Portable or wearable peritoneal devices--the next step forward for peritoneal dialysis?

Peritoneal dialysis can be considered a "wearable" dialysis therapy. However, patients typically require 3 or 4 daily exchanges, each taking 20-40 minutes and potentially increasing the risk of infection by repeated disconnection and reconnection. Although peritoneal dialysis cyclers allow patients to be "free" from their machine for 13-15 hours, they similarly need a supply of fresh dialysate. Several groups have therefore explored the possibility of trying to minimize dialysate exchanges by recycling dialysate. However, that approach introduces not only a series of challenges, including regeneration of the spent dialysate, maintenance of acid-base and electrolyte balance and adequate ultrafiltration, but also new hurdles to be overcome, including monitoring the sorbents to determine when capacity is exceeded. The proposed Vicenza Wearable Artificial Kidney system consists of a continuous-flow peritoneal dialysis system that combines sorbents in series and urease to regenerate dialysate during the day, and a 7.5% icodextrin exchange overnight.