Has anyone heard of a new company called Xcorporeal (www.xcorporeal.com)? According to the company’s web site, Xcorporeal is developing a renal replacement product that employs sorbents to regenerate the dialysate, affording a large reduction in the amount of dialysate required for each treatment. The company also promises to eventually develope a wearable device. Any thoughts on the practicality of the sorbent technology or the wearable device? Is it reasonable to believe that a wearable device would let patients remain active while they dialysate? People have been talking about a wearable device for forty years. Maybe it hasn’t been developed for a reason.
Let’s walk through a day in the life of someone wearing a dialysis contraption.
I’ve just woken up, made a bit of coffee, had a bite to eat, taken a shower and now I need to cannulate myself and get to work.
How long does it take to get on this wearable dialysis machine? Just doing the blood pressures, weighing and taping takes time add in whatever amount of time it takes to prepare the device. 30 minutes? an hour? This all comes out of my morning time so I am waking up earlier to get to work on time. This could be acceptable.
Can I drive myself to work? Are there concerns about low blood pressure with this device?
Before work I stop at the park to walk the dog. Can I go for a brisk walk with the device?
At work let’s assume I am on a computer (Put aside my primary duties of making signs/working in a sign production facility). can I type two handed with the needles in? Is there something protecting the cannulaiton site from being inadvertantly bumped? What if I start to feel like I"m having low blood pressure (turns out I’ve gained real weight)? Can I give myself saline? Do I stop treatment and take a union sactioned de-cannulation break? Have a bit of salty broth?
How am I feeling after eight hours of work/dialysis? Am I going to meet friends for happy hour? Run errands. Walk the dog again. Cook dinner. Is this device going to let me move my arm without thought to being cannulated?
And all this is compared to dialyzing overnight - I am able to do all the above unencumbered. Last weekend I went skiing after dialyzing overnight - I don’t suppose anyone will be skiing while cannulated. Will a wearable device give that much better dialysis than daily nocturnal?
I’m sceptical. And if it is meant to be used by someone who stays home then really all you’re doing is lengthing the tether which seems to be less of an advantage.
People have been talking about a wearable device for a LOT longer than 4 years–the American Society for Artificial Internal Organs (ASAIO) has journals dating back to the 1950s, and there was probably interest even earlier. It’s been revived recently by some advances, and lots of folks are working on possibilities.
From the online XCorporeal presentation (http://www.xcorporeal.com/pdfs/LatestPresentation.pdf), Victor Gura, MD, is their Chief Medical Officer. He’s associated with the Wearable Artificial Kidney that has been tested in humans (If you put his name into the PubMed search engine here: http://www.ncbi.nlm.nih.gov/sites/entrez you’ll see that his last 4 published papers were on this topic.
Bill makes some excellent points about usability, to which I’d respond: different strokes for different folks. At Home Dialysis Central, we are all about having the maximum number of viable home treatment options available for dialyzors so they can make choices that best fit their lives. These folks plan to have clinical trials going in 2 years, and more power to 'em. Let’s keep our eyes open and see what they come up with.
Check out this patent from 1968 it’s for a wearable dialysis apparatus - it looks to be designed to use a Scribner shunt.
UPDATE: there seems to be an issue passing on US Patent links - if you go to this search pageand enter patent number 3,388,803 and then click “images” you can see the patent for the wearable dialysis apparatus from 1968
Very cool, Bill.
Looks like there’s another completely different direction in artificial internal organs, too–growing them from scratch. Check this out! http://www.cbsnews.com/stories/2008/01/13/tech/main3705870.shtml
And, in case anyone didn’t recall, the sorbent technology used by XCorporeal is also integral to the Renal Solutions Allient Sorbent machine (http://www.renalsolutions.com. Renal Solutions is now a wholly-owned subsidiary of Fresenius Medical Care, and they are also working on a smaller (perhaps one day wearable) system.
Hey, ya’ll, XCorporeal made the Washington Post–with a photo of the device! Check it out: http://www.washingtonpost.com/wp-dyn/content/article/2008/02/08/AR2008020803410.html
Not everybody is in the same boat and maybe these machines will give people the freedom to go on a holiday without having to spend three days out of the week at another dialysis unit.
[QUOTE=Bill Peckham;15456]Let’s walk through a day in the life of someone wearing a dialysis contraption.
I’ve just woken up, made a bit of coffee, had a bite to eat, taken a shower and now I need to cannulate myself and get to work.
How long does it take to get on this wearable dialysis machine? Just doing the blood pressures, weighing and taping takes time add in whatever amount of time it takes to prepare the device. 30 minutes? an hour? This all comes out of my morning time so I am waking up earlier to get to work on time. This could be acceptable.
Can I drive myself to work? Are there concerns about low blood pressure with this device?
Before work I stop at the park to walk the dog. Can I go for a brisk walk with the device?
At work let’s assume I am on a computer (Put aside my primary duties of making signs/working in a sign production facility). can I type two handed with the needles in? Is there something protecting the cannulaiton site from being inadvertantly bumped? What if I start to feel like I"m having low blood pressure (turns out I’ve gained real weight)? Can I give myself saline? Do I stop treatment and take a union sactioned de-cannulation break? Have a bit of salty broth?
How am I feeling after eight hours of work/dialysis? Am I going to meet friends for happy hour? Run errands. Walk the dog again. Cook dinner. Is this device going to let me move my arm without thought to being cannulated?
And all this is compared to dialyzing overnight - I am able to do all the above unencumbered. Last weekend I went skiing after dialyzing overnight - I don’t suppose anyone will be skiing while cannulated. Will a wearable device give that much better dialysis than daily nocturnal?
I’m sceptical. And if it is meant to be used by someone who stays home then really all you’re doing is lengthing the tether which seems to be less of an advantage.[/QUOTE]
A PD cycler or a NxStage System One machine can give folks those freedoms today. Not to mention that getting treatments more often than 3x week is likely to help head off long-term problems like nerve, joint, and bone damage and some types of heart disease. (Oh, wait, I just mentioned it).
Hi Folks
Saw pics of wearable kidney not my cup of tea. But I could see a use for it for some folks???
Quote:
Originally Posted by Unregistered View Post
Not everybody is in the same boat and maybe these machines will give people the freedom to go on a holiday without having to spend three days out of the week at another dialysis unit.
Hi Dori
I went on vacation with nxstage last fall. And while it was great to go where I did not need a center . I could not bring purflow ( was not sure of water issues) so I had to take bags of nxstage dalysate? to do tx. That a lot of bags. (6 bags a night). Don’t get me wrong , I loved going and it was the first trip my wife and me had taken since 2001. But if a type of art. kidney came along, it a step in the right direction.
.
bob obrien
Oh, no question, Bob, especially if you bring the bags along yourself. But NxStage–or Baxter or Fresenius if someone does PD–will ship bags to a destination in the continental US. I just would hate for folks to think it’s not possible to travel until a wearable kidney comes out, because we’ve already been waiting several decades for one…
Hi Folks
Oh for sure the nxstage is opening all sorts of doors for all sorts of people. Where I and Eleanor went were into the mts. No sure if or where nxstage could ship ,no street no nearby post office or ups or fed ex. But just getting away to where we like to go was a very very great trip. And will and would do every yr.
bob obrien
Feel free to post some photos–we’d love to see them!
Hi Folks
Thanks Dori, never thought of pics when went ,we were so happy to get away… And at first were not sure how things with dialysis would go, but things could not have worked better. We did took pics but we are not good with the camera and took pics of the lake etc and the weather was too warm( no real tree color). WE were up there in mid oct. when we get away this yr we think more towards pics that show things and try to keep in mind posted some.
bob obrien