It weighs about 4 lbs, and is designed to be worn around the waist. It works as follows: the patient instills an initial amount of fluid into the peritoneal cavity. Every few hours, the PD fluid is moved through a fibrin and debris trap, a carbon filter and also through sorbents that help clean and regenerate the dialysate. The PD fluid is sterilized and enriched with electrolytes and glucose removed by the sorbent apparatus. It is then returned to the peritoneal cavity for another cycle of dialysis. The desired fluid volume to be removed is stored in a small bladder, which can be emptied periodically. The filter and sorbent module are changed periodically, and the dialysate can be exchanged every 2-3 months.
It’s time to write about something truly cool in the world of dialysis (how often do we get to say that?). In early 2011, clinical trials are scheduled to begin testing the AWAK, or Automated Wearable Artificial Kidney. First introduced two years ago, AWAK is a peritoneal dialysis strategy using an automated pump to fill, drain and filter peritoneal dialysis fluid.
While the advantages of having round-the-clock, wearable technology are obvious, just as clear are the challenges that face this novel technology. Will the sorbent cartridges cleanse the peritoneal fluid adequately? And will the zirconium used in the cartridges be safe in the short and long term? It is also unclear how a patient would adjust the system to alter desired fluid removal. Reliability and infection risk will need to be thoroughly evaluated. And not least, it remains to be seen whether patients will really want to wear a bulky dialysis belt around all day (fashionable, it’s not). Still—it’s novel, and cool. And if it works, it may provide select patients with a better quality of life.