Lab-Grown Kidneys: Are we there yet?

kidney-structure-6-art-views-yellow

  • Current options for kidney failure quite onerous for patients
  • Survival rates not good enough with these treatments
  • Newer options like WAK will still take long time and may not completely solve these problems
  • Lab-grown kidneys would be an excellent alternative but will still take a long time to become usable by a common patient

Recently, the press has been agog with the news of a lab-grown kidney being implanted into rats and pigs and working well.

A lab-grown kidney is really the holy grail when it comes to treating those with kidney failure. A lot of work has gone into this area. Some projects are also underway that involve developing artificial systems that mimic the function of the kidney and can either be implanted or can be carried around.

The only therapies widely available today for those with kidney failure are hemodialysis, peritoneal dialysis and a kidney transplant. Each one of these has its own pros and cons. The survival of a transplanted kidney after ten years is estimated currently at 60%. This means that two in every five patients would lose their kidney in less than ten years. The five-year survival rate of dialysis patients is an abysmally low 36% which means about two-thirds of the patients who get on to dialysis do not survive beyond five years!

A major impediment to kidney transplants is the woefully low availability of kidneys. World-wide, this has been an almost insurmountable challenge.

In this scenario, it is critical for alternate modalities to become widely available. The advances in dialysis have been few and far between. Hemodialysis machines that are used by most patients around the world are as big as washing machines. Dialysis sessions are also associated with extreme fatigue and complications such as cramps and hypotension. Hemodialysis patients are also subjected to a punishing diet and fluid restriction. Peritoneal dialysis, though it offers a relatively freer lifestyle, has been less widespread due to various reasons such as the cost, the burden of self-care and the risk of infections which are often difficult to treat.

There have been attempts at reducing the size of the hemodialysis machine but these machines are not widely available across the world and also have some clinical issues like requiring high blood flow rates which are not conducive to long term access survival. More than ten years after the launch of a fully portable hemodialysis machines in the US, it is available in a very small number of countries and being used by a minuscule number of patients.

Several ongoing projects such as Dr. Victor Gura’s “Wearable Artificial Kidney” (WAK) and Dr. Shuvo Roy’s Implantable Artificial Kidney (IAK) are at different stages in their development and will take a lot more time, effort and money to become easily accessible to patients. However, even with these devices, there are still several unresolved problems and even when fully ready, will not address many of the issues that exist with today’s technology as well.

The only long term, ideal solution is a lab-grown kidney. With this, patients would not need immunosuppressive medication (which has innumerable side-effects). They would also be free from diet or fluid restrictions. Such kidneys could potentially last a lifetime or you could get a new one in case one failed! Patients would also be free from the side effects of kidney failure such as Anemia, Mineral and Bone disorders, Heart problems and so many others.

Currently, what has been achieved is no doubt, a spectacular achievement. For the first time, we have a prototype of a working kidney with all its chief functions that is functioning inside a living animal. However, there are many problems to be solved. There are many new obstacles that will arise which would need to be resolved. This would take several more years. Also, for such a radical new system, clinical trials and subsequent approvals would take several more years.

The cost of such “lab-grown kidneys” could potentially be a huge limiting factor in its widespread use. So, even after the kidneys begin getting commercially available in countries like the US, patients in the developing world might only get to use them many, many years after.

While all this might sound gloomy, it is important that patients on various renal replacement therapies today realise that until these new systems become widely available, there is still a lot that can be done to lead a close-to-normal, productive and meaningful life. By optimising your dialysis regimen or being mindful about what you do in case you have received a transplanted kidney, you can still lead a life you were meant to lead. While there are compromises to be made, things to be foregone, life does not need to be as depressing as it is often made out to be. By looking at the positive aspects of what you have, by counting your blessings and being grateful for what you can do, you will realise that life can be as fulfilling as you want it to be!