Artificial kidney: Challenges and opportunities

This review aims to present the developments occurring in the field of artificial organs and particularly focuses on the presentation of developments in artificial kidneys.The challenges for biomedical engineering involved in overcoming the potential difficulties are showcased,as well as the importance of interdisciplinary collaboration in this marriage of medicine and technology.In this review,modern artificial kidneys and the research efforts trying to provide and promise artificial kidneys are presented.But what are the problems faced by each technology and to what extent is the effort enough to date?

Efficiency and safety of lamivudine therapy in patients with chronic HBV infection, dialysis or after kidney transplantation

AIM: To analyze the effectiveness and safety of lamivudine treatment in patients with chronic HBV infection undergoing hemodialysis or after kidney transplantation, and to study the frequency of tyrosine - methionine - aspartate - aspartate (YMDD) mutation occurrence after lamivudine treatment. METHODS: We analyzed 91 patients with chronic hepatitis B, among whom, 16 patients underwent hemodialysis, 7 patients had kidney transplantation and 68 patients had normal function of kidney. The hemodialysis patients were treated by lamivudine 300 mg/wk. patients after kidney transplantation and patiente with normal function of kidney were treated with lamivudine 100 mg/d. Therapy lasted for 12 mo. HBV-DNA, HBsAg, HBeAg and anti-HBe, and anti-HCV antibodies were assessed in sera of patients. The analysis was performed before and 6 mo after the end of lamivudine treatment. Before, during and after the lamivudine therapy, the number of erythrocytes, leukocytes, platelets and hemoglobin concentration, ALT and AST activity, as well as bilirubin, urea and creatinine concentrations were analyzed in sera from patients. RESULTS: After the 12-mo lamivudine treatment, elimination of HBV - DNA was observed in 56% patients undergoing hemodialysis and in 53% patients with normal kidney function. Only 1 from 7 (14%) kidney-transplanted patients eliminated HBV-DNA. Furthermore, HBeAg elimination was observed in 36% hemodialysis patients, in 51% patients with normal function of kidneys and in 43% kidney transplanted patients. Among the patients undergoing dialysis, no YMDD mutation was found after 12 mo of therapy, while it was detected in 9 patients (13%) with normal function of kidney and in 2 kidney-transplanted patients (29%, P<0.006). We did not observe significant side effecte of lamivudine treatment in studied patiente. CONCLUSION: Effectiveness of lamivudine therapy in dialysis patients is comparable with that in patiente with normal function of kidney. Lamivudine treatment is well tolerated and safe in patiente with renal insufficiency undergoing hemodialysis and kidney-transplantation. However, in the latter group, high incidence of YMDD mutation after lamivudine treatment was observed.

人工肾病人血清乙肝两对半的检测及临床意义

目的 对广东省人民医院人工肾病区的病人血清进行乙肝两对半的检测。调查其感染情况并分析原因，以达到进一步采取预防措施，防止血透患者感染乙肝。方法 收集2005年6月～2005年10月在本院人工肾病区进血液透析的患者共205例，对其进行乙肝两对半检测，与其入院时的乙肝两对半结果进行比较分析，分析其可能感染的原因及感染情况。结果 初始血透治疗前感染乙肝病毒者共56例，乙肝两对半全阴者为89例。现检测结果为：56例乙肝患者不变，但是89例乙肝两对半全阴者中有15例出现HBsAg阳性，占16．8％，其余64例仍为乙肝两对半全阴。15例出现HBsAg阳性患者接受血透治疗平均为3．2年，13例有输血史，与64例仍为乙肝两对半全阴者相比有显著性差异，有输血史的患者亦显著增加（P〈0．05）。结论 与普通人群相比，血透患者感染HBV的危险性相当大，可能与其血透过程及输血有很大的关系。

Coordination of thin-film nanofibrous composite dialysis membrane and reduced graphene oxide aerogel adsorbents for elimination of indoxyl sulfate

The protein-bound uremic toxins,represented by indoxyl sulfate(IS),have been associated with the progression of chronic kidney disease and the development of cardiovascular disease in the presence of impaired renal function.Herein,we proposed a novel strategy of thin-film nanofibrous composite(TNFC)dialysis membrane combined with reduced graphene oxide(rGO)aerogel adsorbents for clinical removal of IS as well as high retention of proteins.The TFNC membrane was prepared by electrospinning in conjunction with coating-reaction method and proved to have good selectivity and permeability.To further improve the removal rate of toxins,we used a medium hydrothermal method following by freeze-drying treatment to obtain the r GO aerogel adsorbents.It exhibited excellent adsorption for IS with a maximum adsorption capacity of 69.40 mg·g^(-1)throughπ-πinteraction and hydrogen bonding interaction based on Langmuir isotherm models.Time-dependent absorption experiments showed that it reached adsorption equilibrium within 4 h,which was matched with the hemodialysis time.The coordination was significantly exhibited by introducing r GO aerogel blocks into the dialysate for absorbing the diffused free IS during hemodialysis.Taking the advantages of the TFNC dialysis membrane and the rGO aerogel,the volume of dialysate for hemodialysis was only one-tenth of that without adsorbent blocks but with very comparable dialysis performance(the clearance of IS at 51.8%and the retention of HSA over 98%),which could lighten conventional hemodialysis effectively and be benefit to realize the miniaturization of the hemodialysis equipment.Therefore,the coordination of the TFNC dialysis membrane and rGO aerogel adsorbents would open a new path for the development of portable artificial kidney.