were identified including allowance of prolonged and frequent dialysis treatments without interfering in activities of daily living, safe connection and disconnection systems, a reduced risk of biofilm formation and coagulation, and high biocompatibility.
Researchers found the most feasible option would be a device similar to a chronic central venous catheter (CVC) with a 5Fr lumen, though, according to the researchers, a point of concern with the common CVC model is risk of physical damage and contamination to the external portion which can lead to infection and hospitalization. However, the reviewed studies suggested that totally subcutaneous port devices, like the Dialok (Biolink) and LifeSite (Vasca) systems, can help Wearable Artificial Kidney and Wearable Ultrafiltration to operate continuously while simultaneously allowing patients to participate in activities of daily living and reducing the risk of infection.
“Despite significant technological evolution in [renal replacement therapy] RRT, HD continues to be associated with poor morbidity, mortality and [health-related quality of life] HRQoL outcomes in ESRD patients,” the researchers wrote. “The development of [wearable artificial kidney] WAK and [wearable ultrafiltration] WUF devices may be an important turning point in the care of ESRD patients. The development of an appropriate VA with reduced risk of complications is the first step in making the WAK and WUF feasible, safe, efficacious, cost-effective and convenient therapies for needy patients.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.