Novel Ultra-Permeable Membrane-based Dialyzer for Home Hemodialysis

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 DESCRIPTION (provided by applicant): The PI aims to apply his Microsystems Engineering background to the study of hemodialysis treatment for End Stage Renal Disease (ESRD). To achieve this goal he requires additional training and mentorship in the areas of biomedical engineering, translational medicine, and nephrology (especially Renal Replacement Therapies). This will be accomplished through a combination of coursework, seminars, conferences, and close interaction with the mentor and his multidisciplinary research team as detailed below. All years of the award include participation at journal clubs, seminars, and conferences, but the first two years will include training of a didactic nature. There will be more time in those first two years as the small animal model studies will be less time consuming than those for the large animal model. This award will be used to add more structure to my studies by allowing me to attend courses, seminar series, and conferences. With the planned training and mentorship the PI will lead the research effort to explore and develop hemodialysis devices using ultrathin nanoporous membrane technology. More than 430,000 patients with End Stage Renal Disease (ESRD) in the US undergo routine dialysis either in dialysis centers or in their homes. Hemodialysis (HD) treatments account for > 6% of all Medicare spending ($34B), despite the fact that ESRD patients account for less than 1% of the total number of Medicare beneficiaries. This disproportionate impact on the US health care costs is expected to worsen. Home hemodialysis (HHD) is significantly less expensive than in-center dialysis owing to reduced staffing and infrastructure requirements. HHD also enables frequent dialysis on a flexible treatment schedule. The numerous health benefits associated with increasing the frequency of hemodialysis beyond the 3-days-per-week regiment are now well- documented. Despite these economic, health, and quality-of-life incentives for home dialysis, HHD accounts for only 1.5% of all HD treatments. This number should be compared to an estimate that 30% of ESRD patients are candidates for HHD. A major reason for the lack of home adoption is patient and doctor concern over the risk of injury or death during a patient-managed, high flow rate (>300 mL/min) HD session. These facts lead us to draw two conclusions about the future of HD treatments for ESRD. First, both economic and health drivers will push HD therapies away from the traditional center-based treatment model and toward more frequent, patient-managed, dialysis in the home. Second, the rate at which this trend progresses will depend on the simplicity and safety of alternatives to standard in-center HD. The purpose of our proposal is to validate the benefits of a breakthrough membrane technology that we believe can help hastening the adoption of home based HD therapies.