To be honest, the best system I had ever seen for home dialysis (other than a full-fledged dialysate delivery unit for which most patients lack the space, lack the capital to acquire, and the technical ability to maintain) was the system developed by Home Intensive Care (HIC).

Actually, HIC did use a full-fledged dialysis delivery unit, a water purification system, and it provided technical support.  But, it was their business model that made the biggest difference.  Technicians maintained all the units.  But, the units were all mobile- the delivery system, the water purification, and peripheries were on wheels that could be brought into a patient’s home, set up in minutes (to the tap water of the home), and then hooked to the patient who underwent the four hour treatment.  At that point, the equipment was disconnected, brought back to the “office” were it was disinfected and serviced, to be ready for the next patient. Each system served about 6 people a week.   (As I’ve written, Medicare took HIC to court- and terminated this program.)

Long before HIC was instituted, REDY (the brainchild of Dr. Martin Roberts) hoped to conquer the home market.  REDY was never well capitalized, so it was subsumed by AKZO, a major chemical firm that had interests in dialysis. (They produced the membranes that were used in dialyzers.)

The system used a conventional dialyzer (most often, a hollow fiber device) and a very small amount of dialysate (a salt water solution).  This meant the amount of pure water needed was pretty low- but that the dialysate solution (about 6 liters in total) was continually recycled through the dialyzer, to clean the blood.

Obviously, the dialysate needed to be “cleaned” or it would not be able to remove toxins from the blood after a few minutes.  This “cleansing” was done by passing the dialysate through a purifying cartridge (the heart of the REDY).  The cartridge had activated carbon (to absorb organics), urease enzyme (to convert the urea to innocuous materials), and some ion exchange components.

REDY really never was a “portable” dialysis machine.  But, it was small enough to work in the home.  The problem was the dialysate flow rate was too low to afford good transfer of toxins and materials from the blood and a limited capability of the cartridge to purify the dialysate to have it match that of a normal dialysis system.

After a few years, the system disappeared.  (Marty continued working on concepts based on the REDY; the AWAK, which also never went far, was his newest version.  I reported on that back in 2011.)

But, as the saying goes… the more things change, the more things stay the same.

Two smallish firms, Debiotech SA and Neokidney BV are attempting to bring a “plug and play” home hemodialysis system to market.

Debiotech has had some success- it developed a peritoneal dialysis system (for home use) that Fresenius has picked up.  (Fresenius is the world’s largest provider of dialysis services.  By the way, it also acquired HIC years ago.)

This new device, NeoKidney, was developed by the Dutch Kidney Foundation (with help from the health insurance companies) along with Dialyss Pte Ltd.  But, if you look carefully, what you see is an updated version of the REDY unit, one that uses 7 liters of fluid instead of 6, but pretty much the same cartridge purifier for the reused dialysate.  Oh, and it uses new computer/electronics  technology so the control module that used to weigh 30 pounds is now smaller and more compact- but still about 20 pounds.

I am still waiting for the embargo against stem cell research to be lifted.  We needed that bioengineered artificial stem cell kidney- decades ago.

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