Advances in sorbent peritoneal dialysis technologies: A narrative review

Sorbent peritoneal dialysis (SPD) removes a tidal volume of spent dialysate, passing it through sorbent layers before infusing replacement electrolytes and dextrose to regenerate dialysate. We examine the five devices using SPD in published literature, reviewing their design, dialysis clearance, and ultrafiltration (UF) capacity-Automated Wearable Artificial Kidney (AWAK), now called Viva Kompact since 2024, Carry Life System PD/Carry Life UF, Wearable Artificial Kidney (WEAKID), Vicenza Wearable Artificial Kidney (ViWAK), and Renart-PD. Carry Life devices and Viva Kompact have reported on human trials, WEAKID and Renart-PD on animal studies, while ViWAK has published in vitro data. All devices have published data on dialysis clearance capabilities. WEAKID and Carry Life PD achieved a high dialysate:plasma concentration gradient for small solutes. Viva Kompact and Renart-PD reported stable or lower serum concentrations of urea, creatinine, phosphate, and β2-microglogulin following treatments. ViWAK demonstrated removal of creatinine, B2 microglobulin, and angiogenin to <10% of pre-treatment levels. UF capacity remains unknown for many devices. In human trials, Carry Life UF has achieved 863 mL UF in a 5-h treatment with the addition of 20 g/h of glucose to 1.5% dextrose dialysate. Viva Kompact has demonstrated 877 mL UF in a 9-h treatment using 1.5% dextrose dialysate in an animal model, comparable to 10-h APD, with the addition of 6.6 g/h glucose. Both devices have demonstrated improved UF per gram of glucose used. The expected use of these devices varies greatly, from an adjunct to currently available treatments to a complete replacement for current modalities. Large-scale, human studies are needed to determine their role in the future of PD delivery.