Novel Ultra-Permeable Membrane-based Dialyzer for Home Hemodialysis

 描述（由申请人提供）：PI旨在将其微系统工程背景应用于终末期肾病（ESRD）血液透析治疗研究。为了实现这一目标，他需要在生物医学工程，转化医学和肾脏病学（特别是肾脏替代疗法）领域进行额外的培训和指导。这将通过课程，研讨会，会议的组合，并与导师和他的多学科研究团队的密切互动，如下所述。该奖项的所有年份都包括参加期刊俱乐部，研讨会和会议，但第一个 两年将包括教学性质的培训。头两年将有更多的时间，因为小动物模型研究比大动物模型研究耗时更少。该奖项将用于通过允许我参加课程、系列研讨会和会议来为我的学习增加更多结构。通过计划的培训和指导，PI将领导研究工作，探索和开发使用纳米多孔膜技术的血液透析设备。在美国，超过430，000名终末期肾病（ESRD）患者在透析中心或家中接受常规透析。血液透析（HD）治疗占所有医疗保险支出（340亿美元）的6%以上，尽管ESRD患者占医疗保险受益人总数的不到1%。这种对美国医疗保健成本的不成比例的影响预计将恶化。家庭血液透析（HHD）比中心透析便宜得多，因为它减少了对人员和基础设施的要求。HHD还可以根据灵活的治疗计划进行频繁透析。增加血液透析频率（超过每周3天）的众多健康益处现已得到充分证明。尽管家庭透析具有这些经济、健康和生活质量方面的激励因素，但HHD仅占所有HD治疗的1.5%。这一数字应与估计的30%的ESRD患者是HHD的候选人进行比较。缺乏家庭采用的一个主要原因是患者和医生担心在患者管理的高流速（>300 mL/min）HD治疗期间发生损伤或死亡的风险。这些事实使我们得出两个关于HD治疗ESRD的未来的结论。首先，经济和健康驱动因素将推动HD治疗远离传统的基于中心的治疗模式，并转向更频繁的患者管理的家庭透析。其次，这一趋势的发展速度将取决于标准中心HD替代品的简单性和安全性。我们提案的目的是验证突破性膜技术的益处，我们相信该技术有助于加速家庭HD治疗的采用。

 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.