Removal of Urea in a Wearable Dialysis Device: A Reappraisal of Electro-Oxidation

Metal-Doped CoS Nanosheets: Breaking Scaling Limitations for Enhanced Urea Electrooxidation and Hydrogen Evolution

The electrocatalytic urea oxidation reaction (UOR) is a promising approach to lowering the energy barrier of the anode half-reaction in water splitting for energy-efficient hydrogen production and to remove excess urea from blood or dialysis fluid. However, the sluggish kinetics and large overpotential caused by scaling relationships significantly limit the development of the UOR technology. Herein, bifunctional amorphous M-CoS (M = Zr, Cu, Mn, Fe) nanosheets were synthesized via a one-step electrodeposition process. Among them, Zr-CoS exhibited exceptional electrocatalytic performance, achieving 10 mA cm-2 in UOR at an overpotential of 1.26 V, outperforming recently reported catalysts, while CoS demonstrated 10 mA cm-2 in the hydrogen evolution reaction at an impressively low overpotential of -175 mV. Density functional theory calculations revealed that doped Cu and Zr ions migrated to the adsorption sites of N atoms before and after C-N cleavage, breaking the limitation of scaling relationships. Meanwhile, the energy barrier of the C-N cleavage step showed a good linear relationship with the variation of integrated crystal orbital Hamilton population (ΔICOHP), indicating that ΔICOHP was a good descriptor to evaluate UOR performances. This work not only emphasized the outstanding performances of Zr-CoS but also offered innovative insights into the role of metal sulfides in UOR.

Scalable ion concentration polarization dialyzer for peritoneal dialysate regeneration

A wearable artificial kidney (WAK) stands poised to offer dialysis treatment with maximal temporal and spatial flexibility for end-stage renal disease (ESRD) patients, while portability has not yet been achieved due to difficulties in portable purification. The ion concentration polarization (ICP), one of the nanoelectrokinetic phenomenon, has garnered substantial attention in the realm of portable purification applications, owing to its remarkable capacity for charge separation. In this work, scalable ICP dialyzer with 10,000-fold increase in throughput, was applied for peritoneal dialysate regeneration. First, the mechanism underpinning dialysate purification was corroborated based on micro-nanofluidics. Simultaneously, the electrochemical reactions utilized the complete decomposition of uncharged toxin (urea), achieving approximately 99% clearance, while the ICP phenomenon promoted the removal of positively charged toxin (creatinine), achieving approximately 30% clearance. Second, 3-D scalable ICP dialyzer was developed with a creation of micro-nanofluidic environment inside. Throughput scalability was demonstrated up to 1 mL/min with average approximately 30% toxins clearance. Ultimately, the 3-D ICP dialyzer was applied to assist peritoneal dialysis (PD) using a bilateral nephrectomy rat model. We demonstrated that regenerated dialysate successfully reduced in vivo toxicity, with average toxins removal ratio of approximately 30% per cycle. We believe that the integration of this scalable ICP dialyzer into the WAK holds tremendous potential for substantially enhancing the quality of life for individuals with ESRD.

Regeneration of dialysis solution by dual-layer hollow fiber mixed matrix membrane (DLHF-MMM) incorporated with amine-functionalized mesoporous silica nanoparticles

A large amount of purified water is used in conventional hemodialysis (HD) for treating end-stage kidney disease (ESKD). To minimize the water demand and waste generation, the regeneration of dialysis solution is considered the most efficient control strategy. In this study, an innovative dual-layer hollow fiber (DLHF) mixed matrix membrane (MMM) incorporated with amine-functionalized mesoporous silica nanoparticles (MPS-NPs) was developed to regenerate spent dialysis solution. The fabricated DLHF-MMM configuration enabled the continuous removal of small, medium, and large weight uremic toxins (UTs) through dual mechanisms. The inner layer composed of polyethersulfone (PES) and polyethylene glycol (PEG) rejected medium-large weight UTs (i.e., MW > 500 Da) via the molecular sieving. Meanwhile, the outer layer containing amine-functionalized MPS-NPs effectively removed small weight UTs, such as urea and creatinine. The DLHF-MMM with 6 wt% of amine-functionalized MPS-NPs demonstrated the most favorable characteristics, i.e., high water permeability (298.6 ± 3.2 mL/m2.h.mmHg) and adsorption capacity of urea (523.5 mg/g) and creatinine (28.1 mg/g). Notably, the optimal membrane (DLHF-4) also achieved favorable removal rates from the spent dialysis solution of actual patient, i.e., urea (74.4 %), creatinine (56 %), hippuric acid (16.1 %), and lysozyme (58.7 %, additionally spiked as a mimicking for β-2 microglobulin). These results indicate that the fabricated DLHF-MMM in this study can effectively overcome the challenges posed by the complex matrix components. Overall, the results of this study demonstrate that the DLHF-MMM incorporated with amine-functionalized MPS-NPs is a promising and potential tool for the regeneration of dialysis solution. Furthermore, this approach can contribute to water conservation and reduce the burden on wastewater treatment processes associated with wastewater generated from conventional HD.

Catalytic urea electrooxidation on nickel‐metal hydroxide foams for use in a simplified dialysis device

Electrocatalytic urea removal is a promising technology for artificial kidney dialysis and wastewater treatment. Urea electrooxidation was studied on nickel electrocatalysts modified with Cr, Mo, Mn, and Fe. Mass transfer limits were observed for urea oxidation at physiological concentrations (10 mmol L). Urea oxidation kinetics were explored at higher concentrations (200 mmol L), showing improved performance, but with lower currents per active site. A simplified dialysis model was developed to examine the relationship of mass transfer coefficients and extent of reaction on flowrate, composition, and pH of the reacting stream. For a nickel hydroxide catalyst operating at 1.45 V, 37 , and pH 7.1, the model shows a minimum geometric electrode area of 1314 cm2 is needed to remove 3.75 g urea h with a flow rate of 200 mL min for continuous operation.

Urea catalytic oxidation for energy and environmental applications

Urea is one of the most essential reactive nitrogen species in the nitrogen cycle and plays an indispensable role in the water-energy-food nexus. However, untreated urea or urine wastewater causes severe environmental pollution and threatens human health. Electrocatalytic and photo(electro)catalytic urea oxidation technologies under mild conditions have become promising methods for energy recovery and environmental remediation. An in-depth understanding of the reaction mechanisms of the urea oxidation reaction (UOR) is important to design efficient electrocatalysts/photo(electro)catalysts for these technologies. This review provides a critical appraisal of the recent advances in the UOR by means of both electrocatalysis and photo(electro)catalysis, aiming to comprehensively assess this emerging field from fundamentals and materials, to practical applications. The emphasis of this review is on the design and development strategies for electrocatalysts/photo(electro)catalysts based on reaction pathways. Meanwhile, the UOR in natural urine is discussed, focusing on the influence of impurity ions. A particular emphasis is placed on the application of the UOR in energy and environmental fields, such as hydrogen production by urea electrolysis, urea fuel cells, and urea/urine wastewater remediation. Finally, future directions, prospects, and remaining challenges are discussed for this emerging research field. This critical review significantly increases the understanding of current progress in urea conversion and the development of a sustainable nitrogen economy.

Portable, wearable and implantable artificial kidney systems: needs, opportunities and challenges

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.

Selectively mixed matrix hemodialysis membrane for adequate clearance of p-cresol by the incorporation of imprinted zeolite

The adequacy in uremic toxin removal upon hemodialysis treatment is essential in patients with kidney failure diseases as poor removal leads to heart failure, hypertension, and stroke. The combination of adsorption and diffusion processes has become very advantageous for hemodialysis membranes. By this mechanism, water-soluble uremic toxins (WSUTs) and protein-bounded uremic toxins (PBUTs) could be removed at one time. Therefore, this study aimed to develop a novel imprinted zeolite by p-cresol (IZC) and then incorporated it into polyethersulfone (PES) and poly(vinyl pyrrolidone) (PVP) to produce hollow fiber mixed matrix membrane (HF-MMM). The IZC proved to be sensitive in attracting the adsorbate, classifying it as having a strong adsorption behavior. Accordingly, IZC is very promising to be applied as an adsorbent in the hemodialysis treatment. In this study, IZC as p-cresol's adsorbent was incorporated into a PES-based polymeric membrane with a small addition of PVP to produce HF-MMM using a dry/wet spinning process. The effect of air gap distance between the spinneret and coagulant bath and percentage loading for PES, PVP, and IZC were studied and optimized to obtain the best performance of HF-MMM. The 40 cm of air gap distance, 16 wt% of PES, 2 wt% of PVP, and 1 wt% of IZC loading were able to produce a superior hemodialysis membrane. These optimized parameters showed sufficient uremic toxin removal, i.e., 60.74% of urea, 52.35% of p-cresol in the phosphate buffer saline solution, and 66.29% of p-cresol in bovine serum albumin solution for 4 h permeation using the dialysis system. These HF-MMMs also achieved pure water flux of 67.57 L m^-2 h^-1 bar^-1 and bovine serum albumin rejection of 95.05%. Therefore, this membrane has proven to be able to clean up WSUT and PBUT through a one-step process. Moreover, as compared to the neat PES membrane, MMM was able to remove p-cresol at 186.22 times higher capability.

Current Status and Future of Artificial Kidney in Humans

The number of patients needing renal replacement therapy (RRT) is increasing rapidly with an increase in lifestyle diseases such as diabetes, hypertension, and metabolic syndrome. Kidney transplantation, whenever feasible, is the most preferred mode of RRT. However, there is a growing shortage of donor kidneys for transplantation. While dialysis is partially able to perform the filtration and excretion function of the kidneys, it is still not able to perform the other renal tubular and endocrine functions of a normal kidney and has quality-of-life issues with significant long-term morbidity. The need of the hour is to develop an ideal artificial kidney that would be wearable or implantable and would be able to perform the complete excretory, filtration, tubular, endocrine, and metabolic functions of the kidney while preserving the quality of life and minimizing complications. In this review, we discuss the characteristics of an ideal artificial kidney, the challenges of developing such a device, a brief description of the past and current work on this topic, and what the artificial kidney of the future should look like.

Strategies for optimizing urea removal to enable portable kidney dialysis: A reappraisal

BACKGROUND

Portable hemodialysis has the potential to improve health outcomes and quality of life for patients with kidney failure at reduced costs. Urea removal, required for dialysate regeneration, is a central function of any existing/potential portable dialysis device. Urea in the spent dialysate coexists with non-urea uremic toxins, nutrients, and electrolytes, all of which will interfere with the urea removal efficiency, regardless of whether the underlying urea removal mechanism is based on urease conversion, direct urea adsorption, or oxidation. The aim of the current review is to identify the amount of the most prevalent chemicals being removed during a single dialysis session and evaluate the potential benefits of an urea-selective membrane for portable dialysis.

METHODS

We have performed a literature search using Web of Science and PubMed databases to find available articles reporting (or be able to calculate from blood plasma concentration) > 5 mg of individually quantified solutes removed during thrice-weekly hemodialysis sessions. If multiple reports of the same solute were available, the reported values were averaged, and the geometric mean of standard deviations was taken. Further critical literature analysis of reported dialysate regeneration methods was performed using Web of Science and PubMed databases.

RESULTS

On average, 46.0 g uremic retention solutes are removed in a single conventional dialysis session, out of which urea is only 23.6 g. For both urease- and sorbent-based urea removal mechanisms, amino acids, with 7.7 g removal per session, could potentially interfere with urea removal efficiency. Additionally for the oxidation-based urea removal system, plentiful nutrients such as glucose (24.0 g) will interfere with urea removal by competition. Using a nanofiltration membrane between dialysate and oxidation unit with a molecular weight cutoff (MWCO) of ~200 Da, 67.6 g of non-electrolyte species will be removed in a single dialysis session, out of which 44.0 g are non-urea molecules. If the membrane MWCO is further decreased to 120 Da, the mass of non-electrolyte non-urea species will drop to 9.3 g. Reverse osmosis membranes have been shown to be both effective at blocking the transport of non-urea species (creatinine for example with ~90% rejection ratio), and permissive for urea transport (~20% rejection ratio), making them a promising urea selective membrane to increase the efficiency of the oxidative urea removal system.

CONCLUSIONS

Compiled are quantified solute removal amounts greater than 5 mg per session during conventional hemodialysis treatments, to act as a guide for portable dialysis system design. Analysis shows that multiple chemical species in the dialysate interfere with all proposed portable urea removal systems. This suggests the need for an additional protective dialysate loop coupled to urea removal system and an urea-selective membrane.

Functionalized Hemodialysis Polysulfone Membranes with Improved Hemocompatibility

The field of membrane materials is one of the most dynamic due to the continuously changing requirements regarding the selectivity and the upgradation of the materials developed with the constantly changing needs. Two membrane processes are essential at present, not for development, but for everyday life-desalination and hemodialysis. Hemodialysis has preserved life and increased life expectancy over the past 60-70 years for tens of millions of people with chronic kidney dysfunction. In addition to the challenges related to the efficiency and separative properties of the membranes, the biggest challenge remained and still remains the assurance of hemocompatibility-not affecting the blood during its recirculation outside the body for 4 h once every two days. This review presents the latest research carried out in the field of functionalization of polysulfone membranes (the most used polymer in the preparation of membranes for hemodialysis) with the purpose of increasing the hemocompatibility and efficiency of the separation process itself with a decreasing impact on the body.

Safety of electrooxidation for urea removal in a wearable artificial kidney is compromised by formation of glucose degradation products

A major challenge for the development of a wearable artificial kidney (WAK) is the removal of urea from the spent dialysate, as urea is the waste solute with the highest daily molar production and is difficult to adsorb. Here we present results on glucose degradation products (GDPs) formed during electrooxidation (EO), a technique that applies a current to the dialysate to convert urea into nitrogen, carbon dioxide, and hydrogen gas. Uremic plasma and peritoneal effluent were dialyzed for 8 hours with a WAK with and without EO‐based dialysate regeneration. Samples were taken regularly during treatment. GDPs (glyoxal, methylglyoxal, and 3‐deoxyglucosone) were measured in EO‐ and non‐EO‐treated fluids. Glyoxal and methylglyoxal concentrations increased 26‐ and 11‐fold, respectively, in uremic plasma (at [glucose] 7 mmol/L) and 209‐ and 353‐fold, respectively, in peritoneal effluent (at [glucose] 100 mmol/L) during treatment with EO, whereas no change was observed in GDP concentrations during dialysate regeneration without EO. EO for dialysate regeneration in a WAK is currently not safe due to the generation of GDPs which are not biocompatible.

Co-Adsorptive Removal of Creatinine and Urea by a Three-Component Dual-Layer Hollow Fiber Membrane

The development of wearable artificial kidney demands an efficient dialysate recovery, which relies upon the adsorption process. This study proposes a solution to solve the problem of competitive adsorption between the uremic toxins by employing two adsorptive components in a membrane separation process. Dual-layer hollow fiber (DLHF) membranes, which are composed of a polysulfone (PSf)/activated carbon (AC) inner layer and a PSf/poly(methyl methacrylate) (PMMA) outer layer, were prepared for co-adsorptive removal of creatinine and urea from aqueous solution. The DLHF membranes were characterized in terms of morphological, physicochemical, water transport, and creatinine adsorption properties. The membrane was then subjected to an ultrafiltration adsorption study for performance evaluation. The incorporation of AC in membrane, as confirmed by microscopic and surface analyses, has improved the pure water flux up to 25.2 L/(m² h). A membrane with optimum AC loading (9 wt %) demonstrated the highest maximum creatinine adsorption capacity (86.2 mg/g) based on the Langmuir adsorption isotherm model. In the ultrafiltration adsorption experiment, the membrane removed creatinine and urea with a combined average percent removal of 29.3%. Moreover, the membrane exhibited creatinine and urea uptake recoveries of 98.8 and 81.2%, respectively. The combined action of PMMA and AC in the PSf DLHF membrane has made the adsorption of multiple uremic toxins possible during dialysate recovery.

Urea removal strategies for dialysate regeneration in a wearable artificial kidney

The availability of a wearable artificial kidney (WAK) that provides dialysis outside the hospital would be an important advancement for dialysis patients. The concept of a WAK is based on regeneration of a small volume of dialysate in a closed-loop. Removal of urea, the primary waste product of nitrogen metabolism, is the major challenge for the realization of a WAK since it is a molecule with low reactivity that is difficult to adsorb while it is the waste solute with the highest daily molar production. Currently, no efficient urea removal technology is available that allows for miniaturization of the WAK to a size and weight that is acceptable for patients to carry. Several urea removal strategies have been explored, including enzymatic hydrolysis by urease, electro-oxidation and sorbent systems. However, thus far, these methods have toxic side effects, limited removal capacity or slow removal kinetics. This review discusses different urea removal strategies for application in a wearable dialysis device, from both a chemical and a medical perspective.

Feasibility of osmotic dilution for recycling spent dialysate: Process performance, scaling, and economic evaluation

Hemodialysis is one of the therapies for patients with kidney failure. Hemodialysis requires large amounts of pure water, and is one of the most water-hungry medical procedures, and thus represents a clear opportunity where improvements should be made concerning the consumption and wastage of water. In this paper, we explored the potential of forward osmosis (FO) membrane for recycling the spent dialysate using the dialysis concentrate as the draw solution. Partially diluted dialysis concentrate could be further diluted with pure water to form dialysate for further dialysis process. Using commercial cellulose triacetate (CTA) FO membranes, the water recovery of approximately 64% was achieved and the final volume of the partially diluted dialysis concentrate was about four times the initial volume. Flux decline of the FO process was observed, mainly due to concentration of synthetic spent dialysate and dilution of dialysis concentrate, while membrane scaling had little impact on the flux decline. The urea rejection was found to be relatively low owing to the small size and electroneutral nature of the urea molecule. Obvious membrane scaling was observed after three FO cycles. The energy dispersive spectroscopy analysis of the scaling layer indicated that the scalants were phosphates and carbonates. The scaling was removed via osmotic backwash and almost completely recovery of FO flux was obtained. Economic analysis showed that the centralized treatment of spent dialysate in a dialysis center using the proposed osmotic dilution process could greatly save water resources and cost. Improving the urea rejection of FO membrane was identified as an important research focus for future research on the potential application of FO technology for recycling the spent dialysate in hemodialysis.

A Lattice-Oxygen-Involved Reaction Pathway to Boost Urea Oxidation

The electrocatalytic urea oxidation reaction (UOR) provides more economic electrons than water oxidation for various renewable energy-related systems owing to its lower thermodynamic barriers. However, it is limited by sluggish reaction kinetics, especially by CO₂ desorption steps, masking its energetic advantage compared with water oxidation. Now, a lattice-oxygen-involved UOR mechanism on Ni⁴⁺ active sites is reported that has significantly faster reaction kinetics than the conventional UOR mechanisms. Combined DFT, ¹⁸ O isotope-labeling mass spectrometry, and in situ IR spectroscopy show that lattice oxygen is directly involved in transforming *CO to CO₂ and accelerating the UOR rate. The resultant Ni⁴⁺ catalyst on a glassy carbon electrode exhibits a high current density (264 mA cm^-2 at 1.6 V versus RHE), outperforming the state-of-the-art catalysts, and the turnover frequency of Ni⁴⁺ active sites towards UOR is 5 times higher than that of Ni³⁺ active sites.

New chemistry supporting portable solutions for end-stage renal disease dialysis treatment

A new polymeric adsorbent to improve portable dialysis treatment by simplifying urea removal at the dialysate regeneration step is proposed. An adsorbent to remove urea was synthesized by molecular imprinting technology that can potentially overcome drawbacks existing in urease enzyme-based dialysate regeneration technology. Molecularly imprinted polymer (MIP) for urea generates cavities both in shape and in size targeted for urea. Using the synthesized MIP, we have shown removal of urea present in the dialysate buffer. Various experimental conditions such as choice of monomers, porogen, and template to monomer ratios were optimized to achieve highest binding capacity on a column flow through system monitored using high-performance liquid chromatography (HPLC). Taking advantage of the basicity of urea molecule, monomers having Brønsted acidic groups such as acrylic acid, methacrylic acid and itaconic acid were screened. The MIP synthesized using urea:acrylic acid:EGDMA (1:4:12) in acetonitrile:ethylene dichloride (1:1) as porogen gave highest binding capacity of 24.5 g/kg of urea in the dialysate buffer matrix.

A swan song for Kt/Vurea

Dialyzer clearance of urea multiplied by dialysis time and normalized for urea distribution volume (Kt/V_urea or simply Kt/V) has been used as an index of dialysis adequacy since more than 30 years. This article reviews the flaws of Kt/V, starting with a lack of proof of concept in three randomized controlled hard outcome trials (RCTs), and continuing with a long list of conditions where the concept of Kt/V was shown to be flawed. This information leaves little room for any conclusion other than that Kt/V, as an indicator of dialysis adequacy, is obsolete. The dialysis patient might benefit more if, instead, the nephrology community concentrates in the future on pursuing the optimal dialysis dose that conforms with adequate quality of life and on factors that are likely to affect outcomes more than Kt/V. These include residual renal function, volume status, dialysis length, ultrafiltration rate, the number of intra-dialytic hypotensive episodes, interdialytic blood pressure, serum potassium and phosphate, serum albumin, and C reactive protein.

Removal of urea by electro-oxidation in a miniature dialysis device: a study in awake goats

The key to success in developing a wearable dialysis device is a technique to safely and efficiently regenerate and reuse a small volume of dialysate in a closed-loop system. In a hemodialysis model in goats, we explored whether urea removal by electro-oxidation (EO) could be effectively and safely applied in vivo. A miniature dialysis device was built, containing 1 or 2 "EO units," each with 10 graphite electrodes, with a cumulative electrode surface of 585 cm2 per unit. The units also contained poly(styrene-divinylbenzene) sulfonate beads, FeOOH beads, and activated carbon for respective potassium, phosphate, and chlorine removal. Urea, potassium, and phosphate were infused to create "uremic" conditions. Urea removal was dependent on total electrode surface area [removal of 8 mmol/h (SD 1) and 16 mmol/h (SD 2) and clearance of 12 ml/min (SD 1) and 20 ml/min (SD 3) with 1 and 2 EO units, respectively] and plasma urea concentration but not on flow rate. Extrapolating urea removal with 2 EO units to 24 h would suffice to remove daily urea production, but for intermittent dialysis, additional units would be required. EO had practically no effects on potassium and phosphate removal or electrolyte balance. However, slight ammonium releasewas observed, and some chlorine release at higher dialysate flow rates. Minor effects on acid-base balance were observed, possibly partly due to infusion of chloride. Mild hemolysis occurred, which seemed related to urea infusion. In conclusion, clinically relevant urea removal was achieved in vivo by electro-oxidation. Efficacy and safety testing in a large-animal model with uremia is now indicated.

From portable dialysis to a bioengineered kidney

INTRODUCTION

Since the advent of peritoneal dialysis (PD) in the 1970s, the principles of dialysis have changed little. In the coming decades, several major breakthroughs are expected.

AREAS COVERED

Novel wearable and portable dialysis devices for both hemodialysis (HD) and PD are expected first. The HD devices could facilitate more frequent and longer dialysis outside of the hospital, while improving patient's mobility and autonomy. The PD devices could enhance blood purification and increase technique survival of PD. Further away from clinical application is the bioartificial kidney, containing renal cells. Initially, the bioartificial kidney could be applied for extracorporeal treatment, to partly replace renal tubular endocrine, metabolic, immunoregulatory and secretory functions. Subsequently, intracorporeal treatment may become possible.

EXPERT COMMENTARY

Key factors for successful implementation of miniature dialysis devices are patient attitudes and cost-effectiveness. A well-functioning and safe extracorporeal blood circuit is required for HD. For PD, a double lumen PD catheter would optimize performance. Future research should focus on further miniaturization of the urea removal strategy. For the bio-artificial kidney (BAK), cost effectiveness should be determined and a general set of functional requirements should be defined for future studies. For intracorporeal application, water reabsorption will become a major challenge.

Nanofibrous Tubular Membrane for Blood Hemodialysis

As the most important components of a hemodialysis device, nanofibrous membranes enjoy high interconnected porosity and specific surface area as well as excellect permeability. In this study, a tubular nanofibrous membrane of polysulfone nanofibers was produced via electrospinning method to remove urea and creatinine from urine and blood serums of dialysis patients. Nanofibrous membranes were electrospun at a concentration of 11.5 wt% of polysulfone (PS) and dimethylformamide (DMF)/tetrahydrofuran (THF) with a ratio of 70/30. The effects of the rotational speed of collectors, electrospinning duration, and inner diameter of the tubular nanofibrous membrane on the urea and creatinine removal efficiency of the tubular membrane were investigated through the hemodialysis simulation experiments. It was found that the tubular membrane with an inner diameter of 3 mm elecrospun at shorter duration with lower collecting speed had the highest urea and creatinine removal efficiency. The hemodialysis simulation experiment showed that the urea and creatinine removal efficiency of the tubular membrane with a diameter of 3 mm were 90.4 and 100%, respectively. Also, three patients' blood serums were tested with the nanofibrous membrane. The results showed that the creatinine and urea removal rates were 93.2 and 90.3%, respectively.

A regenerable potassium and phosphate sorbent system to enhance dialysis efficacy and device portability: a study in awake goats

Background

Patients on standard intermittent haemodialysis suffer from strong fluctuations in plasma potassium and phosphate. Prolonged dialysis with a wearable device, based on continuous regeneration of a small volume of dialysate using ion exchangers, could moderate these fluctuations and offer increased clearance of these electrolytes. We report in vivo results on the efficacy of potassium and phosphate adsorption from a wearable dialysis device. We explore whether equilibration of ion exchangers at physiological Ca 2+ , Mg 2+ and hypotonic NaCl can prevent calcium/magnesium adsorption and net sodium release, respectively. Effects on pH and HCO3- were studied.

Methods

Healthy goats were instrumented with a central venous catheter and dialysed. Potassium and phosphate were infused to achieve plasma concentrations commonly observed in dialysis patients. An adsorption cartridge containing 80 g sodium poly(styrene-divinylbenzene) sulphonate and 40 g iron oxide hydroxide beads for potassium and phosphate removal, respectively, was incorporated in a dialysate circuit. Sorbents were equilibrated and regenerated with a solution containing NaCl, CaCl 2 and MgCl 2 . Blood was pumped over a dialyser and dialysate was recirculated over the adsorption cartridge in a countercurrent direction.

Results

Potassium and phosphate adsorption was 7.7 ± 2.7 and 4.9 ± 1.3 mmol in 3 h, respectively. Adsorption capacity remained constant during consecutive dialysis sessions and increased with increasing K + and PO43-. Equilibration at physiological Ca 2+ and Mg 2+ prevented net adsorption, eliminating the need for post-cartridge calcium and magnesium infusion. Equilibration at hypotonic NaCl prevented net sodium release Fe 2+ and arterial pH did not change. Bicarbonate was adsorbed, which could be prevented by equilibrating at HCO3- 15 mM.

Conclusion

We demonstrate clinically relevant, concentration-dependent, pH-neutral potassium and phosphate removal in vivo with small volumes of regenerable ion exchangers in our prototype wearable dialysis device. Application of the selected ion exchangers for potassium and phosphate removal in a wearable dialysis device appears to be effective with a low-risk profile.

In vitro trials of a wearable artificial kidney (WAK)

BACKGROUND

This paper presents results of in vitro trials of a wearable artificial kidney (WAK).

MATERIALS AND METHODS

To carry out the trials, a test bench was developed. It consisted of a patient imitator, a tubing set and measuring equipment.

RESULTS

Our WAK can eliminate urea, uric acid and creatinine from spent dialysate with mean mass rates of 0.85 ± 0.1 g/h, 0.10 ± 0.04 g/h and 0.05 ± 0.01 g/h, respectively. Concentrations of Na+, Cl- and Ca2+ ions were kept in the 10% range from initial values. We demonstrated that our WAK can operate for 38 hours without having to replace expendable materials.

CONCLUSIONS

The WAK that we developed can eliminate metabolites from spent dialysis fluid with mass rates that are sufficient to maintain stable, physiologically normal metabolite concentrations in patients' blood.