The Kidney Project successfully tests a prototype bioartificial kidney | Hacker News Reader

The Kidney Project successfully tests a prototype bioartificial kidney

pharmacy.ucsf.edu

389 points72f988bf71 comments

As someone who has gone through a kidney transplant, this is actually a bit depressing since progress in this field is painfully slow.

I have seen these articles pop up at regular intervals for a decade now, and if we're going to be honest: nothing much has happened during that decade. This is still an under-funded area where nothing more than "pre-clinical" prototypes keep getting press - and then nothing.

I used to be active on various forums for kidney patients (one of which had more than 27.000 members last I checked). I'm not very active anymore because it is too depressing to read about people who are less fortunate than me (I have good health, live in a country with socialized medicine and my total cost per year for keeping the transplanted healthy is less than $300). For instance non-affluent people living in the US.

I've lost count of how many americans I've known who have ended up in a place where taking their own life seems like the best option. Either because they are tired of finding money for the medications that keep them alive, tired of navigating bureaucracy, because they don't want to drag their entire family into a financial hole, or because they are just physically exhausted. (Dialysis is time-consuming and slowly ruins your body)

Take some time to think about that. Think about what it means that every so many months someone on a forum you frequent tells you "I've had it - I'm going to give up and die". It can be quite taxing if you allow yourself to care.

So excuse me for being negative, but this isn't anything to be excited about. This is just a reminder that nothing much that actually has any impact is happening in this area.

Please take some time to review the national statistics for the US and please consider becoming an organ donor.

https://www.organdonor.gov/learn/organ-donation-statistics

That’s awesome to hear that youve gotten a transplant and are still in good health. I suspect that you didn’t need one because of CKD caused by diabetes/blood pressure?

Probably high blood pressure for 15+ years, but at the point where this was discovered it was impossible to know for sure if it was the primary reason or a consequence of kidney failure. Fortunately, the blood pressure turned out to be easy to manage with medication.

And after the transplant, things have gone exceptionally well and I live a completely normal lifet. I just need to down a fistful of pills every day :-)

Holy crap, that sounds exactly like mine. We dont know the reason why I had kidney failure and there was so much damage a bioposy would not be fruitful. The guess is blood pressure, but its not known.

Nephroschlerosis?

If the experience taught me anything: make sure you start doing an annual health checkup with bloodwork every year or two starting in your 20s. It is likely I could have avoided this.

I dont know the term, but by the time we found out there was so much bruising on the kidney, couldnt do a biopsy as it would cause bleeding and further delay the transplant. I didnt want any more delays so I opted out of it after discussing with my doctor.

As someone who has also gone through a kidney transplant I relate with you completely. I stopped visiting those websites because I too get overwhelmed with the content.

I have taken my life circumstance to share my story and ask others to sign up to become an organ donor. It can change the life of someone and you can truly make a difference not only for a person but an entire family.

I also look at this news as positive, Ill take anything no matter how slow the progress is. Decades ago before transplant techniques were developed my story would have ended (unless I had a twin) but its because of work like this I'm able to type this out right now. So perhaps a few decades from today someone will benefit from this technology and not have to go through what you and I did.

Ill add the link in for the National Kidney Registry who do great work and if someone wants donate their cause can do so. https://www.kidneyregistry.org/

I’m on my 7th year of having a transplanted kidney, having a scumbag disease that will eventually destroy my current one… I feel your cynicism. On the other hand this stuff still gives me hope, I dream of the days I don't need to start the day and end the day with meds… One day

It's obviously a hard problem. As someone who used to do dialysis-access operations (AV fistulas/AV shunts), just looking at their diagram and seeing 3 location with a plastic::tissue interface (artery, vein, bladder) is a massive hurdle alone. The connection between the artery and the device will stenose, the connection between the vein and the device will clot (despite whatever is in the press release, I can guarantee it will). And then exposing the entire apparatus to the bladder - it will get infected, and then the whole thing needs to be removed.

So, even if they got the actual device perfect, the realities of interfacing that with an actual person, for any reasonable length of time... Don't hold your breath.

This is why kidney transplant is so great... it's all real tissue, even if you need lifelong antisuppression.

In September 2019 i was diagnosed with kidney function of 54 percent (at 44) out of 100. It doesn't run in the family and my other prior condition was high cholesterol at 37 then at 40 i had some Gout attacks. I took a statin for the high cholesterol for a few years. I never took any other meds outside of a sleeping pill here and there (12 times in a few years). My kidney doc thinks my kidney damage was from medication i took so maybe it was the statin.

After being diagnosed my doc said avoid taking all meds, which i did and do. I also went ahead and changed my diet where i drink 3 liters of water per day and cut out all pork and redmeatl, as well increased my fruits & vegetable intake. Also, avoid fatty foods and lost five to ten pounds (around 170 5'10). My kidney function as of just getting my results today is 79 out of 100(creatitine 1.1). Though my monthly test shows me the average to be in the low 70s usually. Not sure why it was higher this month..did lose a few pounds further.

Overall Im thinking if I continue on with this lifestyle I may not have to go on dialysis for another 20 to 30 years possibly more. Yet its all in the air thus I constantly get it monitor each month to bi-monthly even if my doctor says that's not needed. She did say sure try changing your diet/lifestyle and see how it works. Some docs I hear will just say diet won't improve your kidney yet I joined a Facebook group where a guy's kidney was completely failed yet his wife revolutionized his diet and his function went from crazy low on dialysis to like 30 percent and off of dialysis.

I am just sharing my experience with my kidney issues maybe it will help others .. maybe not. Im not here to argue just offer what has worked for me positively and many others in that Facebook group mentioned.

That looks interesting, but the linked article is a bit short on details, but high on praise.

For example I would like to know, if the goal is, to actually put this inside of people?

Currently it is smartphone sized. That might work, but only if the person moves not much, because it does not seem flexible. And having a stiff smartphone in your body would mean moving like a old school robot. That still might beat the alternative, but would be a serious limitation. Maybe they get it smaller and more flexible - then I would be curious how long the bioreactor and hemofilter lasts, before they need replacement? Because that means dangerous surgery.

So the first versions would be probably carried outside the body and connected to your arteries?

You know, I have never actually considered this aspect of "cyborg-life". Given how much I slouch at desks all day, yeh, a life saving kidney digging in my ribs would get annoying !

I suspect it would just be an internal version of the parental "stop slouching dear". Users might report better backs as well as kidneys !

And just to be clear, Science and medicine makes amazing advances each day and decade. I am astonished by the idea this even is close to working.

" Users might report better backs as well as kidneys !"

I doubt that. A healthy back needs twisting and bending in all directions.

I'm really having to rein in my SWE-desire to start pitching "what if we just" fixes to this thread.

when you're in the situation where you need a kidney replacement uncomfortable positions are the least of your worries.

Like you said: I'm amazed by the fact that were close to having a replacement. Not sure how many will be able to afford it but still. It's one step forward.

And not having the side effects and ongoing costs of imunosupressant drugs - It will be very good for BAME communities that have problems with low % of compatible donors.

Leaving aside that it's very early days for this technology, kidneys aren't all that flexible, either. Kidney swelling or inflammation is as painful as it is (and it is very painful) because the kidney is enclosed in a protective capsule of tough connective tissue, which makes it unable to increase significantly in total volume. (This is also why kidney swelling is a medical emergency, especially when bilateral and regardless of cause: in addition to being painful, severe swelling occludes blood vessels and causes tissue-killing ischemia, which can result in partial or total loss of function.)

A kidney isn't all that different in length on the major axis from a smartphone, either, and in volume is larger besides. Speaking as someone with recurrent kidney trouble, if things do get bad enough and I can't get on the transplant list due to age or comorbidity, I'd rather take a chance on something like this than suffer the known drawbacks of periodic dialysis, especially the all but guaranteed progressive impairment of cognition.

>>especially the all but guaranteed progressive impairment of cognition

Could you expand a bit more on this? What causes the impairment in cognition?

"Filtering the Evidence: Is There a Cognitive Cost of Hemodialysis?" (https://jasn.asnjournals.org/content/29/4/1087) reviews recent research and finds cognitive impairment both significant and prevalent as a side effect of in-center hemodialysis (as opposed to peritoneal dialysis, which is less harmful). It cites among other things an RCT result entitled "Cognitive impairment in hemodialysis patients is common" (https://pubmed.ncbi.nlm.nih.gov/16864811/), which is frequently cited in studies and articles reviewing this phenomenon; the "Cited by" list on that page is a fertile ground for further review.

Dirty blood is toxic to many organs. The ears, eyes, and nose will all degrade along with the mind as kidneys fail. The worst is that dirty blood is toxic to the kidneys, so failing kidneys cause kidney failure.

This is actually an internal artificial kidney. There are other projects like you describe. https://pharm.ucsf.edu/kidney/device/faq has some helpful info about this.

This would basically replace dialysis if they are able to achieve the numbers they quote (GFR of 20-30). Occasionally having a minor surgery is likely much safer and more affordable than dialysis.

Does it have to be implanted within the body?

I've seen the pain and eventual death 2 close family members have had to suffer due to Kidney failure and I also will face the same as my kidneys continue to gradually fail, the complications are bad and side effects can lead to death alone, the limitations of sometime like this artificial Kidney are absolutely miniscule compared to the benefits on offer.

My kidneys are failing as well. I am currently being evaluated to be on transplant list. Artificial kidney is an exciting development. It wont replace the need for transplant but will definitely improve quality of life for people on dialysis.

I wish all the best to you two!

To deal with the inflexibility, it could be encased in a soft artificial shell.

While progress in this field has been slow, it's worth saying that if this technology continues to proceed towards success, this is not just a life-saver but a game-changer for humanity.

650K USD investment is so little for something so important!

Meanwhile, I just read that a recruiting startup raised 100M $ in investment.

There is no issue that is too expensive for humanity. If the COVID hysteria has shown us anything, it is that we could have made ANYTHING a global priority.

Hunger in Africa, no problem. Homelessness or global poverty, could have easily brainwashed the public into rallying behind that cause.

It was just a matter of choice. All our problems are allowed to become that by our useless rulers. And I'm not talking about the ones we "elect", but the ones that have their own different priorities. They only care about their eugenicist fervor.

A disease that spreads like Covid but basically destroys your kidneys would probably lead to greater funding for kidney research. True.

Or imagine if the world just went together to try to build fusion reactors. Spending on ITER is 2 billion a year, why not 20 billion a year? We would probably learn a ton about different ways to do it and maybe innovate stuff, maybe we would have already solved the global energy crisis if we had a 20 billion budget for it 10 years ago? Or even better, imagine if instead of spending hundreds of millions to make ads that just serves to make people spend more on consumption, maybe that could be used to make reactors? People would go into research for the money, they would train hard to get the best reactor jobs, it would be the hot new market! All that could be reality, but no, society says "ads are more important, without ads people might forget to spend their money and that would be a tragedy!".

While I also bemoan the massive waste of money and talent on actively harmful things like ads, I think fusion is a pretty huge waste of resources as well, at least given our current understanding of the universe and somewhat plausible technologies. Here[0] is an article explaining some fundamental problems that make fusion very unlikely to ever be a good source of energy.

Biomedical research seems like a much more relevant and much more likely to advance rapidly given more investment area of knowledge. Especially since, even if we were given a free energy machine today, we still wouldn't be able to cure the vast majority of human diseases, nor be much closer to even understanding a good proportion of them.

[0] https://thebulletin.org/fusion-energy-nuclear-fusion/

Question the incentive structures we have set up which make it possible to get a 10x return on investment in a recruiting startup, but make getting a 10x return on an artificial kidney investment difficult.

There is a lot of malpractice in developing countries like China & India wrt black market kidney trade. I wish this becomes mainstream.

We're entering the age of viable artificial organs. I'll take that over flying cars. Amazing work.

Artificial hearts already work since quite a while.

It is amazing, but real organs can sustain themself - artificial mechanical ones not. And need surgery for replacement.

I have my hopes on artificial real organs and see the mechanical ones as a intermediate solution.

A miraculous breakthrough could be on two fronts: artificial "meat organs" for those whose life is at immediate risk and need a transplant, and regenerative biotech/medicine to repair those with damage without requiring surgery.

Either way, implanted devices can be a good bridge from our current situation.

And they are. One of the other 6 finalists were doing "Genetically-engineered pig kidney xenotransplantation". The idea is to "Genetically engineered pig kidneys that will increase the supply of transplantable organs by eliminating the antibody barrier to xenotransplantation."

I would like a backup heart, but not sure if it makes sense from an engineering standpoint.

For sudden cardiac death? Isn't that mostly caused by arrhythmia? So a prophylactic pacemaker maybe? Isn't that already a thing?

The threat model could be a freak heart stabbing. In which case a backup heart somewhere else (and some truly earthshattering breakthroughs in fast clotting) might make sense.

My dream technology would be a way to make my body just ... stop, if Something Bad happened, like all my blood falling out, until someone stumbled upon my non-rotting corpse, patched the holes, and filled it back up.

It's such bullshit that if I stop living for even a little bit my body melts into useless slag like an engine running without oil.

I imagined damage to the heart muscles or blocked blood vessel.

> Artificial hearts already work since quite a while

Frankly I wouldn't want one for $1B.

IIRC the longest recorded survival with an artificial rate was about 3 months for a continuous flow 'pulse-less' device https://en.wikipedia.org/wiki/Artificial_heart

So yeah, they "work", but are still far from perfect.

Oh. I assumed they performed better by now.

So basically getting a artificial heart as a replacement right now, means taking part in developing science and medicine, but not really realistically with any hopes of living on.

Seems that the article is a bit outdated. Carmat total artificial heart already had patient with at least 20 months of survival (it is currently used as a bridge until transplantation). * https://www.bfmtv.com/economie/entreprises/services/carmat-u... (20 months in French) https://www.carmatsa.com/en/news/carmat-feedback-6-years-8-m... (latest study results)

This is one of those things that you are hopeful it exists, but you also pray that people won't need.

The big problem being that prayer doesn't work.

If prayer stops people forgetting about the problems of the world, I'd say it does.

Religión is considered by the common people to be true, by the wise to be false, and by the rulers to be useful. --Seneca

(In fact that's too cynical on Seneca's part. Religión is useful for, one imagines, the majority of it's member's, who gain among other things social connection and a safety net from it.)

This is a generalization. Go on /r/exmuslim, /r/exjw, and /r/exmormon on reddit to find countless stories of people from whom religion provides quite the opposite of a safety net. If often as not creates a source of fear, emotional and physical danger, ostracization, and shunning. Not to mention extreme cases like honor killings. You may as well say North Korea gives you a safety net and community (as long as you ignore the ways that it doesn't).

I don't dispute that those things happen and are horrible, but I believe "as often as not" is incorrect. What's your sample? If your sample is a forum where people tell conversion-to-atheism stories, it's not representative. Almost of the religious people I've met feel that way about their church.

Admittedly, my sample is surely not representative either. In particular people stuck in a church community against their will probably don't bring it up a lot with people they don't know very well.

FWIW I'm an atheist. I recently wished I was able to invoke some kind of God concept while talking to a colleague who this year lost her mother, her boyfriend, and two other family members to Covid. I intend to look for something entitled Prayer for Atheists, if it exists.

I've seen this quote before, but I haven't been able to find it myself. Which text is it from?

Here's one from a letter to Lucilius. Seneca is easy to misquote.

"Indeed, no man can be good without the help of God. Can one rise superior to fortune unless God helps him to rise? He it is that gives noble and upright counsel." - Seneca

Interesting! A lot of people on wikiquote[1] appear to believe it's a misattribution. I've only ever heard it secondhand.

[1] https://en.wikiquote.org/wiki/Talk:Seneca_the_Younger#.22Tru...

Well if prayer make you go through hard times and give you peace and hope instead of going into depressing than yes it does work.

Prayer doesn't prevent malfunctioning kidneys, yours or those of random strangers, as far as I know. So, it doesn't work.

Like the artificial bee that Amazon patented.

People already do need it! In the US alone, about a half million people are on dialysis. There are many health and functional consequences to both intermittent and peritoneal dialysis; they are not exactly benign treatments.

It's so badly needed. For some US-centric perspective: "the almost 750,000 people who live with kidney failure are 1% of the U.S. Medicare population but account for roughly 7% of the Medicare budget." [0] This is obviously just one part of the issue; I don't need to describe how attritional and life-altering chronic kidney disease and, subsequently, hemo-/peritoneal-dialysis are.

[0] https://pharm.ucsf.edu/kidney/need/statistics#:~:text=Costs,....

In a preclinical model. Whatever that is, maybe it is a mouse after all?

It is smartphone sized. It wont fit into a mouse.

It is a test, it is not said it is implanted into the model.

I rather would suspect a pig or ape, as the little blood a mouse has, would not allow for real testing.

I would suppose it's working "in vitro" with a technical model of blood circulation

i really hope they make it a reality, so many ppl need this, and will be such a major change in everyday life for them

How long does it last once implanted? Seems a little scarce on details, not sure if its a permanent fix or just supposed to keep you going until a transplant is found. Is it a replacement or a stop gap?

Could it not be kept outside the body?

The major benefit to implanting it under the skin, as we do with pacemakers, is that doing without permanent holes or tubes through the skin reduces infection risk.

Consider also the danger of having something dangling from your body that is powered by your arterial blood pressure (from a major artery, as the kidney is). A trip and fall could be instantly fatal.

I had a kidney stent in for a few days while I healed from an operation. Let me tell you, it’s a huge quality of life downer (obviously the medical operation outweighed the life style concern). You definitely don’t want medical equipment dangling on the outside of your body if you can help it.

As someone who already stubs every stubable body part, I don't need new ones to bash into things.

Reply on news.ycombinator.com