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Panminerva Medica 2011 September;53(3):155-66


lingua: Inglese

Implanted renal replacement for end-stage renal disease

Roy S. 1, Goldman K. 2, Marchant R. E. 3, Zydney A. L. 4, Brown D. L. 5, Fleischman A. J. 6, Conlisk A. T. 7, Desai T. A. 1, Duffy S. 8, Humes H. D. 9, Fissell W. H. 10

1 Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco; 2 H-Cubed, Inc. N. Olmsted, Ohio, USA; 3 Department of Biomedical Engineering, Case Western Western Reserve University, Cleveland, Ohio, USA; 4 Department of Chemical Engineering, Pennsylvania State University, University Park, Pennsylvania, USA; 5 Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA; 6 Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA; 7 Department of Mechanical Engineering, The Ohio State University, Columbus, Ohio, USA; 8 Connecticut Reserve Technologies, Stow, Ohio, USA; 9 Department of Medicine University of Michigan, Ann Arbor, Michigan, USA and Innovative Biotherapies, Ann Arbor, Michigan, USA 10 Departments of Nephrology and Hypertension and Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA


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.

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