Abstract: TH-PO342
Allo-Hemodialysis: Intermittent Donation of Kidney Function as a Novel Treatment for Patients with Kidney Failure in Limited Resource Settings
Session Information
- Dialysis: Dialysate and Clearance
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
- Maheshwari, Vaibhav, Renal Research Institute, New York, New York, United States
- Thijssen, Stephan, Renal Research Institute, New York, New York, United States
Background
A global report suggests that 2.2 to 7.1 million people might have died in 2010 prematurely because renal replacement therapy could not be accessed (Liyanage et al, Lancet, 2015); the authors noted the largest treatment gaps in low-income countries. Current hemodialysis (HD) is expensive and technically challenging. HD requires a substantial amount of water (300 to 1000 L of tap water per HD, depending on dialysate flow rate, treatment time, and reverse osmosis system rejection rate), a dialyzer, blood lines, and a sophisticated dialysis machine with pumps, heating, and ultrafiltration control systems to safely deliver HD, mostly in-centers. In our research, we systematically questioned long-held paradigms and conceptualized a novel treatment option that may have the potential to increase access to HD and reduce the loss of human life owing to kidney failure.
Methods
We conceptually reduced HD to its essential components, the dialyzer, blood lines, a pump, and ultrafiltration control. While - as in traditional HD - on the dialyzer’s blood side the patient’s blood flows, the dialysate side is connected to the circulation of a healthy subject (“buddy”) and perfused with his/her blood (hence called alloHD). Because the “most physiologic dialysate i.e. physiosate” is provided by the buddy, the complexity of HD is substantially reduced. We employed extensive mathematical modeling to explore the feasibility of the alloHD.
Results
Our model simulations show that fluid and urea transferred into the buddy are cleared effectively by the buddy’s kidneys, while bicarbonate diffuse into the patient. We show that a child can sufficiently be treated by an adult buddy with 3-4 weekly treatments. We show that blood flow rates are a key factor, thus alloHD may require catheters or permanent vascular access in buddy. We also address a host of ethical, societal, biological, and technical questions in our ongoing research.
Conclusion
While dialyzing one human against another may seem unthinkable at first, we challenge the kidney community to rethink pre-conceived notions and reflect on the proposed concept. Prototyping of an alloHD device is underway that may be used for bench testing and, ultimately, in vivo studies in animals and humans. We believe that alloHD holds promise to ease the human burden of kidney disease.
Funding
- Commercial Support –