silicon nanotechnology and hemofiltration membranes · 2020. 8. 13. · • h. david humes/roger...
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Silicon Nanotechnology and Hemofiltration
Membranes
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September 30, 2011
William H. Fissell, MD
The Problem (1)
0
100,000
200,000
300,000
400,000
500,000
600,000
1975 1980 1985 1990 1995 2000 2005 2010
0
20,000
40,000
60,000
80,000
100,000
120,000
Transplant
Prevalence
Incidence
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
1990 1995 2000 2005 2010
Medicare ESRD
Medicare Total
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0-19
0-19
0-19
0-19
20-29
20-29
20-29
20-29
30-39
30-39
30-39
30-39
40-49
40-49
40-49
40-49
50-59
50-59
50-59
50-59
60-64
60-64
60-64
60-64
65-69
65-69
65-69
65-69
70-79
70-79
70-79
70-79
80
80
80
80
0000
100100100100
200200200200
300300300300
400400400400
500500500500
600600600600
700700700700
U.S. PopU.S. PopU.S. PopU.S. Pop
TxpTxpTxpTxp
HemoHemoHemoHemo
PDPDPDPD
Benefit From Higher Dose: The Solution?
The London Daily/Nocturnal Hemodialysis StudyThe London Daily/Nocturnal Hemodialysis StudyThe London Daily/Nocturnal Hemodialysis StudyThe London Daily/Nocturnal Hemodialysis Study,
a prospective, comparative, nonrandomized study, directly compared outcomes of quotidian (daily)hemodialysis patients with conventional thrice-weekly hemodialysis patients. Significant clinicalimprovements were seen with quotidian therapy in the areas of nutrition (short-hours daily), bloodpressure (both), volume control (short-hours daily), calcium/phosphorus control (nocturnal), and qualityof life (both). A nonsignificant trend for improvement in anemia management was suggested. Theeconomic analysis showed substantial savings in annualized cost per quality-adjusted life-year inchanging from conventional hemodialysis (carried out in-center, in satellite units, or at home) to home
quotidian hemodialysis.
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quotidian hemodialysis.
TheTheTheThe substantialsubstantialsubstantialsubstantial clinicalclinicalclinicalclinical benefitsbenefitsbenefitsbenefits ofofofof homehomehomehome quotidianquotidianquotidianquotidianhemodialysis,hemodialysis,hemodialysis,hemodialysis, combinedcombinedcombinedcombined withwithwithwith thethethethe economiceconomiceconomiceconomicadvantageadvantageadvantageadvantage shownshownshownshown bybybyby thisthisthisthis study,study,study,study, clearlyclearlyclearlyclearly justifyjustifyjustifyjustify itsitsitsitsexpansionexpansionexpansionexpansion....
Benefit From Higher Dose: The Solution?
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Barriers to Higher Dose
Center hemo
Center self hemo
Home hemo
CAPD
CCPD
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CCPD
Other PD
Uncertain dialysis
Uncertain Transplant
Barriers to Higher Dose
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Arrythmia Care as a Paradigm for the 21st Century
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??
Miniaturization?
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The Kidney’s Natural Hemofilter
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Uniformity of Pores and Shape of Pores Control Selectivity
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Silicon Nanopore MembraneSilicon Nanopore Membrane
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Enhanced Selectivity of Slit Pores
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Silicon Nanopore Membrane: SelectivitySilicon Nanopore Membrane: Selectivity
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Large Animal Hemofilter Implantation
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AcknowledgementsAcknowledgements
•• H. David Humes/Roger Wiggins/Chip BrosiusH. David Humes/Roger Wiggins/Chip Brosius
•• Shuvo Roy & Aaron FleischmanShuvo Roy & Aaron Fleischman
•• Roger MarchantRoger Marchant
•• Andrew L. ZydneyAndrew L. Zydney
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•• Andrew L. ZydneyAndrew L. Zydney
•• Terry ConliskTerry Conlisk
•• NIH/NIBIB K08/R21/Quantum GrantNIH/NIBIB K08/R21/Quantum Grant
•• Cleveland Clinic FoundationCleveland Clinic Foundation
“One must not stay within the lines”- Eric Carle
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