Hemodialysis: Italian revolution is on its way

Millions of people all over the world suffer from Chronic Kidney Disease (CKD). The vast majority of these people are prescribed hemodialysis, a treatment that performs the same functions a kidney normally would. This treatment, however, is invasive, complicated and quite costly for the healthcare system. Yet now, a major breakthrough has arrived from Trento, from a doctor and an engineer…

Hemodialysis: a brief definition

Hemodialysis is a type of replacement therapy whereby a machine functions as a substitute for the kidneys. Hemodialysis is performed on patients who suffer severe loss of renal function. The therapy substitutes the following four basic functions of the kidneys:

  • Removal of toxic substances
  • Regulation of electrolytes balance
  • Regulation of acid-base balance
  • Removal of extra fluids

The first two functions are carried out by pumping the patient’s blood through a dialyzer. As blood is sent through the machine, it comes into contact with a semi-permeable membrane that filters out waste products. Alkaline radicals also pass through the filter to regulate the acid-base balance. Finally, fluids consumed, but not eliminated through diuresis (a function that is markedly reduced in chronically ill patients and absent altogether in the terminally ill) are eliminated through a process called ultrafiltration.

A fast-growing disease throughout the world

For decades there has been a slow, but constant increase in the number of people affected by chronic kidney disease. Subsequently, the need for one of the two main methods of dialysis, hemodialysis and peritoneal dialysis, has increased as well.

Various studies have shown that one adult out of ten world-wide is affected by CKD in mild or severe forms. This number is destined to rise alongside the increase in the incidence of the main risk factors: diabetes, high blood pressure, heart diseases and the aging population (reduced kidney function is the physiological consequence of the organ’s deterioration).

The CARHES (Cardiovascular risk in Renal patients of the Health Examination Survey) study conducted by the Italian Society of Nephrology (SIN), in collaboration with the Italian National Institute of Health and the National Association of Hospital Cardiologists (ANMCO), gathered and made available data related to the diffusion of kidney disease in Italy. The statistics are alarming. Nearly 7.5% of men and 6.5% of women in a population with ages ranging from 35 to 79 years of age suffer from CKD. This means that several million individuals in Italy are carriers of kidney disease and often do not know it. As of today, only 50,000 certified patients have undergone dialysis.

Slow technological progress

Despite the large number of people affected by CKD, since hemodialysis was invented in the 1940s, the technological side of the procedure has been very slow to develop. No great innovations or improvements were made until the 1970s.

Even the machines today, for example, are identical to the ones made in 2000 except for some changes in their outward appearance. This is incredible if one considers the technological evolution the medical sector has seen in the last few decades. It is inevitable that the quality of treatment for patients will suffer due to this “technological standstill”. If only to speak about the machine’s manageability, for example, the last internationally-produced machine defined for domestic use weighs more than 80 Kg.

A revolutionary project arrives from Trento

The futuristic machine for hemodialysis designed by Dr. Paolo Hartmann and engineer Renato Giordano, both from Trento and friends since childhood, is called Dharma. The idea is the result of unfortunate circumstances. Renato became ill and was forced to undergo dialysis for one year. He thus knows first-hand what it means to be hooked up to an enormous machine inside a hospital ward for hours, monitored by a team of doctors and healthcare workers. He decided that something had to be done.

Dharma’s main characteristics:

  • The machine is much smaller, only about 8 kg, portable and self-sufficient.
  • Blood travels only about 80cm with DHARMA instead of dozens of meters with traditional machines.
  • The entire dialysis cycle uses only about 5 liters of distilled water while traditional machines use more than 300.
  • A revolutionary filtering system that does not alter molecular blood levels and maintains blood at a constant temperature. This part of the machine is disposable, making it even safer than before.
  • A nurse’s presence is needed less often (not even weekly), only to install two, soft plastic tubes with a valve to connect the machine to the veins.
  • A computerized system that is always connected via Wi-Fi to the medical support center to keep the patient’s parameters under control while undergoing treatment. If parameters are altered, the system immediately contacts the hospital, guaranteeing prompt intervention if it should be needed 

When will Dharma be put on the market?

The machine is currently undergoing clinical trials at Santa Chiara Hospital in Trento and San Martino Hospital in Genoa, but the national healthcare system has already shown interest in the machine. If we think of travelling costs for patients requiring treatment, the cost of medical personnel involved and other variables- including the rise in the number of people with the disease- it is easy to understand how Dharma ensures that hemodialysis remains affordable.

This project reflects Domedica’s belief that the patient should be placed at the center of a healthcare network, where healthcare must go to the patient and not the other way around.

© Domedica s.r.l.

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