Bella Wu AP Biology Summary Paper - Implantable Artificial Kidneys

Summer Assignment Mr. Kreyling

The kidney is a crucial part of human life. It helps maintain homeostasis throughout the whole body. It has many different functions, the most important being the removal of waste products and fluids from the body in the form of urine (National Kidney Foundation, 2011). The kidney also performs lesser known tasks, such as regulating the bodys salt, potassium, blood pressure and acid content as well as releasing hormones into the body that affect other organs (National Kidney Foundation, 2011). The first artificial kidney was created in 1913 at John Hopkins Hospital by J. J. Abel, L. C. Rowntree and B.B. Turner (Artificial Organ History, 2002). Essentially what they did was imitate the dialysis of a kidney by filtering animal blood treated (with hirudin, an anticoagulant derived from leeches) through tubing made of collodion (Parsons & McCracken, 1959). This attempt was later abandoned because the materials used failed to function properly. They would need to wait for the future arrival/discovery of heparin and plastic tubing to resume work (Early Development of Dialysis and Transplantation, 2006). In 1943, W. J. Kolff and H. T. J. Berk developed the rotating drum artificial kidney (Artificial Organ History, 2002). This is the rough prototype of the artificial kidneys used currently today. In 1967, the the capillary fiber kidney, developed by R. Stewart, was used clinically for the first time and is still currently used universally for long-term hemodialysis (Artificial Organ History, 2002). While currently still in research and development, the artificial kidney has already undergone animal testing and is now going through preclinical trials, so the use of these in human beings is not too far into the future (Bioartificial Kidney, 2011; William Fissell, 2011). David Humes, MD, and colleagues were the first in applying the bioartificial kidney in humans (Martin,

2011). Currently, Humes and his team are working on making the wearable bioartificial kidney smaller and combining it with sorbent dialysis, which would allow the artificial kidney to regenerate dialysate fluid on its own (Bioartificial Kidney, 2011). Their research contributed to the development of the implantable artificial kidney by William Fissell, M.D. and colleagues in the Cleveland Clinic in Ohio. Dr. Fissell and his colleagues in recent years, founded a new membrane technology that allows implantable dialysis devices to be miniaturized (William Fissell, 2011). The implantable artificial kidney outweighs the wearable artificial kidney in benefits, one such benefit being that it is less obtrusive in patients lives because it will function similarly to a normal kidney. Before it can be used in humans however, the implantable artificial kidney must overcome three significant challenges. Firstly, it must have an energy source that is light enough to power it enough for it to perform all the tasks necessary, without using an electrical outlet, and still remain light enough for patients to live without a great weight burden. Secondly, it has to be able to purify and recirculate dialysate without requiring a patient to carry gallons of water around. Thirdly, it must be easily worn by patients, for long periods of time, without disturbing regular day-to-day life (Ronco et al., 2005). Twenty-five million Americans every year suffer from chronic kidney disease (Martin, 2011). Left alone, chronic kidney failure can lead to a build up of wastes in the bodily fluids and tissues, eventually leading to death (National Kidney Foundation, 2011). In 2008, 382,343 residents in the United States received dialysis, a treatment that imitates only ten percent of the functions of a kidney (Kidney and Urologic Diseases Statistics, 2011). Currently the most common treatment for chronic kidney disease is dialysis. Essentially the dialysis machine monitors and mixes the dialysate (S., 2011). Mainly, Dialysate helps remove

waste products from patients blood and get electrolyte and mineral levels to the proper levels in a patients body (S., 2011). Dialysate is made up of bicarbonate, purified water and a acidified solution (S., 2011). This acidified solution contains the electrolytes and minerals that a patients body needs. The blood runs through tubes similar to a semi-porous membrane (Discovery Health, 2011). Important parts of the blood such as red blood cells and white blood cells are too big to fit through the pores, but waste like salt and urea are able to flow through the pores into the dialysate solution and are then removed (Discovery Health, 2011). The problem with dialysis is that it does not replace all the various functions that a kidney does. Mainly, dialysis does not deal with the endocrine functions of a kidney, essentially, secreting the hormones that deliver messages to other organs. These hormones are Renin, Erythropoietin, Calcitriol and Thrombopoietin (Smith, 1998). Renin or angiotensinogenase is found in the bodys renin-angiotensin system (Smith, 1998). It regulates the bodys average blood pressure within the arteries (Smith, 1998). Erythropoietin is a hormone that controls red blood cell production. Calcitriol or 1,25-dihydroxycholecalciferol is a form of vitamin D that deals with the increases and decreases concerning calcium in the blood (Smith, 1998). Thrombopoietin is a hormone produced also by the liver that deals with the producing of platelets by bone marrow (Smith, 1998). Research found that sixty-five percent of dialysis patients survive less than five years (Martin, 2011). Much literature on the subject of dialysis conclude that increased and prolonged dialysis can help lengthen lives as well as improve the quality of life of patients (WQTV, 2011). Daily dialysis would require a great deal more manpower in terms of doctors and nurses and would have a very high price tag. CRRT (Continuous renal replacement therapy) machines can deliver dialysis therapy twenty-four hours a day, seven days a week. The problem with these

machines are that they are very heavy, need large amounts (several gallons) of water and need to be plugged into the wall, which means that patients are unable to go about living their day to day lives (Ronco et al., 2005). This is where the idea of the implantable, artificial kidney comes in. It is essentially a small version of the CRRT machine and will allow patients to live their lives with minimal disturbance while still prolonging life and even improving their life quality. The optimum treatment for kidney failure is a kidney transplant, but the problem is that the number of patients on the waiting list far outnumber the number of donors (Kidney and Urologic Diseases Statistics, 2011). The discovery/invention of the implantable artificial kidney will change many peoples lives for the better and mankind would benefit greatly. It will allow people with chronic kidney failure to resume their lives again, without a kidney transplant or the hassle of the almost daily five-hour dialysis treatment some patients must undergo (ABC News, 2011). The artificial kidney could also be beneficial economically for patients as its cost may be less than that of expensive frequent dialysis treatments. It could also negate the need for kidney transplants altogether, by perhaps replacing them, which would save many patients who would die on dialysis otherwise. The idea of the implantable artificial kidney becoming available in the near future is very significant to the scientific landscape. The definition of a true artificial organ is a device made by mankind that is implanted into a human to replace a natural organ that functions as that organ without requiring the patient to be stationary or require any sort of recharging (Ronco et al., 2005). The kidney is one of the only organs that does not have an artificial counterpart, as the traditional treatment of dialysis is not considered a true artificial organ according to the definition of an artificial organ.

I believe that the discovery of the implantable artificial kidney is one of the most important discoveries in the field of bio-medical research. If fully developed, it will benefit various groups of people, from those who suffer from chronic kidney disease, to the health insurance companies, to the medical staff that give dialysis treatments, to the researchers developing the idea at this very moment. Those who suffer from chronic kidney disease will be able to live a normal life and live much longer, while perhaps, paying less than they would in total for a lifetime on dialysis. One of the largest costs in the U.S. healthcare market is kidney dialysis. About six percent or twenty-five billion dollars of the Medicare budget goes to those who suffer from chronic kidney failure (Martin, 2011). This means that the implantable artificial kidney would cut the costs spent by health insurance companies on kidney failure patients, thus allowing more funds to be used elsewhere. Medical staff, such as doctors and nurses, that deal with giving patients dialysis could be used elsewhere for other medical programs. Once the implantable artificial kidney is fully developed, researchers as well can turn their attentions to other issues and diseases.

Bibliography ABC News. (2011, February 23). Artificial kidney may replace dialysis | abc7.com. ABC Owned Television Stations. Retrieved September 1, 2011, from http://abclocal.go.com/kabc/story?section=news/health/your_health Artificial Organ History: A Selective Timeline. (2002).Exploring and Collecting History Online. Retrieved August 24, 2011, from http://echo.gmu.edu/bionics/exhibits.htm

Bioartificial Kidney-index. (2011). University of Michigan Health System. Retrieved August 25, 2011, from http://www.med.umich.edu/humes/ Boyle, R. (2010, September 3). Researchers Announce First Implantable Artificial Kidney Prototype | Popular Science.Popular Science: New Technology, Science News, The Future Now. Retrieved August 24, 2011, from http://www.popsci.com/science/article/2010-09/researchers-announce-first-artificial-kidney-prototype Did You Know? Willem J. Kolff, MD, the Father of Dialysis. (2007). KidneyTimes.com. Retrieved September 1, 2011, from http://kidneytimes.com/article.php?id=20071012022338 How does a kidney dialysis machine work?. (2011).Discovery Health. Retrieved August 25, 2011, from http://health.howstuffworks.com/medicine/tests-treatment/question17.htm Kidney and Urologic Diseases Statistics for the United States Page - National Kidney and Urologic Diseases Information Clearinghouse . (2011, August 19). National Kidney and Urologic Diseases Information Clearinghouse . Retrieved August 25, 2011, from http://kidney.niddk.nih.gov/KUDiseases/pubs/kustats/index.aspx Martin, P. J. (2011). Artificial Kidneys To The Rescue! . LIFE EXTENSION from the Leading Edge | The HOW and the WHY | AgelessZoom . Retrieved August 25, 2011, from http://www.agelesszoom.com/artificial-kidneys-to-the-rescue/ National Kidney Foundation. (2011). National Kidney Foundation. Retrieved August 27, 2011, from http://www.kidney.org Parsons, F. M., & McCracken, B. H. (1959). The Artificial Kidney. British Medical Journal,1(5124). Retrieved August 25, 2011, from http://www.bmj.com/content/1/5124/7 Ronco, C., Brendolan, A., & Levin, N. W. (2005).Cardiovascular disorders in hemodialysis. Basel: Karger. S., J. (2011). How does a dialysis machine work?. Kidney disease and dialysis information - DaVita. Retrieved August 25, 2011, from http://www.davita.com/kidney-disease/dialysis/in-the-center/how-does-a-dialysis-machinework?/e/181 The Early Development of Dialysis and Transplantation. (2006, November 24). Renal Medicine, Edinburgh. Retrieved September 8, 2011, from http://renux.dmed.ed.ac.uk/EdREN/Unitbits/historyweb/HDWorld.html William Fissell, M.D. - Nephrology and Hypertension, Cleveland Clinic . (2011).Cleveland Clinic . Retrieved August 25, 2011, from http://my.clevelandclinic.org/staff_directory/staff_display.aspx?doctorid=8023 WQTV. (2011, February 16). Implantable Artificial Kidney . ABC36 News WTVQ Lexington Kentucky. Retrieved August 20, 2011, from http://www.wtvq.com/health/7104-implantable-artificial-kidneySmith, P. (1998). Renal Endocrine functions. The University of Liverpool. Retrieved August 25, 2011, from http://www.liv.ac.uk/~petesmif/teaching/1bds_mb/notes/kidney/endocrn.htm