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Bioartificial Kidneys: Potential Application in Renal ReplacementDr. Wolf is Assistant Professor of Medicine, Department of Medicine, Downstate Medical Center, Brooklyn, New York.
As more and more people in many countries are maintained by current kidney replacement therapies, the medical and economic burdens caused by chronic kidney failure continue to grow. Although approximately 700,000 patients in the United States alone, as of December 31, 2003, were receiving treatment for end stage renal disease (ESRD)] (see Figure 1), their annual survival has not really improved over the past decade because other associated diseases such as heart failure, cancer, infection are now much higher as shown in Figure 2. Figure 1.
Total Number of Patients with ESRD in the United States on December, 2003.
USRDS Annual Data Report 2005.
Figure 2.
Death Rate By Cause in the United States.
During the next decade, the number of new cases of ESRD in the U.S. is projected to double, driving costs way beyond the current $18 billion annually. In developing nations, the actual number of patients receiving renal replacement therapy is unknown. What is clear, however, is that given the high costs of both maintenance hemodialysis and kidney transplant, most of the world is unable to afford therapy for failing kidneys. Figure 3.
Cost per Patient Year by Modality of Renal Replacement Therapy.
Patients = 452,957 Deaths = 82,588 Medicare $ Per Patient
Medicare Total $18.3 billion
Source: USRDS 2005.
Indeed, as charted by the World Health Organization and the Central Intelligence Agency Data Base, life expectancy follows income (see Figure 4). Figure 4.
Life Expectancy Is Higher in Nations with Higher Gross National Income, from World Bank and CIA.
GNI = gross national income per person, World Bank April, 2003.
Life Expectancy, World Factbook 2003, Central Intelligence Agency, May 31, 2003.
The number of patients with ESRD who gain treatment is closely linked to annual per person income. The citizens in the wealthiest countries presently die from heart disease and not from kidney failure. Yet despite improved dialysis and support care, patients need new kidneys of some sort because kidney failure remains deadly with more than 50% of patients dying from the disease.(2)(3)(4) Since there are now more patients on dialysis, waiting time for a deceased donor kidney transplant has lengthened significantly (to a decade in the New York region).(1) As a consequence, physicians have increasingly relied on transplantable kidneys harvested from donors previously excluded because of advanced age or other disorders and from living unrelated donors. But, nevertheless, these remedies fall short of meeting the need for donor kidneys. Given the expanding demand for kidney replacement therapy, medical scientists are attempting to devise innovative, low cost regimens that go beyond dialysis and which may truly replace renal function. Whatever the solutions, researchers realize that they be must be affordable within developing nations.
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