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Published ahead of print on August 20, 2009
Clin J Am Soc Nephrol 4: 1441-1448, 2009
© 2009 American Society of Nephrology
doi: 10.2215/CJN.02790409
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Dialysis

Technical Breakthroughs in the Wearable Artificial Kidney (WAK)

Victor Gura*,{dagger}, Alexandra S. Macy{ddagger}, Masoud Beizai{ddagger}, Carlos Ezon{ddagger}, and Thomas A. Golper§

* Cedars-Sinai Medical Center, Los Angeles, California; {dagger} UCLA Geffen School of Medicine, Los Angeles, California; {ddagger} Xcorporeal Inc., Los Angeles, California; § Vanderbilt University Medical Center, Nashville, Tennessee

Correspondence: Dr. Victor Gura, Cedars-Sinai Medical Center, Associate Clinical Professor of Medicine; UCLA, the Geffen School of Medicine, 9100 Wilshire Boulevard, Suite 360W, Beverly Hills, California 90212. Phone: 310-550-6242; Fax: 310-276-4276; E-mail: vgura{at}cs.com

Background: The wearable artificial kidney (WAK) has been a holy grail in kidney failure for decades. Described herein are the breakthroughs that made possible the creation of the WAK V1.0 and its advanced versions V 1.1 and 1.2.

Design: The battery-powered WAK pump has a double channel pulsatile counter phase flow. This study clarifies the role of pulsatile blood and dialysate flow, a high-flux membrane with a larger surface area, and the optimization of the dialysate pH. Flows and clearances from the WAK pump were compared with conventional pumps and with gravity steady flow.

Results: Raising dialysate pH to 7.4 increased adsorption of ammonia. Clearances were higher with pulsatile flow as compared with steady flow. The light WAK pump, geometrically suitable for wearability, delivered the same clearances as larger and heavier pumps that cannot be battery operated. Beta2 microglobulin (β2M) was removed from human blood in vitro. Activated charcoal adsorbed most β2M in the dialysate. The WAK V1.0 delivered an effective creatinine clearance of 18.5 ± 3.2 ml/min and the WAK V1.1 27.0 ± 4.0 ml/min in uremic pigs.

Conclusions: Half-cycle differences between blood and dialysate, alternating transmembrane pressures (TMP), higher amplitude pulsations, and a push-pull flow increased convective transport. This creates a yet undescribed type of hemodiafiltration. Further improvements were achieved with a larger surface area high-flux dialyzer and a higher dialysate pH. The data suggest that the WAK might be an efficient way of providing daily dialysis and optimizing end stage renal disease (ESRD) treatment.


Related Article

Will Nephrologists Use a Wearable Artificial Kidney?
Eli A. Friedman
Clin. J. Am. Soc. Nephrol. 2009 4: 1401-1402. [Full Text] [PDF]



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E. A. Friedman
Will Nephrologists Use a Wearable Artificial Kidney?
Clin. J. Am. Soc. Nephrol., September 1, 2009; 4(9): 1401 - 1402.
[Full Text] [PDF]


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