Kidney Matters - Issue 9 Summer 2020

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LEARN MORE28AWAK-PD: leading the revolutionin peritoneal dialysis?An automated wearable artificial kidney(AWAK) successfully delivers high-doseperitoneal dialysis (PD) for up to onemonth, according to a recent study. Thisis the first time that AWAK-PD has beenused in people with kidney failure.AWAK-PD weighs less than 2 kg and needs only 2 litresof PD solution a day, so it can be used on the moveduring the day, as well as over night. According to themanufacturers, AWAK-PD provides six to eight hoursof tidal PD and achieves recommended clearance witha single daily treatment.AWAK-PD uses sorbent-based technology (a sorbent is amaterial that binds another substance to it by a physicalor chemical reaction). The sorbent enables the device toreconstitute used dialysis fluid into fresh fluid to deliverhigh-dose dialysis with a low volume of PD solution.Dr Martin Wilkie commented: “There is still muchdevelopment to be done, and it remains to be seen ifcarrying 2 kg around during the day will be acceptablefor patients. However, the potential to reduce solutionvolumes is really important in terms of cost andsustainability, and internationally where solutions aredifficult to obtain.” Martin is Consultant Nephrologistat Sheffield Teaching Hospitals NHS Foundation Trust,and has a special interest in PD.The study was conducted at Singapore GeneralHospital, and included 15 people who had beenusing conventional PD for an average of 21 months.The most common side effects were abdominaldiscomfort, fibrin in the drain, and bloating. Therewere no serious side effects.The US Food & Drug Administration has designatedAWAK-PD as a breakthrough technology to streamlineapproval for marketing in the United States. “Assumingdevelopment remains on track, I would envisage thatAWAK-PD will take several years before if becomesavailable in the UK. However, in future this technologycould potentially revolutionise the way PD has beendone,” concludes Martin.The end of dialysis?AWAK-PD needs standard dialysis access with a PDcatheter, but other researchers are aiming to abolish theneed for dialysis. A team from the Kidney Project at theUniversity of California San Francisco (UCSF) recentlyreported that they have surgically implanted a ‘kidneybioreactor’ into pigs. This is an important milestone,as it is the first time that the kidney bioreactor hassuccessfully been implanted into animals.The kidney bioreactor is about the size of a deck ofcards and consists of two parts. A filter processesincoming blood to create a fluid containing toxins plussugars and salts. A bioreactor of human kidney cellsthen processes the filtered fluid, sending the sugarsand salts into the blood. Water is reabsorbed backinto the body and is concentrated into ‘urine’, which isexcreted through the bladder.The kidney bioreactor would not have the samefunction as a transplanted kidney—researchersanticipate an eGFR of 20-30—and EPO will still beneeded. However, people would no longer needdialysis and, based on the animal study, they would nothave to take medication to prevent rejection.More research is essential before the kidneybioreactor can be tested in people with kidney failure.Researchers are hoping to receive approval for thefirst clinical trial in the near future.Dr Martin Wilkie is Co-chair of International Society for Peritioneal Dialysis /EuroPDTo read more about AWAK technology, go to https://awak.comFor more information about the Kidney Project, visit https://pharm.ucsf.edu/kidneykidneycareuk.org
29It’s never too late...When 83 year-old Derek Hunt was out visiting familyin Australia over Christmas last year he decidedit was ‘high-time’ to take on a challenge eventto help support two of his favourite charities -Kidney Care UK and Pancreatic Cancer UK. Hedid his jump in Western Australia on boxingday and has raised well over £1,000 for us.Thank you Derek!
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