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Vol. 31. Núm. 1.Enero 2011
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Vol. 31. Núm. 1.Enero 2011
Páginas 1-128
DOI: 10.3265/Nefrologia.pre2010.Nov.10758
Acceso a texto completo
Los dispositivos portátiles miniaturizados el futuro del riñón artificial
The future of the artificial kidney: moving towards wearable and miniaturized devices
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, C.. RONCOb, C.. RONCOb, A.. DAVENPORTc, V.. GURAd
b Department of Nephrology, Dialysis and Transplantation, Ospedale San Bortolo, and International Renal Research Institute of Vicenza (IRRIV)., Vicenza, Italy,
c UCL Center for Nephrology, Royal Free & University College Medical School, London, UK,
d The David Geffen School of Medicine, Cedars Sinai Medical Center,UCLA, Los Angeles, California USA,
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Información del artículo
Resumen
Bibliografía
Estadísticas

Los nuevos enfoques en la investigación en diálisis incluyen el abaratamiento de los tratamientos, las terapias domiciliarias y métodos más sencillos de purificación sanguínea. Probablemente estos objetivos se consigan gracias a los avances en riñones artificiales mediante el uso de nuevas técnicas, como la miniaturización, los microfluidos o la nanotecnología. Esta línea de investigación podría llevarnos a una nueva era en el campo de la diálisis, en la que los nuevos retos serán la transportabilidad, la portabilidad y, por qué no, la posibilidad de desarrollar dispositivos implantables. A pesar de no haber alcanzado aún ese punto, recientemente se han publicado una serie de trabajos en los que los resultados sobre los sistemas de ultrafiltración portátiles y los riñones artificiales portátiles se revelan prometedores y de gran interés. Algunos de ellos recurren a la modalidad extracorpórea como método de purificación sanguínea, mientras que otros recurren a la diálisis peritoneal como modalidad de tratamiento (ViWAK, Vicenza Wearable Artificial Kidney, y AWAK, Automated Wearable Artificial Kidney). Merece mención especial el sistema de ultrafiltración portátil para la terapia de la sobrehidratación y la insuficiencia cardíaca congestiva (WAKMAN). Este sistema permitirá reducir el número de hospitalizaciones, el tratamiento de pacientes con menor comorbilidad y una mayor tolerancia. Durante la investigación en el riñón artificial portátil se han ido sucediendo nuevos avances, como el desarrollo de un sistema completo de hemofiltración para recién nacidos (CARPEDIEM, Cardio Renal Pediatric Dialysis Emergency Machine). El neonato, de hecho, es el paciente que más podría beneficiarse de la miniaturización del circuito de diálisis.

Esta revisión analiza los fundamentos de esta tendencia y los obstáculos que se le presentan a la hora de alcanzar un sistema de diálisis totalmente ambulatorio.

Se presentan los resultados iniciales de estos nuevos dispositivos. Con este trabajo nos gustaría promover un esfuerzo común para dar un salto cuantitativo tecnológico y hacer que el riñón artificial portátil sea una realidad y no una quimera.

New directions in dialysis research include cheaper treatments, home based therapies and simpler methods of blood purification. These objectives may be probably obtained with innovations in the field of artificial kidney through the utilization of new disciplines such as miniaturization, microfluidics, nanotechnology. This research may lead to a new era of dialysis in which the new challenges are transportability, wearability and why not the possibility to develop implantable devices. Although we are not there yet, a new series of papers have recently been published disclosing interesting and promising results on the application of wearable ultrafiltration systems (WUF) and wearable artificial kidneys (WAK). Some of them use extracorporeal blood cleansing as a method of blood purification while others use peritoneal dialysis as a treatment modality (ViWAK and AWAK.) A special mention deserves the wearable/portable ultrafiltration system for the therapy of overhydration and congestive heart failure (WAKMAN). This system will allow dehospitalization and treatment of patients with less comorbidity and improved tolerance. On the way to the wearable artificial kidney, new discoveries have been made such as a complete system for hemofiltration in newborns (CARPEDIEM). The neonate in fact is the typical patient who may benefit from miniaturization of the dialysis circuit.

This review analyzes the rationale for such endeavour and the challenges to overcome in order to make possible a true ambulatory dialysis treatment. Some initial results with these new devices are presented. We would like to stimulate a collaborative effort to make a quantum leap in technology making the wearable artificial kidney a reality rather than a dream. 

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