Bioartificial Kidney: History, Present, and Future

End-stage kidney disease (ESKD) demands novel treatments capable of simulating the physiological functions of native kidneys. The bioartificial kidney (BAK), combining a glomerular biomimetic filter and a cell-based bioreactor to restore tubular functions, is a promising therapeutic option that is still under preclinical development. This article reviews the technological evolution of BAK, summarizes the latest progress in membrane materials, cell resources and bioreactor construction, and elaborates on key supporting technologies such as kidney-on-a-chip systems, decellularization-recellularization and device miniaturization. Although considerable achievements have been made, critical hurdles including poor biocompatibility, unstable cell activity, immune isolation defects and insufficient vascularization still hinder its clinical application. Future development depends on interdisciplinary collaboration between precision medicine and smart bioengineering, to ultimately promote the clinical translation of BAK for ESKD treatment.