© 2020 The Proactive Path: Empowering the Steps Ahead

The Kidney Project: Implantable Kidney

Overview: Implantable Kidneys

1. How does the device work? And how big is the device?

The bioartificial kidney, the size of a coffee cup, consists of two modules that work together to get rid of wastes. First, a hemofilter module processes incoming blood to create a watery ultrafiltrate that contains dissolved toxins as well as sugars and salts. Second, a bioreactor of kidney cells processes the ultrafiltrate and sends the sugars and salts back into the blood. In the process, water is also reabsorbed back into the body, concentrating the ultrafiltrate into “urine,” which will be directed to the bladder for excretion.

2. What is the surgical process like to insert the device? Where can I have the procedure done?

The procedure will be similar to kidney transplant surgery and it will be performed under general anesthesia. Once the bioartificial kidney device is available publicly, the procedure can be completed at any hospital with a trained transplant surgical team.

3. How will the filter be cleaned?

The filter is coated with a special thin biocompatible film to prevent fouling and blood clots. Additionally, the blood flowing over the coated filter surface will also help to keep the membrane free of debris accumulation.

4. How long will the device survive after implantation? Will it have to be replaced?
The device is meant to be permanent and that is what our efforts are pushing towards. Current testing and research suggest that it could be possible for the device to operate for many years, without failure. However, if failures occur, the replacement of the filter and/or cells would likely involve a minimally invasive surgery.

5. Will patients still have to take immunosuppressive drugs or anticoagulant after implantation? Will there be a risk of blood clotting?

The cells in the bioreactor are isolated from the patient’s immune system by the scaffold on which they are grown. The coatings on the device work to prevent blood clotting. In earlier human trials of a large scale bioartificial kidney, no antirejection drugs were needed, and in recent preclinical experiments, no blood thinners were needed.

6. How are the cells in the bioreactor simultaneously isolated from the immune system but still kept alive?

The immunoisolation is provided by the membranes on which the cells are grown. The cells are grown on a porous scaffold which allows water, salts, glucose, amino acids, and other very small molecules to pass through it freely. These nourish the cells and allow the cells to dispose of small wastes, such as carbon dioxide.

The immune system relies on fairly large molecules to identify and attach foreign intruders, which are a thousand times larger than, say, glucose. They are too large to penetrate the sieve of the membrane supporting the cells.

7. Will it also help Polycystic Kidney Disease and Focal Segmental Glomerulosclerosis (FSGS)?

Yes. In any case where a kidney transplant is needed, our device will be a viable option.

8. Will the “cell reactor” part of your kidney be able to generate Erythropoietin and eliminate the need for artificial EPO injections?

The kidney cells in the bioreactor are different cells than the cells that secrete erythropoetin.

9. What kind of GFR value would you expect to see once this device gets implanted in you? How much increase in GFR might occur?

While this will be confirmed as we progress through preclinical studies, we anticipate a GFR value of 20-30 ml/min with this device implanted.

10. Can you still get this device if you still have 15% kidney function? Or is it exclusive to those whose kidneys have totally failed?

This is case-specific, so it would depend on the details of a particular patient’s case and will be decided by both the patient and physician.

11. Will this be available internationally? Or will international patients have to go to United States for procedure?

Once the device is released commercially, it will be available to all patients in need, domestic or international. Clinical trials, however, will likely be conducted in the United States initially because it is where the key research is taking place as well as needing to adhere to all FDA guidelines.

12. Any predicted side effects?

Adverse side-effects that might occur would be similar to side effects known in other procedures involving implanted medical devices. These include complications like surgical trauma, scars, and infections. Additionally, there might be a need for increased fluid consumption.

13. How much will this device cost?

We anticipate that the device will cost no more than what transplant costs. It is challenging to put a dollar figure on procurement, implantation, and monitoring in the future due to what the business and economic climate will be at the time the device is released.

14. Will this device be covered by insurance?

Generally, medical devices that are successful are products for which insurance provides coverage. Our analysis suggests that the implantable bioartificial kidney will be associated with over 50% cost savings compared to dialysis and, as such, we anticipate that the device will be attractive to those considering coverage decisions.

15. What are the challenges (long term and short term)?

The Kidney Project is an ambitious project and is not without its challenges. In the short term, our primary challenge is funding the research and development. A significant hurdle is procuring enough money in order to complete the preclinical studies for both device components, and build full-scale prototypes for the first rounds of in-human studies.

The long term challenges center around keeping the device operating trouble-free after implantation beyond a few months. Some problems won’t become clear until we do clinical trials, so for now, we are looking at ways to increase the lifetime of cells as well as ways to minimize, or even eliminate, thrombus formation (blood clotting). We will get a better handle on the long-term challenges once we transition to preclinical studies and begin to gather clinical-scale data.

16. Why did The Kidney Project partner with Home Dialyzors United (HDU), and what does that partnership mean?

In spring of 2017, The Kidney Project announced a new partnership with Home Dialyzors United. We are very excited about the opportunities this partnership will bring, and believe it is an important milestone for The Kidney Project.

Partnerships with patient-advocacy groups, such as HDU, allow The Kidney Project to access the opinions and the unique perspectives of kidney disease patients, helping to improve the bioartificial kidney device for all users. The FDA (Food and Drug Administration) encourages medical device developers to incorporate patient perspectives, acknowledging that their voice is often unheard in the medical device development process.

HDU works tirelessly within today’s legal and medical systems to advocate for, and inform dialysis patients about their options for dialysis care. We have partnered with HDU because of their advocacy experience, and their deep understanding of the daily obstacles presented to dialysis patients, and their loved ones.

The Timeline

17. What can be done to speed up the research and development process?

Our progress is driven by two components: time required to conduct scientific analysis and development, and funding. The scientific analysis and development process cannot necessarily be forced into a faster pace. Because we are developing a novel device and are held to the safety standards of the FDA, we must maintain scientific rigor and technical excellence in a logical order without skipping steps.

However, additional funding allows us to hire more personnel, expedite our ordering, purchase additional equipment and generally complete tasks faster. Therefore, donations, fundraisers, and federal funding all help to speed up the research and development process. In short, more funds allow us to operate at a faster pace.

18. How long with clinical trials take to complete?

There are several required steps to the clinical trial process.

Our initial clinical trial, anticipated to begin by early 2018, will be a materials safety test of the Hemofilter. During this trial, we will confirm that all the materials included in our Hemofilter component are safe for human blood exposure. This is the first step of many to receive FDA approval for a completed bioartificial kidney device.

Once our initial clinical trial is complete and the data analyzed, we will apply for a follow-up study to test the Hemofilter’s functional components, namely its ability to filter human blood. Subsequent clinical tests will focus on verifying individual components of the Hemofilter until we graduate into full device implantation in humans. We anticipate this could occur as early as late 2018.

A truncated series of clinical trials will then be required for the combined Hemofilter and Bioreactor device, i.e. the bioartificial kidney. After these trials are completed, the bioartificial kidney will be available to the public. We expect to arrive at this final stage of clinical trials by 2020. This scenario assumes that we have sufficient funding and no unanticipated scientific, technical, or regulatory drawbacks

19. When will the device be ready after clinical trials?

See: How long will the clinical trials take to complete, above.

During the clinical trials, we will be working with manufacturers to discuss and manage the details of production.  

Watch this UCSF informative video 

NOTE: The information above was taken from UCSF’s School of Pharmacy and Medicine’s website at this link: https://pharm.ucsf.edu/kidney 

Stages of Kidney Disease

What are the Stages of Kidney Disease?

The patient’s glomerular filtration rate, also known on laboratory reports as “GFR,” is the best indicator of how well kidneys are functioning. In 2002, the National Kidney Foundation published treatment guidelines that identified five stages of CKD based on declining GFR measurements.  The guidelines recommend different actions based on the stage of kidney disease. The information below is from the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. 

The list below reflects an overview of kidney disease risk stages and risk factors:

  • Increased risk of CKD. A GFR of 90 or above is considered normal. Even with a normal GFR, you may be at increased risk for developing CKD if you have diabetes, high blood pressure, or a family history of kidney disease. The risk increases with age: People over 65 are more than twice as likely to develop CKD as people between the ages of 45 and 65. African Americans also have a higher risk of developing CKD.
  • Stage 1: Kidney damage with normal GFR (90 or above). Kidney damage may be detected before the GFR begins to decline. In this first stage of kidney disease, the goals of treatment are to slow the progression of CKD and reduce the risk of heart and blood vessel disease.
  • Stage 2: Kidney damage with mild decrease in GFR (60 to 89). When kidney function starts to decline, your health care provider will estimate the progression of your CKD and continue treatment to reduce the risk of other health problems.
  • Stage 3: Moderate decrease in GFR (30 to 59). When CKD has advanced to this stage, anemia and bone problems become more common. Work with your health care provider to prevent or treat these complications.
  • Stage 4: Severe reduction in GFR (15 to 29). Continue following the treatment for complications of CKD and learn as much as you can about the treatments for kidney failure. Each treatment requires preparation. If you choose hemodialysis, you will need to have a procedure to make a vein in your arm larger and stronger for repeated needle insertions. For peritoneal dialysis, you will need to have a catheter placed in your abdomen. Or you may want to ask family or friends to consider donating a kidney for transplantation.
  • Stage 5: Kidney failure (GFR less than 15). When the kidneys do not work well enough to maintain life, you will need dialysis or a kidney transplant.

In addition to tracking your GFR, blood tests can show when substances in your blood are out of balance. If phosphorus or potassium levels start to climb, a blood test will prompt your health care provider to address these issues before they permanently affect your health.

 

Common Mistakes Kidney Patients Make & How to Avoid Them

Common Mistakes Kidney Patients Make & How to Avoid Them, Part 1: Ignoring Your Numbers

Written By Risa Simon

Everyone makes mistakes. I’ve certainly made my share as a kidney patient. I guess the upside of making a mistake is the powerful lesson that follows. Of course, the learning only sinks in when the memory of error lingers longer than the mistake itself. 

Wouldn’t it be great to avoid all those unforeseen blunders long before they throw you into a tailspin of reactive, uninformed decision-making? While you can’t control everything in your life, at the very least, you could influence the best outcome by being more prepared for the unpredictable.

Over the next few weeks, you will find some golden nuggets to help you avoid the five most common CKD landmines by becoming your own best advocate. Incorporate these proactive behaviors and you’ll soon be on your way to becoming a more empowered patient in pursuit of your best life possible.  The life every CKD patient deserves.

Mistake #1: Ignoring Your Numbers 

Are you monitoring your blood pressure, weight and lab results closely, or are you relying on your doctors to translate all that fuzzy math? Don’t assume that you’re being told everything you need to know.  Take some responsibility. Your numbers play a significant role in the progression of your disease and can alert you to a problem that you might be able to reverse before it gets worse. Of course, easier said than done if you don’t get a copy of your results after each draw.

To keep yourself well informed and proactively involved in your health, step-up your game a notch or two by following these patient self-advocacy tips:

  1. Set your digital calendar to sound an alarm or send you a message when it’s time to check your BP and weight, or get down to the lab.
  2. Keep a spreadsheet for tracking your blood pressure and weight by date.
  3. Keep an observation diary for tracking new and unusual symptoms that might be associated with fluctuations in areas such as blood pressure or weight.
  4. Insist on getting a copy* of your lab results faxed to you at the same time your doctor’s office receives them. This way you can review them and prepare your questions in advance. (*Your doctor will need to indicate this “CC” request on EACH lab order. Do not leave the office until this request has been confirmed. There’s nothing more frustrating than arguing with a lab about your right to obtain your results).
  5. Create a spreadsheet for your lab values as well. This will allow you to plot your numbers by date for visual comparison trends. Being organized will also allow you to more efficiently formulate your questions at each visit.

While your labs can look like Greek to you, do not be intimidated. Keep your eagle eyes on these numbers at all times.

(1) eGFR (this is an estimated number that shows how efficiently your kidneys are sifting, sorting and cleaning waste from your blood).

(2) Creatinine (the measurement that gauges your kidney’s ability to breakdown muscle cell waste).

(3) BUN (the amount of protein in your blood and urine)

Of course, paying attention to all your numbers, including electrolytes like potassium, blood cell counts like hemoglobin and hematocrit, and monitoring calcium, phosphate and lipids, is also very important. Of course, watching for blood or protein in the urine must not be overlooked either. Follow these tips to more effectively partner with your healthcare team as you become your own best advocate. Information is power.

Check back next week for part 2 in our new series!

About Risa Simon: As a motivational speaker, 3x published author, patient educator and Peer Mentor for the National Kidney Foundation. Known as a positive distruptor and inspirational patient advocate and coach, Risa followed the proactive systems she created for herself and others, and is now living her best life ever. This is what she wants for all transplant eligible patients. Her tips, scripts and Donor Magnet® system can be found in her inspirational “how to” patient empowerment books: Shift Your Fate: Life-Changing Wisdom For Proactive Kidney Patients and In Pursuit of A Better Life: The Ultimate Guide for Finding Living Kidney Donors. 

For more information visit: www.theproactivepath.com

 

Kidney Donors Get Job Security

Kidney patients who hope to get their much-needed transplant can take a big sigh of relief now that the Department of Labor (DOL) Secretary, Alexander Acosta, clarified language that states organ donors qualify for FMLA time-off work. This means that living kidney donors are included in FMLA’s protections for an eligible employee to take up to 12 workweeks of leave (for the surgery and recovery) while they are unable to perform their job functions, without risk of losing their job.

The TransplantFirst Academy applauds Paul Conway, former Chief of Staff of the U.S. Department of Labor, who also serves as President of American Association of Kidney Patients (AAKP) and Chair of the Patient Engagement Advisory Committee of the U.S Food and Drug Administration (FDA) for his role in achieving this massive victory. This united effort also included top kidney community allies, such as the American Society of Nephrology (ASN), the American Society of Transplant Surgeons (ASTS), the American Society of Transplantation (AST) and the Renal Physicians Association (RPA).

For medically-eligible kidney patients, organ transplants are the best treatment available for kidney failure. Transplants help kidney patients either proactively avoid dialysis altogether by securing a preemptive transplant or by allowing them to transition off of dialysis treatment dependency so they can enjoy a vastly improved quality of life. Currently, in the United States, over 114,000 patients are on the organ donation waiting list and of those, over 95,000 are awaiting a kidney transplant.

FLMA wins like this not only encourage more living organ donations for the tens of thousands of Americans who await a life-saving transplant, it helps gain momentum for passing further protections for organ donors, through the Living Donor Protection Act (H.R. 1270).

Learn More about FMLA Opinion Letter here:
https://www.dol.gov/whd/opinion/FMLA/2018/2018_08_28_2A_FMLA.pdf

Learn More About AAKP Efforts Here:
https://aakp.org/press-release/labor-secretary-acosta-earns-patient-praise-organ-donor-job-protections-eve-labor-day-weekend/

Learn More about Living Donor Protection Act here:
https://www.congress.gov/bill/115th-congress/house-bill/1270

Proactive Patient Engagement Leads To Better Outcomes

New data reveals a lack of proactive patient engagement can lead kidney disease patients down a troubling path. While dialysis patients are promised more days of life, three of those days (every week) are spent tethered to a dialysis machine.

To make matters worse, the days in between treatments are filled with nausea, fatigue and lingering distress. Sadly, the decision to start dialysis often occurs in the 11th hour, with little if any proactive engagement. More often than not, end stage kidney disease patients have no idea what they’re getting into — or how they could have bypassed dialysis if they were transplant eligible and took a more proactive approach.

This is not a matter of accepting or rejecting dialysis. It’s a matter of fighting for the best life possible through proactive self-advocacy. It’s about slowing disease progression, managing symptoms and making lifestyle changes that preserve remaining kidney function. It’s about requesting an early evaluation and getting approved for a transplant before numbers get into the redzone (before GFR10). It’s about sharing one’s story and increasing awareness in our nation’s organ shortage and the need for more living kidney donors.

Did I get your attention? Is it time to become your own best advocate and secure a better future? Whether you’re hoping to avoid dialysis or get off dialysis by securing a living kidney donor transplant, learn how to use your voice and become a Donor Magnet Wizard today! Learn more here: www.findingkidneydonors.com

5 Ways To Help Someone With Kidney Disease

Did you know 31 million people in the US have kidney disease? Do you happen to know one of them? Wish you could help? You’re in luck—here’s 5 ways you can!

1. Keep Hydrated!
Hydration keeps kidneys strong and helps prevent kidney stones. Ensure your friends and family members with kidney disease are staying hydrated—and don’t forget to stay hydrated, as well. If they see you with a bottle, they’ll be more likely to grab one too!

2. Avoid Pain Relievers
Find ways to help someone with kidney disease relieve pain without the use of pain relieving products that are hard on your kidneys, like ibuprofen (Advil, Motrin and Nurofen), aspirin and acetaminophen. Look for neutral ways to manage pain with doctor recommended stretching, meditation and Epsom salt baths.

3. Improve Habits
Eating less protein and more vegetable along with doctor-recommended exercise are great ways to care for your body and kidneys! If they’re cigarette smokers, encourage them to put those cigarettes down!
Smoking slows the blood flow to the kidneys and can make kidney disease worse.

4. Empower Engagement
Encourage kidney disease patients to learn as much as they can about slowing the progression of their disease. Information is power. Get them engaged with their doctors by helping them prepare a list of questions before they arrive to their appointments and don’t let them leave the office until their questions have been answered satisfactorily. Are care providers teaching them how to secure their best possible outcome? Empower kidney disease patients to use their voice and become their own best advocate. Learn more here: www.shiftyourfate.com

5. Improve Outcomes
Most kidney patients don’t realize they can avoid dialysis (or end their need for dialysis) by receiving a transplant from a living kidney donor. Currently, there are 100,000 people waiting for a kidney from a deceased organ donor, with an average wait of 5 years. Living kidney donors can end the wait.

This year, less than 18,000 people of the 100,000 waiting will receive a kidney transplant. Considering these statistics, your help is needed to increase awareness and interest in living kidney donation. Get involved today.

Learn more about living kidney donation here: 

Learn how to find a living kidney donor here: www.findingkidneydonors.com.

Want to learn more?
Check out these powerful books on Amazon:

Shift Your Fate: Life-Changing Wisdom for Proactive Kidney Patients
Book page: www.shiftyourfate.com

In Pursuit of A Better Life: The Ultimate Guide For Finding Living Kidney Donors Book Page: www.findingkidneydonors.com

Living Kidney Donor Tribute Inspires Followers

Melissa.Billboard.UP.2

Melissa Blevins Bein is honored on theTransplantFirst Academy’s Living Kidney Donor “Tribute for Awareness” Billboard Campaign, in downtown Phoenix during the week of Christmas 2015 – The ultimate gift. Want to get more billboards up? Make your contribution: https://www.theproactivepath.com/campaigns-projects/

TransplantFirst Academy hopes to make a difference by raising community awareness of living kidney donation. Recently, TransplantFirst Academy urged Phoenix Mayor Greg Stanton to approve a proclamation in honor of living kidney donors for their brave gift. The proclamation was approved to be recognized throughout the month of January.

“Most healthy individuals don’t realize that they can donate one of their kidneys and make an immediate impact on someone’s life,” said Risa Simon, founder and CEO of TransplantFirst Academy. “The mayor’s proclamation combined with our billboard campaign, a tribute showcasing real-life living kidney donors, aims to expand awareness.”

“Since living kidney donors don’t wear a Medal of Honor or a superhero’s cape, it’s often hard to recognize them. Their decoration of a few tiny scars is a unique distinction of lifetime achievement for the role they played in saving lives.”

Living kidney donation is not for everyone. It takes a very special and healthy person to qualify. Simon added, “Kidneys are hard to come by and our nation’s deceased organ supply simply cannot meet the demand. We hope that our billboard campaign makes people aware that they can make an impact now, not just after they are deceased.”

TransplantFirst Academy’s billboard campaign goal is simple:
1. Honor living kidney donors for saving more than 132,160 lives (2,834 lives in Arizona) as of December 25, 2015.
2. Capture community attention that ignites interest in living kidney donation.
3. Save lives by ending the life-threatening wait for those in need.

As a passionate patient advocate and preemptive transplant recipient, Simon said, “When my living donor stepped forward on my behalf, I received more than a highly functioning kidney. I received a sense of duty to advocate for all those facing this reality.”

About TransplantFirst Academy:
TransplantFirst Academy is a 501c3 non-profit organization based in Phoenix, Ariz., dedicated to empowering and improving kidney patient outcomes. For more information, visit transplantfirst.org. To become a sponsor or request an interview, contact Risa Simon at 480-575-9353 or risa@www.theproactivepath.com.

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