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@KidneyRebel is a patient with ADPKD who wishes to remain anonymous at this time for personal reasons. They are a staunch advocate for progress and innovation in nephrology and regularly engages on #NephTwitter. 

Competitors for the Artificial Kidney Region

WAK – Wearable HD vs AWAK – Wearable PD

Implantable Bioartificial Kidney vs Scaffolded Bioartificial Kidney

Copyright: Yurchanka Siarhei / Shutterstock

Dialysis innovation is a personal issue for me. I have ADPKD and my anger as I needlessly waited for the FDA to reconsider its rejection of the one medication that would slow down my progression toward ESKD turned to hope after participating in an inspiring Twitter session on KidneyX. I joined #NephTwitter and never looked back.

The scouting report for this region presents a damning picture of today with chronic underinvestment of nephrology’s financial and intellectual resources in dialysis innovation and a potentially glorious tomorrow. With 550,000 people on dialysis in the United States alone and technology that has not increased much in fifty years, the status quo is not acceptable.

The miniature hemo- and peritoneal-based dialysis machines represent a next evolution of the dialysis machine. However, it must be asked why there has been so little progress in the last ten years as patients continue to suffer. As a kidney community, we must aggressively push for faster timelines in dialysis innovation with more funding and investment. We know from the ideas put forth in the KidneyX competition sponsored by the ASN that there are plenty of great ideas out there and dialysis is a multi-faceted opportunity. For example, in addition to portability, the goal should be to have devices that decrease mortality and reduce side effects such as fatigue so that patients can lead fully functional lives.

If highly portable hemo- and peritoneal-based dialysis machines represent the opportunity to quickly put a lot of points on the board from shots near the basket, the potential for implantable bioartificial or scaffolded organs ought to be the big plays that bring the crowd to its feet. The boldness and ambition to create the ultimate implantable device fills me with excitement. Call me a dreamer, but with the exponential progress that is being made in the technologies underlying these endeavors, I believe we are going to see far more progress in the coming years than many are expecting.

With four future alternative artificial kidney models, we stand at the crossroads. Nephrology can ignore that the current, archaic state of dialysis is a major problem and continue to pay an enormous price as evidenced by unfilled fellowship positions, poor patient outcomes, and other metrics. Alternatively, we can redefine the storyline of nephrology as one that is boldly going forward to make the field the most technologically advanced and innovative specialty in medicine, while delivering huge benefits for its patients. Just as the semiconductor industry has Moore’s Law, it is time for a similar law for advancing dialysis progress and innovation. Let us call it Kolff’s Law and make it a constant topic of discussion, from the local staff meeting to the keynote address at Kidney Week.

Let us not stop there. We can democratize dialysis innovation and enable anyone with experience in dialysis or its related technologies to make incredible contributions. Imagine hosting an expert forum in a field related to filtration – chemistry, physics, mathematics, the list goes on and on, explaining how dialysis works, brainstorming new ideas, and sharing them with the public. One hundred ideas that improve dialysis just 2% each, when compounded on each other, would improve dialysis over 7x. The widely studied theory of the diffusion of innovation shows how a small, growing number of people on a platform can fundamentally reshape the world. Our platform here is the vibrant #NephTwitter scene. It is estimated that 2.5% of a population are innovators, 13.5% are early adopters, and 34% are the early majority. When 15-18% of a population accepts a point of view (in this case, advocating for dialysis innovation), it has reached critical mass and is likely to eventually be accepted by the profession.

Just as US President John F. Kennedy said we choose to go to the moon in this decade, not because it is easy, but because it is hard, it is time for nephrology to pick big, exciting, and seemingly impossible kidney replacement goals that everyone in the community can get behind. Let us create a future of dialysis where today is the beginning of the beginning and tomorrow is a future we can barely imagine. This is the region to watch, ready to make one gravity defying dunk after another as the medical world and its patients watch in awe.

– Guest Post written by @KidneyRebel

As with all content on the AJKD Blog, the opinions expressed are those of the author of each post, and are not necessarily shared or endorsed by the AJKD Blog, AJKD, the National Kidney Foundation, Elsevier, or any other entity unless explicitly stated.

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