title: Implanted renal replacement for end-stage renal disease.
abstract: The nearly 400000 American patients on dialysis suffer high cardiovascular and infectious mortality, but there is now evidence that this morbid phenotype can be rescued by intensive dialytic therapy. Self-care dialysis at home is limited by patient fears about skill and safety. An implanted artificial kidney would provide the benefits of intensive therapy while avoiding the focal points of patient concern. Hollow fiber polymer membranes and dialytic waste removal are lifesaving innovations but are difficult to adapt to implantable therapies. Biomimetic membranes and living cells can replicate the native kidney's strategy for waste removal. Three key technology developments are necessary for implementation of an implantable artificial kidney: high efficiency ultrafiltration membranes, control of blood-materials interactions such as thrombosis and fouling, and stable differentiated function of renal proximal tubule cells in an engineered construct. There has been significant progress in demonstrating proof-of-concept experiments in each key technology area.
authors.affiliation: Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA. fisselw@ccf.org
authors.forename: S
authors.initials: S
authors.lastname: Roy
authors.forename: K
authors.initials: K
authors.lastname: Goldman
authors.forename: R
authors.initials: R
authors.lastname: Marchant
authors.forename: A
authors.initials: A
authors.lastname: Zydney
authors.forename: D
authors.initials: D
authors.lastname: Brown
authors.forename: A
authors.initials: A
authors.lastname: Fleischman
authors.forename: A
authors.initials: A
authors.lastname: Conlisk
authors.forename: T
authors.initials: T
authors.lastname: Desai
authors.forename: S
authors.initials: S
authors.lastname: Duffy
authors.forename: H
authors.initials: H
authors.lastname: Humes
authors.forename: W
authors.initials: W
authors.lastname: Fissell
mesh_terms: D032701:Biomimetics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008567:Membranes, Artificial; D019736:Prostheses and Implants; D017582:Renal Replacement Therapy / Q000379:methods*
chemical_list: D008567:Membranes, Artificial