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The kidney was the first solid organ whose function was approximated by a machine and a synthetic device. In fact, renal substitution therapy with hemodialysis (HD) or peritoneal dialysis (PD) has been the only successful long-term ex vivo organ substitution therapy to date. However since the design of the first BAK by David Humes, substantial and promising advances have made to the device for better efficient functionality. While the Humes’ model provided both the filtration and regulatory functions of the nephronal units, its effect was only observed in a short timeline (180 days) doubting its efficiency in long term care.
Another model by Hoppensac showed an improvement on this ephemeral efficiency using a small intestinal submucosa (SIS) of porcine. However, controversies over the use of this animals lineage has resulted in mixed critics on the feasibility of this model in term of hemo-compatibily and bio-efficiency in humans. Current approaches are leading toward a simulated models.
In this stimulation, two device designs each channel blood through the BAK filter system; One design distributes blood flow across multiple layers of filtering membranes, while the other channels blood back and forth through a single undulate path.
This simulation method could eradicate years off the design process for BAKs and produce a device with a well-tested safety profile for platelet activation and subsequent clot formation. An integration of this simulation in the revised model of BAKs might plausibly enhance the fallibility of the model and improve its filtration component. While the implantable BAK (IBAK) delineated above has the potential to avoid both supply limitations to renal transplant, the fundamental membrane engineering challenge for the IBAK is to simultaneously maximize water permeability, while minimizing leakage of albumin and other important macromolecules.
Other researches have opted to focus instead on wearable bioartificial kidney (WEBAK) combining PD with a bioartificial renal epithelial cell system (BRECS). Gura et al. have published research into a lightweight, wearable, continuous ambulatory ultrafiltration device consisting of a hollow fiber hemofilter, a battery operated pulsatile pump, and two micro-pumps to control heparin administration and ultrafiltration . This device regenerates dialysate with activated carbon, immobilized urease, zirconium hydroxide and zirconium phosphate. An entirely different approach utilizes continuous regeneration of PD fluid relying on continuous-flow PD systems [38, 39]. Although a cell therapy device requires a continuous source of nutrients and oxygen, the use of blood circuits for this nutrient stream has been avoided due to clotting and infection risks.
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