부산대학교 도서관

Haemodialysis is life sustaining but expensive, provides limited removal of uraemic solutes, is associated with poor patient quality of life and has a large carbon footprint. Innovative dialysis technologies such as portable, wearable and implantable artificial kidney systems are being developed with the aim of addressing these issues and improving patient care. An important challenge for these technologies is the need for continuous regeneration of a small volume of dialysate. Dialysate recycling systems based on sorbents have great potential for such regeneration. Novel dialysis membranes composed of polymeric or inorganic materials are being developed to improve the removal of a broad range of uraemic toxins, with low levels of membrane fouling compared with currently available synthetic membranes. To achieve more complete therapy and provide important biological functions, these novel membranes could be combined with bioartificial kidneys, which consist of artificial membranes combined with kidney cells. Implementation of these systems will require robust cell sourcing; cell culture facilities annexed to dialysis centres; large-scale, low-cost production; and quality control measures. These challenges are not trivial, and global initiatives involving all relevant stakeholders, including academics, industrialists, medical professionals and patients with kidney disease, are required to achieve important technological breakthroughs. Portable, wearable and implantable artificial kidney systems require compact and efficient dialysate regeneration systems and novel membranes for improved toxin removal and long-term patency. Here, the authors discuss efforts to overcome these challenges and future perspectives for achieving miniaturized dialysis. Key points: Haemodialysis is expensive and is associated with high patient mortality and poor quality of life; portable, wearable and implantable artificial kidney systems are being developed to improve patient care. An important challenge for designing portable or wearable artificial kidney systems is the continuous regeneration of a small volume of dialysate; recycling systems based on sorbents have great potential for dialysate regeneration. Novel dialysis membranes composed of polymeric or inorganic materials are being developed to improve the removal of uraemic toxins, with low levels of membrane fouling. Bioartificial kidney systems can provide important biological functions and thereby potentially improve patient outcomes; however, their implementation has manufacturing, feasibility and logistics challenges. Important technological breakthroughs can be achieved via global initiatives involving relevant stakeholders including academics, industrialists, medical professionals and patients. [ABSTRACT FROM AUTHOR]