The Future of Kidney Care

The global rise of end-stage renal disease (ESRD) is driving innovation in wearable and implantable dialysis technologies (Groth, 2022). ESRD is the final and most advanced stage of chronic kidney disease, where the kidneys can no longer effectively filter waste (like urea), excess water, and electrolytes (like potassium and sodium) (Groth, 2022). While kidney transplant is the preferred treatment, some patients are not candidates. Alternatives include peritoneal dialysis and hemodialysis, both of which are time consuming and resource intensive (Groth, 2022). These treatments place a burden on patients, the environment, and the healthcare system. Emerging technologies, such as wearable peritoneal dialysis, wearable artificial kidneys, and implantable artificial kidneys, offer a promising shift in renal replacement therapy by enhancing mobility, convenience, and quality of life (Groth, 2022).

Wearable Peritoneal Dialysis (PD) 

Several international initiatives are developing wearable PD devices aimed at improving mobility and quality of life for patients. These devices are typically compact (purse-sized) and use disposable cartridges that regenerate dialysate, reducing the need for large volumes of fluid (Wieringa et al., 2025). Cartridges are designed to last approximately seven hours before needing replacement (Wieringa et al., 2025). Wearable PD device, unlike wearable artificial kidneys, do not require vascular access.

Notable programs include: 

• AWAK 

• WEAKID 

• ViWAK PD 

Wearable Artificial Kidneys (WAK) 

WAKs are portable, battery-powered dialysis devices designed to provide continuous kidney therapy while allowing patients to maintain daily activities (Gura et al., 2016). Unlike traditional machines, WAKs are lightweight and worn as a belt or vest (Gura et al., 2016). They filter blood, remove waste and excess fluids, and regenerate dialysate using sorbent technology, reducing fluid usage (Gura et al., 2016). WAKs aim to improve quality of life by offering more flexibility and shorter treatment times compared to in-centre hemodialysis. WAKs require vascular access (Gura et al., 2016).

A key limitation in wearable dialysis devices is the efficient removal of urea (UCLA Health, 2024). Strategies under investigation include: 

• MXenes: Nanomaterial filter capable of binding and adsorbing urea (Javaherchi et al., 2025; Nephria Bio. 2025). 

• Urease-based breakdown: Converts urea into ammonia and carbon dioxide, requiring subsequent management of ammonia (Fabiani et al., 2025). 

• Electrochemical degradation: Electrical currents break urea into nitrates and carbon dioxide (Fabiani et al., 2025). 

• Thermolysis: Heat-based degradation of urea, producing ammonia and carbon dioxide (UCLA Health, 2024). 

Notable programs include: 

• WAK by Gura

• NextKidney

Implantable Artificial Kidney

Implantable artificial kidneys are a promising innovation aimed at providing a long-term solution for patients with kidney failure. These devices are designed to work inside the body, filtering waste (like urea and electrolytes) and excess fluid (also called ultrafiltration), continuously like a natural kidney (UCLA Health, 2024). Daily dialysis tends to have less complications and is easier on the cardiovascular system. Also, traditional dialysis methods are resource-intensive, using an estimated 6.2 billion gallons of water each year in the United States alone (UCLA Health, 2024). Future implantable devices must prioritize water conservation, especially since they cannot rely on external water sources (UCLA Health, 2024). While still in clinical development, implantable artificial kidneys could revolutionize kidney care by offering greater freedom and improved quality of life for patients. 

Notable programs include: 

• The Kidney Project

• Development of an Artificial Kidney

The future of kidney care is evolving, with wearable peritoneal dialysis, wearable artificial kidneys, and implantable kidneys offering promising alternatives to traditional treatments (Groth, 2022). These innovations have the potential to greatly improve patients' quality of life. While technical challenges remain and nothing has been fully endorsed for public use, proof of concept has already been demonstrated. As research advances, these solutions could transform kidney care, making treatment more convenient and accessible.