Nephrologist William Fissell IV, MD, associate professor of Medicine and Biomedical Engineering at Vanderbilt University, Nashville, TN, is intent on creating and mass-producing an implantable bioartificial kidney for people with chronic kidney disease who would otherwise be forced onto dialysis.
Only 50 percent of dialysis patients are still alive three years after the start of therapy for kidney disease, compared with 91 percent survival at three years for those who instead receive a preemptive kidney transplant. Dialysis costs $80,000 per patient per year, and the total US cost for treatment of end-stage renal disease is upward of $40 billion.
Vanderbilt and the University of California at San Francisco are partnering to develop the bioartificial kidney.
As an MIT undergrad in physics and electrical engineering, Fissell had worked in a lab developing a piece of technology called an X-ray diffraction grating, used to analyze the atomic constituency of stars. “I saw that the very structures destroyed in most chronic kidney disease had the same approximate size and shape as these devices I had been involved in making and testing as an undergraduate. Could we bring these tools from electrical engineering to bear to assist a population of patients that had immense unmet need?” he asked.
Using silicon nanotechnology similar to computer microprocessor technology, the bioartificial kidney joins nano filters made of silicon with living human kidney cells cultured in the lab from samples harvested from deceased donors. The donated cells form a membrane positioned downstream from the device’s intake filter, out of reach of the body’s immune response, to avoid rejection. The device, he says, runs on the body’s normal blood pressure, with no other power source required.
Beyond filtering waste from the blood, the bioartificial kidney will also perform other vital functions of the kidney, including maintenance of blood pressure and pH levels and vitamin synthesis.
In clinical research conducted at the University of Michigan, intensive care patients with kidney failure were greatly helped by an externally deployed, large-scale version of the device. The challenge now is to condense the technology into a mass-producible small package.
Preclinical testing is ongoing and Fissell hopes to begin testing an implantable device in humans in 2017.