Achieving more frequent and longer dialysis for the majority: wearable dialysis and implantable artificial kidney devices William H. Fissell, Shuvo Roy,

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Achieving more frequent and longer dialysis for the majority: wearable dialysis and implantable artificial kidney devices William H. Fissell, Shuvo Roy, Andrew Davenport Kidney International Volume 84, Issue 2, Pages 256-264 (August 2013) DOI: 10.1038/ki.2012.466 Copyright © 2013 International Society of Nephrology Terms and Conditions

Figure 1 The artificial wearable ambulatory kidney (AWAK) consists of two main components: a daily replaceable sorbent cartridge containing electrolyte and glucose solution to regenerate spent dialysate, and a second assembly comprising ammonia detector, protein, and bacterial filters designed to be changed monthly. Kidney International 2013 84, 256-264DOI: (10.1038/ki.2012.466) Copyright © 2013 International Society of Nephrology Terms and Conditions

Figure 2 The artificial wearable ambulatory kidney (AWAK) uses a single lumen peritoneal dialysis access catheter, and therefore peritoneal effluent is either pumped into the AWAK (upper panel) or returned to the patient (lower panel). Kidney International 2013 84, 256-264DOI: (10.1038/ki.2012.466) Copyright © 2013 International Society of Nephrology Terms and Conditions

Figure 3 Circuit diagram of version 1.0 of the wearable artificial kidney (WAK) showing micro-shuttle pump for countercurrent blood and dialysate flows, a series of sorbent cartridges, and minipumps for refreshing electrolyte solution, bicarbonate, heparin, and ultrafiltration control. Kidney International 2013 84, 256-264DOI: (10.1038/ki.2012.466) Copyright © 2013 International Society of Nephrology Terms and Conditions

Figure 4 Scanning electron microscopy images showing explanted darts taken from rat femoral vein showing debris on the uncoated (left) and clean surfaces on polyethylene glycol–coated (right) darts. (adapted from ref. 18) Kidney International 2013 84, 256-264DOI: (10.1038/ki.2012.466) Copyright © 2013 International Society of Nephrology Terms and Conditions

Figure 5 Light microscopy of vein removed from a rat that had an uncoated silicon dart inserted showing thrombus formation. (adapted from ref. 18) Kidney International 2013 84, 256-264DOI: (10.1038/ki.2012.466) Copyright © 2013 International Society of Nephrology Terms and Conditions

Figure 6 Scanning electron microscope images showing silicon nanopore membranes. (a) Low magnification showing an array of rectangular membranes; (b) higher magnification showing the pores on a single membrane; and (c) tilted, high magnification showing a close-up of the slit pore. Kidney International 2013 84, 256-264DOI: (10.1038/ki.2012.466) Copyright © 2013 International Society of Nephrology Terms and Conditions

Figure 7 Fluorescent microscopy image of human renal proximal tubule cells cultured from discarded renal transplant kidneys on silicon nanopore membranes. Blue stain refers to cell nuclei, green refers to tight junctions, and red refers to cilia. (adapted from ref. 34) Kidney International 2013 84, 256-264DOI: (10.1038/ki.2012.466) Copyright © 2013 International Society of Nephrology Terms and Conditions

Figure 8 Schematic design for an implantable artificial kidney device, using iliac vessels for arterial blood inflow and venous return, with ultrafiltratate draining into the bladder. Kidney International 2013 84, 256-264DOI: (10.1038/ki.2012.466) Copyright © 2013 International Society of Nephrology Terms and Conditions