What a marvelous time to be a nephrologist as we stand at a crossroads in end stage kidney disease care. The old technology—dialysis—a life-saving application of a ridiculously simple principle of physics, can be further refined into implantable devices that provide some but not all of the benefits of functioning kidneys. Complex machines incapable of healing from damage, they only become affordable at an enormous scale. As discussed in the October/November issue of Kidney News (1) and other recently published articles (2–5), a new biological technology, using pig tissue genetically engineered to evade human immune trip-wires, is real kidney tissue, theoretically able to perform all of the functions of a human kidney. It is also initially hugely expensive but self-replicating and likely scaling to affordability quite rapidly. Yes, there are risks of endogenous retroviruses, and the melange of hormones and other effectors it makes is not human, with inherent riska of dysregulation of the multiple metabolic pathways in which human kidneys participate.
Must we choose one over the other? Not necessarily. We will likely need both approaches because for various reasons, not every patient will find one or the other optimal. But now there are dawning alternatives to a lifetime of hemodialysis or peritoneal dialysis and the chronic shortage of human homografts. I say again, what a marvelous time to be a nephrologist!
References
- 1.↑
Kuehn BM. Pig-to-human xenotransplants take another step forward. Kidney News, 2023; 15(10 and 11):1, 7–8. https://www.asn-online.org/publications/kidneynews/archives/2023/KN_2023_10_oct.pdf
- 2.
Montgomery RA, et al. Results of two cases of pig-to-human kidney xenotransplantation. N Engl J Med 2022; 386:1889–1898. doi: 10.1056/NEJMoa2120238
- 3.
Tector AJ, et al. Current status of renal xenotransplantation and next steps. Kidney360 2023; 4:278–284. doi: 10.34067/Kid.0007152021
- 4.
Groth T, et al. Wearable and implantable artificial kidney devices for end-stage kidney disease treatment: Current status and review. Artif Organs 2023; 47:649–666. doi: 10.1111/aor.14396
- 5.
Padgett Powers M. Kidney X Summit highlights innovative approaches to kidney care. Kidney News, 2023; 15(7):1, 3. https://www.asn-online.org/publications/kidneynews/archives/2023/KN_2023_07_jul.pdf
