The use of a bioartificial kidney could save the transplant population from a life of immunosuppression drugs and save costs, according to Shuvo Roy, PhD, professor of bioengineering at the University of California San Francisco.
There are more than 750,000 people in the United States who have end-stage kidney disease (ESKD), and 70% are receiving regular dialysis treatment.1 The majority (87%) of people on the national transplant waiting list are waiting for a kidney, and the average wait time to get a kidney is 3 to 5 years.2 Ultimately, only 12% of patients on the waitlist end up getting a kidney.3
For patients with kidney failure who are initiating dialysis, the care is very expensive, particularly if they are not insured by Medicare. The annual mean spending for patients on Medicare was $80,509 compared with $238,126 for privately insured patients in the first year of dialysis.4
However, new technology could help solve both the cost of dialysis and the long waitlist for a transplant. A bioartificial kidney is being tested to replace a real kidney and reduce wait times for people on the transplant waiting list.
According to Shuvo Roy, PhD, professor of bioengineering at the University of California San Francisco, who is spearheading the development of the first implantable bioartificial kidney along with nephrologist William H. Fissell, MD, associate professor at Vanderbilt University, the device can also cut costs.
Roy presented on the bioartificial kidney at the Kidney Week 2023 Annual Meeting, held November 2-5, 2023, in Philadelphia, Pennsylvania.
The American Journal of Managed Care® (AJMC®): There are strict criteria for being eligible for organ transplantation—do you envision your bioartificial kidney being different?
Roy: So, the bioartificial kidney is going to be a mass-produced, universal donor kidney. As long as somebody can withstand surgery for implantation, they should be able to get a bioartificial kidney. There will be no need for type matching.
AJMC: Patients who receive a transplant are on lifelong immunosuppression to prevent their body from rejecting the transplant. You proved that immunosuppressant drugs were not needed with the bioartificial kidney.5 What is the benefit of being able to avoid putting patients on these drugs?
Roy: Immunosuppressant drugs are not only expensive, but they also have side effects for the patient, making them more susceptible to infections. We know that one of the most vulnerable populations during the COVID-19 pandemic were patients with kidney disease. So, not having immune suppression will let them have a more robust response to agents that can cause infection.
Second, the immunosuppressant drugs over time are also nephrotoxic. By not putting them on immunosuppression drugs, the kidney cells are going to function without the likelihood of being attacked by the immunosuppression drugs.
And they're expensive.
AJMC: What is your expectation regarding cost and insurance coverage for a bioartificial kidney?
Roy: It’s still preliminary to sort of have any judgments or any assessments of what will happen, but I think what we can anticipate is that the bioartificial kidney will be covered by insurance, including Medicare, and it will be less costly than dialysis, which is fraught with complications. And by avoiding the cost of immunosuppression drugs, [the bioartificial kidney] could be potentially cheaper than somebody on transplant.
1. Hedt S. Dialysis costs the healthcare system three times more in the individual market. USC Schaeffer Leonard D. Schaeffer Center for Health Policy & Economics. March 23, 2021. Accessed November 2, 2023. https://healthpolicy.usc.edu/article/dialysis-costs-the-healthcare-system-3x-more-in-the-individual-market/
2. Transplant waiting list. American Kidney Fund. Accessed November 2, 2023. https://www.kidneyfund.org/kidney-donation-and-transplant/transplant-waiting-list
3. Creating the first implantable bioartificial kidney. Vanderbilt Health. March 14, 2023. Accessed November 2, 2023. https://discoveries.vanderbilthealth.com/2023/03/creating-the-first-implantable-bioartificial-kidney/
4. League RJ, Eliason P, McDevitt RC, Roberts JW, Wong H. Assessment of apending for patients initiating dialysis care. JAMA Netw Open. 2022;5(10):e2239131. doi:10.1001/jamanetworkopen.2022.39131
5. Kim EJ, Chen C, Gologorsky R, et al. Feasibility of an implantable bioreactor for renal cell therapy using silicon nanopore membranes. Nat Commun. 2023;14(1):4890. doi:10.1038/s41467-023-39888-2