Stagnation

[stauffenberg]

In 1975 I read an article in the 'New York Times' which proclaimed that there would soon be available a backpack-sized, portable dialysis machine to make the lives of renal patients easier, but we all know how far that has come in more than 30 years!

In 1985 I watched an episode of the old 'Donaghue' interview program in which he had gathered about thirty dialysis patients, nephrologists, and medical researchers to discuss dialysis, and every problem the patients mentioned was the same as I found to be a continuing reality when I was on dialysis from 1996 to 2005.  Once, when I asked my nephrologist in 2000 about the characteristics of the dialysis machines at the unit, he said they were exactly the same model that had first come out in 1985, since there had been no substantial progress in machine design since then.

In 2000 I went to a conference held by Baxter about the future of dialysis and their great hope was that in 20 years they would have dialysis machines which would achieve better clearance of toxins, though still require three treatments a week of four to five hours each.

Recently, there has been a lot of financial news about Baxter, Fresenius, and Kaiser borrowing billions of dollars to buy out smaller dialysis centers, to expand production capacity of their equipment lines, and to build more dialysis units.  The big banks don't loan that kind of money unless they are assured by the best expert opinion they can hire that the investment is going to repay itself with interest.  That has got to mean that the 'smart money' is betting heavily that renal patients won't have any better way to survive than the living death of dialysis for at least another 20 to 30 years.

Possible hope for growing new kidneys by genetic engineering or stem cell manipulation is still 50 years away from being a clinical reality, since the science is still in its most basic stages, even a decade after the cloning of Dolly the Sheep.

I wonder why the scientific community is apparently so little concerned about this stagnation in the field of renal medicine?  Is it because the financial interests which pervade all of medicine, from the makers of Epo to the surplus of nephrologists in search of guaranteed, high-paying, and routine work, from the makers of dialysis machines and equipment to the owners of private, for-profit dialysis units, find chronic dialysis to be a perfect remedy for what they need, regardless of its inadequacy for the patients?  We form a gigantic 'slave' population, forever trapped on the dialysis 'plantations,' living a dreadful life but making a fortune for the dialysis machinery makers, the dialysis unit operators, and the nephrologists who 'own' us, so why would they want to start a 'Civil War,' a medical revolution in treatment which would free us from their control?

[Zach]

In 1975 I read an article in the 'New York Times' which proclaimed that there would soon be available a backpack-sized, portable dialysis machine to make the lives of renal patients easier, but we all know how far that has come in more than 30 years!

In fact, it did exist in the 1980s, it was called the Suitcase Kidney.  Please read the story of "Dialysis in Wonderland."

Once, when I asked my nephrologist in 2000 about the characteristics of the dialysis machines at the unit, he said they were exactly the same model that had first come out in 1985, since there had been no substantial progress in machine design since then.

Sorry, but you were told wrong.

In 2000 I went to a conference held by Baxter about the future of dialysis and their great hope was that in 20 years they would have dialysis machines which would achieve better clearance of toxins, though still require three treatments a week of four to five hours each.

The truth is, it's the filter, not the machine that is mainly responsible for toxin removal.


Patient empowerment comes with knowledge.  And maybe home dialysis.   

[Epoman]

Well I disagree about the "50" years away comment, as I was reading a article in Popular Science and it was talking about the scientists who grew that working bladder in the lab, remember that story? Here is an article about the Bladder: http://www.cnn.com/2006/HEALTH/conditions/04/03/engineered.organs/index.html The bladders are grown from the patient's OWN cells so there is NO rejection. Currently 7 people have gotten lab grown bladders.

The group is currently working on a Kidney  It's an exciting time, the article says the scientists say there rough estimate for when these lab-grown non rejecting kidneys will be mainstream is 2016 which is just 10 years away.

Granted a bladder is a very simple organ and a kidney is much more complex however it is a start and a step in right direction. So I don't know where you got that 50 years away idea. Mark my words within 20 years people will not die on a waiting list, there will always be dialysis but we wont need donors for transplants.

[Zach]

Well I disagree about the "50" years away comment, as I was reading a article in Popular Science and it was talking about the scientists who grew that working bladder in the lab, remember that story? Here is an article about the Bladder: http://www.cnn.com/2006/HEALTH/conditions/04/03/engineered.organs/index.html The bladders are grown from the patient's OWN cells so there is NO rejection. Currently 7 people have gotten lab grown bladders.

The group is currently working on a Kidney  It's an exciting time, the article says the scientists say there rough estimate for when these lab-grown non rejecting kidneys will be mainstream is 2016 which is just 10 years away.

Granted a bladder is a very simple organ and a kidney is much more complex however it is a start and a step in right direction. So I don't know where you got that 50 years away idea. Mark my words within 20 years people will not die on a waiting list, there will always be dialysis but we wont need donors for transplants.

Once again Epoman, you know your stuff!       

[Epoman]

Well I disagree about the "50" years away comment, as I was reading a article in Popular Science and it was talking about the scientists who grew that working bladder in the lab, remember that story? Here is an article about the Bladder: http://www.cnn.com/2006/HEALTH/conditions/04/03/engineered.organs/index.html The bladders are grown from the patient's OWN cells so there is NO rejection. Currently 7 people have gotten lab grown bladders.

The group is currently working on a Kidney  It's an exciting time, the article says the scientists say there rough estimate for when these lab-grown non rejecting kidneys will be mainstream is 2016 which is just 10 years away.

Granted a bladder is a very simple organ and a kidney is much more complex however it is a start and a step in right direction. So I don't know where you got that 50 years away idea. Mark my words within 20 years people will not die on a waiting list, there will always be dialysis but we wont need donors for transplants.

Once again Epoman, you know your stuff!       

Thanks  , but YOU really impress me with your knowledge and how well you are doing after over 2 decades on dialysis with no transplant.

[Zach]

Two decades sounds like a long time.  Why don't you just say a quarter of a century!     

[Epoman]

Two decades sounds like a long time.  Why don't you just say a quarter of a century!     

  Woah that's right huh? Almost a quarter of a century. 

[Zach]

This is a Cobe Sentry 3 dialysis machine -- these were new in the early 1990s.
I believe the Fresenius 2008K dialysis machines came out in the late 1990s.

Let's not fool ourselves.  These machines (along with better filters in the 1990s) brought with them very significant progress.  No question about it.

[stauffenberg]

The nephrologist who told me in 2000 that in his view there had been no "significant" progress in dialysis machines since 1985 (by which I assume he was referring to all parts of the machine, including filters and tubing), is professor of nephrology at the local medical school.  So I would accept his view, noting that the qualification, "significant," creates a wide ambit for debate about what is significant progress and what is not.  Statistics on the life expectancy of dialysis patients rose gradually until the late 1980s and then levelled off, so I assume that is the best measure of the theory that dialysis was not getting much better over the last generation.  I do believe, however, that people using slow dialysis at home for 6 to 8 hours overnight, six nights a week, will show longer survival times.

[Rerun]

I agree with Stauffenberg.  If they can't find a "significant" profit in it they won't build it.  He is right.  We are their salve camp and they have us "Just" where they want us.  I bet they are kicking themselves for making transplantion work.  It only makes the drug companies happy.  They say it is illegal for us to buy an organ, yet they don't install it for FREE or there is no FREE 90 day maintenance check up.  It is ALL about money.  The reason they haven't found a cure for the "common" cold is because they make too much money treating the symptoms. 

The theory of dialysis has NOT changed in 45 years.  The process has changed, but COME ON GUYS if they wanted to get is a protable kidney and Medicare would pay for it, it would be done.

The only thing I have against Stem-Cell research is:  We can't afford what we have now, why do research on more? 

Until the Medical Community weeds out the greedy bastards and all that is left are the people who truly care about human life and well being then not much is going to change.  In other words......nothing is going to change unless money doesn't matter.  We have HIT our limit.

[kitkatz]

I will put the biomedical engineer in the family to work on it as soon as she graduates from the Milwaukee School of Engineering in three years.  Can we wait that long?

[Zach]

Technology is always moving forward.
We must not let some backward thinking get the better of us.     

What's new?  How about NxStage, developed at the Indiana University School of Medicine.
Another is the Aksys machine.

Please read this from the Association for the Advancement of Medical Instrumentation (AAMI) :

http://www.aami.org/publications/HH/Status.Hoenich.pdf

or

http://www.aami.org/publications/HH/index.html

And go to the link:  The Current Status and Future Directions of Hemodialysis Machine Technology

[BigSky]

This is a Cobe Sentry 3 dialysis machine -- these were new in the early 1990s.
I believe the Fresenius 2008K dialysis machines came out in the late 1990s.

Let's not fool ourselves.  These machines (along with better filters in the 1990s) brought with them very significant progress.  No question about it.

   LOL  Half the machines in our unit are those machines.  The other half are Phoenix  machines.

[kitkatz]

Dialysis City and Transplant (or whatever it is called) had an article about nanite technology.  Maybe Angie could post us a link or article.  How about it Angie?

[Epoman]

Dialysis City and Transplant (or whatever it is called) had an article about nanite technology.  Maybe Angie could post us a link or article.  How about it Angie?

http://www.technologyreview.com/read_article.aspx?id=17493&ch=biotech

[Zach]

http://www.technologyreview.com/read_article.aspx?id=17493&ch=biotech

From the article:
The implant would be tucked under the skin; small fluid bags worn externally could receive the ultrafiltrate and supply replacement electrolytes.

A more sophisticated form of PD.  No thank you.

[angieskidney]

http://www.technologyreview.com/read_article.aspx?id=17493&ch=biotech

From the article:
The implant would be tucked under the skin; small fluid bags worn externally could receive the ultrafiltrate and supply replacement electrolytes.

A more sophisticated form of PD.  No thank you.

Nanotechnology could offer an alternative, according to nephrologist William Fissell at the University of Michigan. He and colleagues are working on nano-pore membranes that could enable dialysis to be miniaturized into implantable devices that provide round-the-clock clearance of toxins, untethering dialysis patients from bulky pumps and clinics. "This is a fundamentally liberating technology," says Fissell.

I enjoyed PD more than HD but that was night time while sleeping and free during the day. If I can be away from machines all the time and drink as much as I want and eat what I wanted again that would be worth it don't you think?

solved half of the challenge: engineering nano-membranes that are efficient enough to support a compact, low-power implant. The team secured a patent for the concept earlier this year. However, engineering pores with the required selectivity--pores that drain away the worst toxins without robbing the body of critical proteins such as albumin, blood clotting factors, and antibodies--is proving to be tougher than expected.

I want to read the report when they finally get this working

Current prototypes contain roughly 10,000 pores per square millimeter, according to Fissell. Next-generation membranes, now being engineered, will have more than 100,000 pores or slits per square millimeter and provide more than 10 times the flow. An implanted device carrying several hundred square centimeters of this next-generation membrane should, Fissell estimates, filter at least 30 milliliters of blood per minute at average blood pressures--about one-third of normal kidney function. The implant would be tucked under the skin; small fluid bags worn externally could receive the ultrafiltrate and supply replacement electrolytes.

It is a shame they can't some how use all the extra fluid we have in our bodies And a shame they can't somehow connect to the bladder ... I would love an implantable dialysis that doesn't make us have to wear bags of fluid

Oh wait ... still reading...

In an implantable version of the bio-artificial kidney, nano-pore membranes would protect the live kidney cells from immune cells and antibodies, which have thwarted most bio-artificial organ implants to date. The live kidney cells, in turn, would improve the function of the implant by reabsorbing and returning to the bloodstream some of the fluids and salts that pass through the nano-pore membrane. Eventually, bio-artificial implants that recover fluids and salts and divert the remaining ultrafiltrate to the bladder might even eliminate the need for external electrolyte and ultrafiltrate bags.

A there we go! That would be great! 

Fissell's 30 milliliters per minute of filtration would provide more than 30 percent of normal kidney function--a huge improvement, according to William Harmon, director of nephrology at Children's Hospital in Boston. It's an "important threshold," he says, above which many symptoms of kidney disease would fade: "If you're at 30 percent you're doing quite well."

This is a great article! 

Dialysis City and Transplant (or whatever it is called) had an article about nanite technology. Maybe Angie could post us a link or article. How about it Angie?

I am glad Epoman posted the link as there is no search feature in D&T City (Dialysis & Transplant City) and it would have been difficult to find!