Wearable Artificial Kidney – Some Thoughts

January 22, 2016 | By Stu | Filed in: Uncategorized.

A picture of the Wearable Artificial KidneyI’ve been following the progress of the Wearable Artificial Kidney for a couple of years now. Progress seems to be slow but I think that it is very worthwhile research, that could result in making life better for a very specific subset of the dialysis community.

The product seems to be coming up against some resistance from the big players in the dialysis game.

I wonder whether this product is getting the same kind of resistance that electric cars are getting from the oil industry and major car manufacturers?

A product like this could sound the death knell for the big players in the dialysis industry such as Baxter and Fresenius, so maybe we’ll see one of those big players lining up to buy this technology to either kill it off or profit from it?

There’s a buttload of money to be made in dialysis. Especially  with the astronomical increases we’re seeing in diabetes (which often leads to renal failure) and kidney disease itself in first world countries such as the USA, UK, Australia etc.

If a technology like this is struggling for funding, even after securing FDA approval for trials in the US, how are they going to get it into the hands of consumers via the doctors, especially if half the doctors in the US are in the pockets of “big dialysis”?

There are three keys for this product:

Firstly, it’s just too big at the moment to wear comfortably. If they get that right and can get patients to ask for it from their doctors, it will be a winner. I personally can’t see myself wearing a ten pound belt around my waist, and I’m a 90-odd kilo bloke (around 200 lb), can you see this on the waist of a 100 pound woman? That’s adding 10% to their weight. I just can’t see this working. Imagine a person who already has a low haemoglobin carrying that kind of weight around.

Secondly, the fact that it requires an access port to the bloodstream, I think they’re going to have a hard time convincing doctors to prescribe this with the increased risk of infection through an open port. Many dialysis patients don’t have to think too hard about infection control because they just go to dialysis and have a nurse or tech put two needles into their fistula. The nurse or tech takes charge of infection control. Infection control for a port or catheter is a convoluted yet extremely important procedure that will be out of reach for the majority of (older) dialysis patients.

Finally, doctor acceptance. This is a two fold issue:

  1. Firstly, many doctors, particularly in the US, have a vested interest in having patients in dialysis units three times a week. Doctors who align themselves with dialysis companies need to walk the precarious line between the profitability of the dialysis unit and the best interests of the patient. I’m not for a minute saying that doctors put profitability before patient outcomes, but this has to be a consideration.
  2. Secondly, the catheter issue. Doctors are going to be a bit leery about letting patients manage their access for the wearable artificial kidney. Doctors are judged on patient outcomes, they’re not going to put them at risk of infection. A port directly into the bloodstream is very different to a tenckhoff catheter used for peritoneal dialysis. When an infection occurs in a tenckhoff catheter, the infection occurs in the peritoneal cavity. While this is a bad thing, and potentially lethal, an infection straight into the bloodstream is another thing altogether. The risk of the infection spreading to the heart is manifestly more dangerous.

So while I’m still a big advocate of the wearable artificial kidney, I believe that there are some big issues that need to be sorted before the product can go mainstream.

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