Renal Research Institute, 315 East 62nd Street, 3rd Floor, New York, NY 10065, USA.
Fresenius Medical Care, 61352 Bad Homburg, Germany.
Toxins (Basel). 2024 Jun 26;16(7):292. doi: 10.3390/toxins16070292.
It has been estimated that in 2010, over two million patients with end-stage kidney disease may have faced premature death due to a lack of access to affordable renal replacement therapy, mostly dialysis. To address this shortfall in dialytic kidney replacement therapy, we propose a novel, cost-effective, and low-complexity hemodialysis method called allo-hemodialysis (alloHD). With alloHD, instead of conventional hemodialysis, the blood of a patient with kidney failure flows through the dialyzer's dialysate compartment counter-currently to the blood of a healthy subject (referred to as a "buddy") flowing through the blood compartment. Along the concentration and hydrostatic pressure gradients, uremic solutes and excess fluid are transferred from the patient to the buddy and subsequently excreted by the healthy kidneys of the buddy. We developed a mathematical model of alloHD to systematically explore dialysis adequacy in terms of weekly standard urea /. We showed that in the case of an anuric child (20 kg), four 4 h alloHD sessions are sufficient to attain a weekly standard / of >2.0. In the case of an anuric adult patient (70 kg), six 4 h alloHD sessions are necessary. As a next step, we designed and built an alloHD machine prototype that comprises off-the-shelf components. We then used this prototype to perform experiments to investigate the transport of solutes, including urea, creatinine, and protein-bound uremic retention products, and to quantitate the accuracy and precision of the machine's ultrafiltration control. These experiments showed that alloHD performed as expected, encouraging future studies in animals with and without kidney failure.
据估计，2010 年，超过 200 万终末期肾病患者可能因无法获得负担得起的肾脏替代治疗（主要是透析）而提前死亡。为了解决透析肾替代治疗的这一不足，我们提出了一种新颖、经济高效且低复杂性的血液透析方法，称为同种异体血液透析（alloHD）。在 alloHD 中，不是传统的血液透析，肾衰竭患者的血液通过透析器的透析液隔室与健康供体（称为“伙伴”）的血液逆流流动。沿着浓度和静水压力梯度，尿毒症溶质和多余的液体从患者转移到伙伴身上，然后由伙伴的健康肾脏排泄。我们开发了 alloHD 的数学模型，系统地探讨了每周标准尿素清除率的透析充分性。我们表明，在无尿儿童（20 公斤）的情况下，进行四次 4 小时 alloHD 治疗即可达到每周标准 / >2.0。在无尿成年患者（70 公斤）的情况下，则需要进行六次 4 小时 alloHD 治疗。作为下一步，我们设计并构建了 alloHD 机器原型，该原型由现成的组件组成。然后，我们使用该原型进行实验，以研究溶质（包括尿素、肌酐和蛋白结合的尿毒症潴留产物）的转运，并定量测定机器超滤控制的准确性和精密度。这些实验表明 alloHD 按预期运行，鼓励未来在有或没有肾衰竭的动物中进行研究。
