Chemical engineering contribution to hemodialysis innovation: achieving the wearable artificial kidneys with nanomaterial-based dialysate regeneration

Abstract Hemodialysis (HD) has long been a cornerstone in the renal replacement therapy for end-stage kidney disease (ESKD), primarily through conventional in-center HD. Current HD systems in hospitals are bulky, water-demanding, and constrain the mobility and quality of life of ESKD patients. Home HD (HHD) offers the chance of delivering more frequent treatments close to the patient, reducing vascular stress and post-treatment hangover and improving patients’ lifestyles. However, current HHD devices are analogous to hospital machines, requiring significant space, costly renovations, and they are energy and water intensive. Miniaturisation of HD systems depends on the reduction of water consumption, requiring the introduction of a dialysate regeneration unit, that purifies the spent dialysate of uremic toxins (UTs) and recirculates it, cutting down the amount of dialysate needed. This represents a crucial step for the development of a wearable artificial kidney. However, regenerating dialysate poses significant technical challenges as it involves separating a complex mixture under strict biomedical safety and stability requirements. This paper provides an engineering perspective into current research on using nanomaterials for adsorbing UTs from spent dialysate.