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'Renal Assist
Device' reduces risk of death from Acute
Kidney Failure
Newswise — For patients
with acute kidney injury (AKI), an external
device containing human kidney cells
promotes recovery of the injured kidneys and
significantly reduces the risk of death,
according to a preliminary clinical study
published in the May Journal of the American
Society of Nephrology.
The experimental renal
tubule assist device (RAD) appears safe and
effective for desperately ill patients with
AKI.
"Deployment of the RAD
was associated with remarkably better
outcomes for these patients—speeding
recovery of kidney function and reducing
risk of death by half," comments Dr. H.
David Humes of University of Michigan, one
of the study authors.
Patients with AKI have
sudden loss of kidney function, resulting
from a wide range of possible causes (such
as blood loss or toxic injury).
The goal of treatment
is to replace lost kidney function through
dialysis and related techniques until the
kidneys have time to recover.
However, even with
treatment, the risk of death during an
episode of AKI is 50 percent or higher.
In the new study, 40 of
58 patients with AKI were randomly assigned
to treatment with the RAD, in addition to
standard renal replacement therapy. The RAD
is a conventional blood filter device lined
with human renal tubule cells, grown from
donor kidneys.
"The cells are made
available to carry out subtle metabolic and
endocrine functions that the patient's
failing kidneys can no longer perform,
thereby staunching a cascading decline in
the patient's health and allowing time for
the patient's own organs to recover," Dr.
Humes explains.
Outcomes were
significantly better for AKI patients
treated with the RAD. After one month, 33
percent of patients in the RAD group had
died, compared to 61 percent of those
treated with renal replacement therapy only.
Patients who received
the RAD were also more likely to be alive
after six months. With adjustment for other
factors, the risk of death was about 50
percent lower in the RAD group.
Patients in the RAD group also had a shorter
time to return of kidney function.
Overall, kidney
function recovered in 53 percent of patients
with RAD, compared to 28 percent without RAD.
In both groups, about 20 percent of patients
survived but never recovered kidney
function, requiring chronic dialysis.
Although the initial
results are encouraging, the benefits of RAD
treatment need to be confirmed in larger
studies. In addition, the researchers need
to study the effects of changes in the
design of the RAD, which are needed to
accommodate mass production.
In addition to
improving the outcomes of AKI, the results
may point the way toward entirely new
classes of cell-based and tissue-engineered
therapies.
"The ability to harness
vital processes of cells, to target their
living molecular machinery on restoring
critical substances which have become
disordered by disease, has vast implications
for the future of medicine," says Dr. Humes.
"Particularly, we
are encouraged that we can develop a related
device to treat chronic renal failure—a
wearable kidney that performs natural
functions unachievable through man-made
technology alone."
The American Society of
Nephrology (ASN) is a not-for-profit
organization of 10,500 physicians and
scientists dedicated to the study of
nephrology and committed to providing a
forum for the promulgation of information
regarding the latest research and clinical
findings on kidney diseases. ASN publishes
JASN, the Clinical Journal of the American
Society of Nephrology (CJASN), and the
Nephrology Self-Assessment Program (NephSAP).
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