Kidney Week 2025 Annual Meeting-Bringing New Technologies to Dialysis Care

Video Transcription

Video Summary

The session focused on bringing new technologies into dialysis care, emphasizing more precise, personalized management.<br /><br />Dr. Christina Brotman discussed volume management as a “therapeutic window,” where both fluid overload and excessive ultrafiltration lead to symptoms, organ damage, and higher mortality. Traditional weight-based “dry weight” targeting is imperfect, and serum biomarkers (e.g., BNP) are confounded by cardiac structure and clearance. She reviewed five technology categories: (1) bioimpedance analysis, which offers objective hydration estimates and has shown improved blood pressure and possible mortality benefit, though it is sensitive to noise and does not localize removable fluid; (2) lung ultrasound to detect pulmonary congestion, often present even in asymptomatic patients, with mixed trial outcomes and potential sex differences in harm via increased intradialytic hypotension; (3) blood volume monitoring, automated but difficult to interpret and integrate; (4) biofeedback systems (UF, temperature, sodium), which may reduce intradialytic hypotension but can cause unintended volume overload if UF is reduced without adjusting treatment time; and (5) AI, which can predict hypotension well and may help by consolidating data into actionable dashboards, though concerns remain about transparency, bias, privacy, and liability. She also highlighted future potential in wearables and remote monitoring.<br /><br />Dr. Patrick Pun argued dialysis innovation has stalled and outcomes remain poor, with sudden cardiac death a leading cause. He made the case for real-time electrolyte monitoring—especially potassium—to reduce harmful serum–dialysate gradients linked to arrhythmias. He reviewed sensor challenges and presented a pilot using point-of-care iSTAT testing with protocolized dialysate K adjustment, showing feasibility and substantial treatment-to-treatment potassium variability missed by monthly labs.<br /><br />Dr. Mani Wassef reviewed vascular access innovations: devices to optimize anastomotic geometry (VASQ), bioresorbable or bioengineered graft conduits (e.g., Zeltis vs Humacyte), strategies to reduce cannulation injury (ultrasound guidance; VenaSure back-wall protection implant), and emerging home monitoring using audio/AI or thermal wearable sensors.<br /><br />Dr. Simon Davies presented on-demand peritoneal dialysis fluid generation to reduce environmental impact, storage burden, supply-chain risk, and enable personalization (e.g., potassium or sodium tailoring). He outlined regulatory and sterility/endotoxin challenges, but described proof-of-principle studies using filtration-based tap-water purification and recirculation/sorbent concepts, suggesting a potential paradigm shift if usability and safety hurdles are met.

Asset Subtitle

Moderator(s): Clare Lyas, Jan Williams

Presentation(s):

National Policy for Kidney Health Equity: The Time Is Now - Cynthia Delgado
Mitigating Disparities with Race-Free Clinical Formulas and Nomograms - Elizabeth Montgomery
Global Inequities in SGLT2 and GLP-1 Use Among Patients with CKD - Chintan Dave
Impact of Investment in CKD Education: Does It Pay Off? - Rebecca Allen

Meta Tag

Date 11/8/2025

Pathway 1 Dialysis

Pathway 2 Interventional Nephrology

Session ID 507317

Keywords

dialysis technology innovation

personalized dialysis care

volume management therapeutic window

bioimpedance analysis hydration assessment

lung ultrasound pulmonary congestion

blood volume monitoring

dialysis biofeedback systems

intradialytic hypotension prediction

artificial intelligence in dialysis

wearables and remote monitoring

real-time electrolyte monitoring

potassium gradient arrhythmia risk

point-of-care iSTAT potassium testing

vascular access innovations grafts and devices

on-demand peritoneal dialysis fluid generation