Castro Ana, Neri Mauro, Karopadi Akash Nayak, Lorenzin Anna, Marchionna Nicola, Ronco Claudio
Department of Nephrology, Dialysis and Transplantation, Oporto Hospital Centre, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal; International Renal Research Institute of Vicenza (IRRIV), IRRIV-San Bortolo Hospital AULSS 8 Berica, Viale Rodolfi, 37, 36100 Vicenza, Italy.
International Renal Research Institute of Vicenza (IRRIV), IRRIV-San Bortolo Hospital AULSS 8 Berica, Viale Rodolfi, 37, 36100 Vicenza, Italy.
Nefrologia (Engl Ed). 2019 Jul-Aug;39(4):372-378. doi: 10.1016/j.nefro.2018.08.012. Epub 2019 Mar 4.
End-Stage Renal Disease (ESRD) is one of the major causes of morbidity and mortality worldwide. Although the incidence of ESRD is relatively stable, the prevalence of maintenance dialysis is increasing, and it is expected to reach a staggering 5439 million patients worldwide by 2030. Despite the great technological evolution that has taken place in recent years, most patients are still treated with in-centre haemodialysis and their prognosis remains far from desirable. Since 1980, there has been an increasing interest in the development of a portable device for renal replacement therapy (RRT), which ultimately led to the creation of the Wearable Artificial Kidney (WAK) and the Wearable Ultrafiltration (WUF) system. Portable RRT devices may be acceptable alternatives that deal with several unmet clinical needs of ESRD patients. So far, 3 important human studies with WAK and WUF have been carried out and, although these devices require considerable technological improvement, their safety and efficacy in solute clearance and fluid removal is undeniable. In this article, we review the evolution of the WAK and the WUF and the main clinical trials performed, highlighting some of their technical features. Some of the main possible clinical advantages that could be achieved with these devices, as well as some economic aspects, are also pointed out. In the future, all renal replacement therapy techniques should evolve to perfectly match the clinical and personal needs of each patient, allowing for an improved health-related quality of life.
终末期肾病（ESRD）是全球发病和死亡的主要原因之一。尽管ESRD的发病率相对稳定，但维持性透析的患病率却在上升，预计到2030年全球将达到惊人的5.439亿患者。尽管近年来技术有了巨大的进步，但大多数患者仍接受中心血液透析治疗，其预后仍远不尽如人意。自1980年以来，人们对开发用于肾脏替代治疗（RRT）的便携式设备的兴趣与日俱增，这最终促成了可穿戴人工肾（WAK）和可穿戴超滤（WUF）系统的诞生。便携式RRT设备可能是满足ESRD患者一些未满足临床需求的可接受替代方案。到目前为止，已经对WAK和WUF进行了3项重要的人体研究，尽管这些设备需要大量的技术改进，但其在溶质清除和液体清除方面的安全性和有效性是不可否认的。在本文中，我们回顾了WAK和WUF的发展历程以及所进行的主要临床试验，突出了它们的一些技术特点。还指出了这些设备可能带来的一些主要临床优势以及一些经济方面的情况。未来，所有肾脏替代治疗技术都应不断发展，以完美匹配每个患者的临床和个人需求，从而提高与健康相关的生活质量。
