Innovations in Dialysis

Dialysis is a life-saving therapy; however, costs of dialysis are high, access is inequitable and outcomes are inadequate. This Review describes the current landscape of dialysis therapy from an epidemiological, economic, ethical and patient-centred framework, and describes initiatives that are aimed at stimulating innovations in the field to one that supports high-quality, high-value care.

Effective treatment of kidney failure depends on reliable vascular access; however, options for chronic vascular access for haemodialysis have remained unchanged for decades. This Review evaluates the key existing challenges in establishing and maintaining vascular access and describes novel and innovative technologies under development that address these issues.

A host of innovative developments in dialysis technologies could potentially transform the field, with benefits for patient outcomes, access to therapy and environmental sustainability.

The need for innovation in dialysis is long overdue. As past and present users of dialysis we are fully aware of the limitations of current dialysis modalities. The time for complacency is over — developers must engage with dialysors to ensure that our needs are met so that we can live the best life possible. Let us share our dream for devices that will enable us to enjoy life.

Regulations for market access and reimbursement of medical devices vary across jurisdictions, complicating the development of innovative technologies for world-wide use; however, several converging regulatory principles are now emerging. Here we discuss approaches by which regulatory and related agencies can promote innovation and boost the effectiveness of regulatory processes to expedite patient access to innovative technologies, including renal replacement therapies.

Peritoneal dialysis (PD) is the dialysis modality of choice for many regions. The application of innovative technology has led to the development of new PD devices that reduce the environmental and economic costs of the therapy, as well as miniaturized devices that provide greater freedom for patients.

Haemodialysis is a life-saving therapy. However, in comparison with the healthy kidney, it removes only a small fraction of the uraemic toxins produced, does not function continuously and cannot replicate biological kidney functions. Innovations in membrane design hold promise to overcome these limitations with potential to improve patient outcomes.

Kidney failure is associated with the retention and subsequent accumulation of uraemic toxins, which have detrimental effects on various physiological processes. The removal of these toxins by current dialysis modalities is inadequate, highlighting the need for innovative approaches to enhance their clearance and/or suppress their generation to improve outcomes for patients with kidney disease.

Peritoneal dialysis and haemodialysis are lifesaving but intrusive treatments that are associated with high morbidity and mortality. Despite the considerable time patients with kidney failure spend tied to their life-saving therapies, relatively few vital signs are monitored. Smart, unobtrusive approaches to track clinical parameters could help to individualize treatments and improve patient outcomes.

Current dialysis technologies require vast quantities of pure water; however, water is a finite resource and water scarcity is increasing globally. For dialysis to be sustainable, a critical need exists for innovative approaches that address the consumption and wastage of water by dialysis.

The most common treatment option worldwide for persons with kidney failure is in-centre haemodialysis; however, this treatment has remained largely unchanged over decades owing to a lack of true patient-centred technological innovation. The development of safe and effective wearable forms of dialysis has the potential to transform the lives of these patients.

Continuous kidney replacement therapy (CKRT) can be a lifesaving intervention for critically ill patients; however, mortality remains high. The adaptation of existing innovations, including anti-clotting measures; cloud-computing for optimized treatment prescribing and therapy monitoring; and real-time sensing of blood and/or filter effluent composition to CKRT devices has the potential to enable personalized care and improve the safety and efficacy of this therapy.