View to the Future

The two most significant barriers to implementation of this technology to renal replacement are long-term biocompatibility of the materials and strategies for synthetic homeostasis. At present, SNMs are manufactured from silicon and silica, possibly the worst choice of material for blood biocompatibility imaginable. The material choice at present is driven solely by fabrication and prototyping convenience, with little more significance attached to that choice than the choice of balsa wood for wind-tunnel models of airplanes and cars. Surface modification of silica and alumina with polyethylene glycol has been well demonstrated, as well as dendrimeric polysaccharides and other surfactant polymers [19-23]. These developments give significant optimism that the medium-term (months to years) biocompatibility of nanopore filters will be achievable [24, 25]. More difficult will be replicating the salient features of the pleiotrophic and redundant neuroendocrine control of ECF volume with sensors and a computerized algorithm. Just as research in membrane design informs our understanding of glomerular physiology, efforts to replicate mechanisms of volume homeostasis may illuminate and expand our understanding of hypertension and cardiovascular disease.

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