Abstract

Nanotechnology, defined as the science of material features between 10-9 and 10-7 of a meter, has received extensive attention in the popular press as proof-of-concept experiments in the laboratory are published. The inevitable delay between feature articles and clinical endpoints has led to unwarranted skepticism about the applicability of the technology to current medical therapy. The theoretic advantages of micro- and nanometer scale engineering to renal replacement include the manufacture of high-hydraulic permeability membranes with implanted sensing and control structures. Recent data in membrane design and testing is presented, with a review of the challenges remaining in implementation of this technology.

Copyright © 2007 S. Karger AG, Basel

The kidney is unique in that it is the first organ for which long-term ex vivo substitutive therapy has been available and lifesaving. Renal failure prior to the era of hemodialysis and transplantation resulted in certain death, and this outcome of renal failure is still current outside the industrialized world.

In the United States, 452,000 patients were listed as having end-stage renal disease (ESRD) by the 2005 USRDS database, of whom 324,826 were receiving maintenance dialysis [1]. The prevalence of ESRD in the United States is rising at approximately 8%/year [1, 2], The financial cost of dialysis is immense, estimated at USD 64,614/hemodialysis patient/year and USD 47,384/peri-toneal dialysis patient/year. In contrast, transplant patients cost an average of USD 22,142/patient/year [1].

The higher cost of maintenance dialysis when compared with transplantation does not translate into better results; annual mortality for patients listed for transplant and awaiting a kidney is 6.3%, compared with only 3.8% for patients listed for transplant who did receive a kidney. These statistics compare favorably to the 16.7% annual mortality for ESRD patients not listed for transplant [3]. Transplantation, despite its advantages in terms of cost, morbidity, and mortality, is severely limited by the scarcity of donor organs. In 2006, there are over 300,000 patients on dialysis and 72,983 patients on the kidney waiting list. Only 4,096 renal transplants were performed in the first quarter of 2006, based on the Organ Procurement and Transplantation data as of 9 June 2006.

KAI\G Ed

© 2007 S. Karger AG, Basel 0253-5068/07/0251-0012$23.50/0

William H. Fissell

Department of Internal Medicine, University of Michigan, 1570D MSRB II 1150 W. Medical Center Drive Ann Arbor, MI 48109 (USA)

Tel. +1 734 764 3157, Fax +1 734 763 0982, E-Mail [email protected]

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