Q&A: Nephrologists’ perspectives matter in wearable dialysis device design
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Insight from nephrologists and nephrology nurses on a wearable hemodialysis device will aid in refining its design, according to a presenter at the Innovations in Dialysis: Expediting Advances Symposium.
In collaboration with the American Society for Nephrology and the American Nephrology Nurses Association, presenter Auður Anna Jónsdóttir, MS, third-year industrial engineering doctoral student at the University of Washington, and researchers from the University of Washington Center for Dialysis Innovation captured responses from 30 nephrologists across 20 U.S. states and 32 nephrology nurses across 16 U.S. states on design features for a wearable dialysis device.
Researchers asked the nephrologists and nurses questions about ideal features, barriers and design parameters, such as size and weight, of the device.
The team’s focus on users’ needs for a wearable dialysis device began in 2018 with researching human factors and interviewing patients and care partners about design elements.
The University of Washington researchers were one of six groups to win in KidneyX’s Artificial Kidney Prize competition with their proposed backpack-sized artificial kidney, Ambulatory Kidney to Improve Vitality (AKTIV). Based on the results of the survey involving nephrologists and nephrology nurses, researchers observed that ease of use, safety, function, support, accessibility and wearability were both ideal design features and potential barriers in the design if they were not fulfilled.
Responses showed the upper limit for the acceptable size of the device was a student backpack, and the upper weight limit was 10 pounds. Additionally, a belt was the most preferred design among the group.
Healio spoke with study authors Jónsdóttir and Larry Kessler, ScD, professor at the University of Washington in the school of public health, department of health systems and population health, about this research.
Healio: You are working with the Center of Dialysis Innovation on a wearable AKTIV. What is this device? What are your goals for it?
Kessler: Jonathan Himmelfarb, MD, and Buddy Ratner, PhD, professors in nephrology and bioengineering, initiated and developed the Center for Dialysis Innovation about 6 years ago. We did that on the heels of a clinical trial that Jonathan and I participated in with a wearable artificial kidney, and the lead inventor of that is nephrologist Victor Gura, MD. That proof-of-principle study showed that you could dialyze somebody with a wearable device. However, in terms of the technology, Jonathan felt we could do better, and he reached out to Buddy who is a premier bioengineer. The Center for Dialysis Innovation was kick-started with a $15 million grant from the Northwest Kidney Centers, which we’re thankful for, and we’ve been developing technologies to make the AKTIV device, a portable or wearable dialysis device. The reason for doing this is current dialysis technology has not changed fundamentally in more than 50 years. Hundreds of thousands of people come in for basically three times weekly dialysis in the United States, and it is a poor quality of life for a wide variety of reasons. Mostly, it’s not biologically compatible with the way our bodies work. We believe a different approach is needed, and we’ve been working on that for several years. We hope to go into clinical trials in the next couple of years.
Healio: What prompted you and your team to conduct this study involving nephrologists’ and nephrology nurses’ perspectives on the design of a wearable dialysis device?
Kessler: One of the principles of the Center for Dialysis Innovation is to keep patients at the center of everything we do. Since the beginning of the AKTIV project, myself, Ji-Eun Kim, PhD, an assistant professor in industrial engineering and Auður Anna Jónsdóttir’s main thesis advisor, and Glenda Roberts, BS, the director of external relations and the lead of our patient advisory board, have been going to patients and their care partners to talk to them about what they need. For the first 2 years, we conducted 84 individual interviews and six separate focus group sessions to find out what patients and care partners want and what is important to them. In the last year, we believed it was now time to also ask nephrologists and nephrology nurses what they think because they are partners in the dialysis process as well. Even if we produce something that patients want, if it is something that would concern the nephrology community and would not work well for them, it will struggle in the marketplace. While we have kept patients and their concerns first, we still recognize in the market, you need to work with nephrologists and nephrology nurses. Both are important partners in the way in which dialysis works in the United States.
Healio: Your research on understanding users’ needs started in 2018 with looking into those of patients and care partners. In what ways did your most recent findings overlap with your previous findings? How did they differ?
Jónsdóttir: Our findings show that nephrologists and nephrology nurses share many of the same perspectives as patients and care partners. They talk in general about designing a user-friendly device, the importance of having it easy to operate and set up, and for patients and care partners to do this independently and collaboratively. They talked about ensuring efficient use for the patient and designing a monitoring system that supports patients’ independent use of the device, yet with a secure support link to their dialysis center. They also talked about durable and appealing designs but at the same time, designing a device that is discrete and ensures privacy for the patient. We also see nephrologists and the nephrology nurses preferring some of our designs over others and sharing preferences with the patients on design types.
Differences between the two user groups are also present. For example, we see more detail preferences for treatment specifications and treatment parameters from the nephrologists and the nephrology nurses compared with those of patients and care partners. We also note that the nephrologists and nephrology nurses talk about their patient population as a whole, while the responses from the patients and care partners are their individual experiences. Although patients and care partners paint a certain picture for us, we get a wider view into the vision of these broader populations from the nephrologists and nephrology nurses. An example is ensuring patients will be accommodated in terms of their individual differences. This includes different levels of patient mobility, eyesight or their native language. The nurses and the nephrologists further highlight the importance of affordability and accessibility of the device for all patients.
Healio: How will the feedback from this study help moving forward with the design of a wearable dialysis device?
Jónsdóttir: The feedback from all our user populations at this point offers us a vision for the most ideal designs of a mobile and wearable dialysis device. Particularly for the nephrologists and nephrology nurses, it should be a device they feel comfortable recommending to their patients as perhaps the primary mode of dialysis treatment. We have a vision now for several components of the device, ideal shapes, form factors, and we also have explored barriers that may prevent nephrologists and nurses from recommending the device to their patients. From this study, our findings help designers and developers set and refine design and usability objectives that prioritize design solutions based on your users’ needs.
Healio: What are your plans for future research on the topic?
Jónsdóttir: We have several studies on the horizon taking our mobile and wearable dialysis devices further in the development process. Some of those include evaluation of current training and monitoring procedures for home dialysis programs, and then to explore what patients and caregivers want in these same procedures for our future mobile dialysis devices. We also intend to conduct several analyses including task, hazard and use risk analyses, to identify potential risk to the patient while operating a mobile dialysis device and under different use settings. We are also heading toward low- and high-fidelity prototyping. With our prototypes, we have opportunities to identify design strengths that meet users’ needs and areas that bring opportunities for improvement.
Healio: KidneyX recently announced the second phase of the Artificial Kidney Prize, and past prize winners are eligible to enter. Is your team going to compete?
Kessler: Yes, we plan to do so. We have been successful with KidneyX, and we’re fortunate to have won a couple of the prizes from them.
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Jónsdóttir A. Nephrologists’ and nephrology nurses’ design preferences for a wearable dialysis device. Presented at: Innovations in Dialysis: Expediting Advances Symposium; Aug. 15-16, 2022; Seattle (hybrid meeting).
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