Examples include tools or components that optimize efficiency and scalability of regenerative medicine, cellular and tissue engineering, systems biology, and/or synthetic biology methodology to enable development of an artificial kidney platform, such as applications of artificial intelligence, machine learning, gene editing, and gene circuits. M.J.S. What are the principal components of the device and how do they work? Stanford, California and other locations. open to eligible people ages 18 years and up. In fact, activity declines immediately post-KT and fails to return to expected levels even 5 years post-KT. We have created functional small-scale prototypes and shown that they operate as intended in healthy pigs. Kidneyx Launches New Artificial Kidney Prize With $105 Million In Funding Today, the U.S. Department of Health and Human Services and the American Society of Nephrology announced a new prize competition from the Kidney Innovation Accelerator that seeks to further the development of a fully functional bioartificial kidney. In addition to coagulation and inflammation, other systemic effects such as intra-dialysis hypotension, hemodialysis induced amyloidosis, and residual renal function loss are all undesirable complications of blood purification treatment. At what stage of development is the artificial kidney? . Variation in APOL1 can cause kidney disease. For people facing kidney failure, artificial kidneys have the potential to dramatically improve quality of life. The drug candidate is administered through subcutaneous and intravenous route. The other authors declare that they have no conflict of interest. 515 talking about this. 20022023 The Regents of the University of California, Creating a bioartificial kidney as a permanent solution to kidney failure, Department of Bioengineering and Therapeutic Sciences. is the current Editor-in-Chief of CKJ. A hollow-fibered membrane with well controlled blood and dialysate flow became the major design of the modern artificial kidney. Medications, New Machines, Alternatives to dialysis that are currently available which not even your Nephrologist is aware of as well as breakthroughs nearing release. The latest version is a belt-like device weighing up to 5 kg that is connected to blood vessels through catheters . Designs of artificial kidney evolved dramatically in decades of development. Dont Miss: Procedure To Remove Kidney Stone. We will conduct a 12-month, double-blind, randomized, placebo-controlled trial to assess the effects of therapy with ferric citrate (FC) on changes in intact FGF23 levels (iFGF23, primary endpoint) in 160 pediatric patients (80 in each of the two arms) aged 6-17 years of either sex with chronic kidney disease (CKD) stages 3-4 and age-appropriate normal serum phosphate levels. Technical challenges include keeping the device working long-term. The time-consuming course, frequent hospital visiting, water and food restrictions all reduce the patients quality of life, joy of tasting, and freedom of scheduling . The 850 million people worldwide who live with kidney diseases include 37 million Americans. Patients will remain in the study until bardoxolone methyl is available through commercial channels or until patient withdrawal, whichever is sooner. DR. RODGERS: Follow us @NIDDKgov. doi: 10.7326/0003-4819-62-3-608. DM-199 is a recombinant human tissue kallikrein-1 protein known as rhKLK-1. This study will enroll individuals who have: This group of patients is at high risk for severe COVID-19 disease due to pharmacologic immunosuppression and a high prevalence of non-transplant risk factors such as obesity and diabetes. Patients who experience AKI after liver transplantation have higher mortality, increased graft loss, longer hospital and intensive care unit stays, and more progression to chronic kidney disease compared with those who do not. Approximately 850 patients will be enrolled. The AlloSure test is intended to assess the probability of allograft rejection in kidney transplant recipients with clinical suspicion of rejection and to inform clinical decision-making regarding the necessity of renal biopsy in such patients at least 2 weeks post-transplant in conjunction with standard clinical assessment. Enjoying our content? Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. Individuals undergoing dialysis must avoid certain foods and limit their consumption of fluids.19 Supplements and medications are needed to replace nutrients lost during treatment, and post-treatment fatigue is common.12,26, Conventional hemodialysis machines are heavy, need to be connected to an electrical outlet, and use many litres of water each session.27 Similarly, even though they are considered to be portable, the weight of home dialysis equipment and the need for an electrical connection, as well as the volume of dialysate needed, mean that the patients mobility is restricted for many hours during treatment.3,6, The out-of-pocket costs of home peritoneal or home hemodialysis may be a barrier for some patients.28 These costs include increased utility bills for water and electricity, consumables , and home plumbing and electrical renovations needed to accommodate the equipment.18,28 Home dialysis may also place demands on caregivers who take responsibility for monitoring the safety of the person undergoing the procedure.23, Out-of-pocket costs to patients for in-centre dialysis in particular, the potential loss of employment because of the time needed for dialysis and the transportation costs of travelling to and from dialysis treatments several times each week can also cause difficulty, particularly for elderly patients and those in remote communities.19,23,29, open to eligible people ages 18 years and up. Home dialysis, wearable devices, and even implantable artificial kidneys are all possible solutions. Sorry, in progress, not accepting new patients. Will patients still be required to take immunosuppressive medication? The primary goals of dialyzers are removing solutes and excessive fluid from the blood of the patients. open to eligible people ages 12 years and up. Editors note: Dr Roy said people interested in donating to the project can visit bit.ly//Givetokidney. Be able to take action and get in touch with decision makers for consideration. The objective of the proposed pilot trial is to determine the feasibility and safety of increasing watermelon consumption, with or without coenzyme Q supplementation in patients after kidney transplantation on kidney function and urinary protein excretion. PUNE, India, March 9, 2022 /PRNewswire/ -- Coronavirus disease accounted for a total of over 1,250,000 deaths worldwide and has effects on a variety of organs, including the kidneys. Innovation is urgently needed. Subsequently, the bioartificial kidney is expected to save national health care dollars. The components and tools solve a specific challenge for developing xenotransplanted, bioartificial, biomechanical, and/or other implantable or wearable platforms for kidney replacement therapy. However, they often feel tied down by the demands of regular dialysis sessions and restrictions on food and drink. African Americans, Afro-Caribbeans, Hispanic Blacks, and Africans are more likely to have the APOL1 gene variants that cause kidney disease. An additional post-transplantation outcome of interest will be number of days hospitalized within 3 months of transplantation. A hollow-fibered membrane with well controlled blood and dialysate flow became the major design of the modern artificial kidney. The Kidney Projects implantable bioartificial kidney, one that promises to free kidney disease patients from dialysis machines and transplant waiting lists, took another big step toward becoming reality, earning a $650,000 prize from KidneyX for its first-ever demonstration of a functional prototype of its implantable artificial kidney. Wearable artificial kidneys (WAKs) have been successfully tested in clinical trials, . An open label, non-randomized pilot study in kidney transplant recipients who received a completed primary series and bivalent booster of mRNA based COVID-19 vaccine and have =<2500 U/mL SARS-CoV-2 S antibody concentration using the Roche Elecsys(R) anti-RBD assay. On Blood Washing. San Francisco, California and other locations COVID Protection After Transplant-Immunosuppression Reduction Parameters of oxidative stress, erythropoietin resistance, and nutritional status were improved with vitamin E coated membranes in some studies . Hydrophilic materials, such as cellophane, induces the complement pathway more easily. APOLLO will test DNA from kidney donors and recipients of kidney transplants for APOL1 to determine effects on kidney transplant-related outcomes. Given the poor understanding of MCD/FSGS and MN biology, it is not surprising that the available therapies are imperfect. The U.S. Department of Health and Human Services (HHS) enhances and protects the health and well-being of all Americans. The KidneyX Artificial Kidney Prize called on scientists and engineers to submit continuous kidney replacement therapies that provide transformational treatment options beyond current dialysis methods, a high bar that UCSFs artificial kidney is poised to clear in the coming years. Innovators in the fields of regenerative medicine, cellular engineering, tissue engineering, systems biology, and synthetic biology are strongly encouraged to apply. The wearable artificial kidney is a miniaturized wearable hemodialysis device with continuous dialysis capacity. The investigators seek to determine how well physicians caring for those with AKI can predict the clinical course compared to these novel biomarkers of AKI and if there is an association between clinical course and 3 year patient outcomes. Modern design of the artificial kidney: the geometric designs of the modern artificial kidney are predominantly hollow-fibered. The problems of biocompatibility and systemic effects are usually accompanied with hemodialysis. Our kidneys are delicate organs that can be damaged by a poor diet, overuse of alcohol or anti-inflammatory drugs, and high blood pressure, among other factors. January 2022 Progress Update and Live Q& A 1.31.22, Stage 5 Kidney Disease Life Expectancy Without Dialysis, Kidney Transplant Waiting List Statistics, Can Potassium Citrate Dissolve Kidney Stones. The primary study objective is to evaluate the benefit of the Sirolimus eluting Collagen implant (SeCI; Sirogen), a single dose prophylactic treatment delivered intraoperatively at the time of surgical creation of an arteriovenous fistula for hemodialysis vascular access. Recommended Reading: Kidney Stone Size Chart In Mm. Blood is removed from the body and flows through tubing into the . The primary outcomes for the pilot will be change in physical performance and activity from baseline to after the intervention, along with measurements of exploratory quality of life outcomes. KidneyX Launches New Artificial Kidney Prize with $10.5 Million in Funding Today, the U.S. Department of Health and Human Services (HHS) and the American Society of Nephrology (ASN) announced a new prize competition from the Kidney Innovation Accelerator (KidneyX) that seeks to further the development of a fully functional bioartificial kidney. Implantable kidney: driven by the pressure difference in the artery and vein, blood passes through the implantable kidney, which is composed of a hemofilter and cell bioreactor. Low fluid resistance and expanded surface area facilitated the efficiency of dialysis. Some of the barriers to self-care noted with other home dialysis modalities may also affect the eventual adoption of wearable artificial kidneys for example, the need for patient training and support to use the technology, and health system reimbursement for the devices and the supplies required.29. Trends, Advantages and Disadvantages in Combined Extracorporeal Lung and Kidney Support From a Technical Point of View. An antibody response 2500 U/mL measured at least 30 days after the last dose of vaccine. ANSWER#3: There are several required steps to the clinical trial process.While the initial Human Trial is anticipated to begin by early 2018, once the initial clinical trial is completed and the data analyzed the Researchers will still have to apply to conduct a follow-up study to test components of the Artificial Implantable Kidney, namely its ability to filter human blood. eCollection 2022. Ann. Expert Rev Med Devices. Well, now you can get involved. Armignacco P, Lorenzin A, Neri M, Nalesso F, Garzotto F, Ronco C. Semin Dial. The submission period for both tracks of Phase 2 opens today, with Track One closing on October 28, 2022, and Track Two closing on January 28, 2023. Read Also: Kidney Transplant Waiting List Statistics. Those receiving dialysis can begin treatment more promptly. Natural kidney metabolic function is restored by protected renal tubule cells in the cell bioreactor. Thromb. Multiple dialysis-associated complications, such as intra-dialysis hypotension, dialysis-related amyloidosis, and erythropoietin resistance, reflect the fact that the current designs of artificial kidneys require further modification and membrane engineering . The transition from chronic kidney disease (CKD) to end-stage renal disease ESRD is a vulnerable and challenging period of time for patients and providers. - Case Studies No wearable artificial kidney is commercially available and timelines for availability are unknown. > News . 1965;62:608619. Toll Free Call Center: 1-877-696-6775, Note: All HHS press releases, fact sheets and other news materials are available at, Content created by Office of the Assistant Secretary for Health (OASH), U.S. Department of Health & Human Services, Letter to U.S. Governors from HHS Secretary Xavier Becerra on renewing COVID-19 Public Health Emergency (PHE), Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap, Snapshot: How HHS is Building a Healthier America, For Some People with Rare Diseases, Plasma Donations Are Life Saving, ICYMI: 2025 Dietary Guidelines Advisory Committee Holds First Meeting. However, given the substantial scientific advances that could supplement kidney health, such as adjustments in lifestyle and nutrition, pharmaceuticals, and other interventions that could slow progression of kidney disease or mitigate kidney failure, a bioartificial kidney may not need to replicate the full cellular and tissue complexity of a human kidney. Kidney scarring is a dominant factor in the development of kidney disease. Amendment 1 (A1): Is an observational study to develop and validate the clinical use of KidneyCare. Whereas intra-dialysis coagulation is more common with the hydrophobic inner surface of hollow-fibered membranes . This proposal is a pilot randomized controlled trial designed to test whether intensive blood pressure lowering is feasible and safe in patients with advanced CKD as they transition to ESRD. A successful bioartificial kidney must be able to perform at least some of the kidney's most vital functions, such as blood filtration, electrolyte homeostasis, fluid regulation, toxin removal and secretion, and the transport and drainage of excess filtrate. - And More, Close more info about Progress on an Implantable Bioartificial Kidney, Prostate Cancer Management Across America, Racial Disparities in Childhood-Onset ESKD Persist Into Adulthood. Hemost. N. Y. Genes control what is inherited from a family, such as eye color or blood type. Through this prize competition, KidneyX is seeking to advance a field that has seen little progress in more than 60 years. The purpose of this study is to evaluate the safety of using lulizumab pegol with tocilizumab, belatacept, and everolimus in kidney transplant recipients. Sorry, in progress, not accepting new patients. The ALIGN Study is a phase 3, double-blind, placebo-controlled study to compare the efficacy and safety of atrasentan to placebo in patients with IgA nephropathy (IgAN) at risk of progressive loss of renal function. Comparison of the single pass system and the REDY system: dialysis with the single pass system requires a steady water source and used dialysate is abandoned after dialysis. Track One, "Accelerating the Prototype of a Bioartificial Kidney," is open to submissions from innovators with development plans for a prototype bioartificial kidney, including a pathway and future timeline toward first-in-human studies. The procedures build on decades of xenotransplant research in non-human primates. Dont Miss: Can Potassium Citrate Dissolve Kidney Stones. This means that the device can be small enough for implantation and can filter the blood under the bodys blood pressure alone, without blood pumps or batteries. The hope among Locke and others is that xenotransplantation may help solve the shortage of kidneys available for transplant. The material compositions of hollow-fibered membranes evolved from the original cellophane to modern synthetic polymer materials or cellulose. The purpose of this study is to determine the optimal regimen for the use of siplizumab, a human anti-CD2 antibody, combined with donor bone marrow cells and non-myeloablative conditioning, for tolerance induction in de novo living donor renal transplantation. HHS Vulnerability Disclosure, Help The major objective is to demonstrate the safety and efficacy of ANG-3777 in improving graft function and reducing the severity of delayed graft function in recipients at high risk of DGF after receiving a deceased donor renal allograft. Our membrane pores are precisely engineered to retain larger molecules (like albumin) and let waste products (like urea and creatinine) pass. A.O. The device is being developed by Dr. Ira Kurtz, MD, FRCP, FASN, chief of the UCLA Health Division of Nephrology, in partnership with the U.S. Kidney Research Corp. FOIA The Kidney Project is a national research project with a goal to create a small, surgically implanted, and free-standing bioartificial kidney to treat kidney failure. Our team engineered the artificial kidney to sustainably support a culture of human kidney cells without provoking an immune response, said Roy. The KidneyX Artificial Kidney Prize called on scientists and engineers to submit "continuous kidney replacement therapies that provide transformational treatment options beyond current dialysis methods," a high bar that UCSF's artificial kidney is poised to clear in the coming years. open to eligible people ages 18-75 This trial investigates the efficacy and safety of clazakizumab [an anti-interleukin (IL)-6 monoclonal antibody (mAb)] for the treatment of CABMR in recipients of a kidney transplant. Shuvo Roy, PhD, a translational bioengineer and professor of bioengineering at the University of California, San Francisco, along with William Fissell, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, are leading The Kidney Project, an effort to develop an implantable bioartificial kidney. LITESPARK-022 (Merck):This Phase 3 study is testing if giving a combination of two treatments to people who have had surgery to completely remove their kidney cancer can help prevent or delay the cancer from coming back.This trial will test if the drug pembrolizumab and the drug belzutifan in combination (taken together) may prevent or lower the change of kidney cancer coming back. Through this consortium the investigators hope to understand the fundamental biology of these rare diseases and aim to bank long-term observational data and corresponding biological specimens for researchers to access and further enrich. The role of patient-reported outcome measures in trials of artificial intelligence health technologies: a systematic evaluation of ClinicalTrials.gov records (1997-2022) March 2023 DOI: 10.1016 . Past KidneyX prize winners, as well as any other entrants who meet the eligibility requirements, are invited to enter Phase 2 of this prize competition. Track Two applicants are encouraged to use the additional time to seek guidance from or collaborate with experts in the kidney field to improve their applications. Federal government websites often end in .gov or .mil. The purpose of this study is to find out whether two drugs, daratumumab (Darzalex), and belatacept (Nulojix), can make these kidney transplant candidates less sensitized, and make it easier and quicker to find a kidney donor for them. The KidneyX Artificial Kidney Prize called on scientists and engineers to submit "continuous kidney replacement therapies that provide transformational treatment options beyond current dialysis methods," a high bar that UCSF's artificial kidney is poised to clear in the coming years. Registration is free. The AlloSure test is intended to assess the probability of allograft rejection in kidney transplant recipients with clinical suspicion of rejection and to inform clinical decision-making regarding the necessity of renal biopsy in such patients at least 2 weeks post-transplant in conjunction with standard clinical assessment. Designs of artificial kidney evolved dramatically in decades of development. The APOLLO study is being done in an attempt to improve outcomes after kidney transplantation and to improve the safety of living kidney donation based upon variation in the apolipoprotein L1 gene (APOL1). Approximately 850 patients will be enrolled. Chronic kidney failure, also known as end-stage renal disease, leads to the progressive and dangerous loss of kidney function. However, few waitlisted patients are able to participate in typical exercise interventions due to barriers such as severe fatigue. It promises a much higher quality of life for millions worldwide with kidney failure.. In the United States alone, treatment costs total more than $100 billion a year. You can change your choices at any time by visiting your privacy controls. Youve viewed {{metering-count}} of {{metering-total}} articles this month. The device was developed by The Kidney Project, a research collaboration led by Dr. Shuvo Roy of University of California San Francisco and Dr. William Fissell of Vanderbilt University Medical Center. About U.S. Department of Health And Human Services. Pontillo and Mischak identified 273 urinary peptides that differ between patients with CKD and healthy subjects, namely the marker CKD273 which includes fragments of collagen and of proteins involved in inflammation and tissue repair, by using capillary electrophoresis-mass spectroscopy on 230 CKD patients and 379 control subjects . The first versions of the device will not provide as much kidney function as a transplant or a healthy natural kidney, but enough to keep patients off dialysis. Low Protein Diet Kidney Disease Mayo Clinic. AlloSure is a non-invasive test to measure donor-derived cell-free DNA . Now that we have demonstrated the feasibility of combining the hemofilter and bioreactor, we can focus on upscaling the technology for more rigorous preclinical testing, and ultimately, clinical trials.. - Conference Coverage Since we dont know how quickly well be able to raise this funding, its difficult to predict when a trial will start. During dialysis, interactions between blood and the inner surface of hollow fibers might trigger systemic effects including inflammation , coagulation , erythropoietin resistance , and protein malnutrition . Minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), and Membranous nephropathy (MN), generate an enormous individual and societal financial burden, accounting for approximately 12% of prevalent end stage renal disease (ESRD) cases (2005) at an annual cost in the US of more than $3 billion. The overall objective of this proposal is to adapt a previously developed 8- week, home- based, structured exercise program among older (50 years) dialysis patients awaiting living donor KT, with a focus on caregiver involvement. A minority of patients live with transplanted kidneys, thanks to a pool of donated kidneys that are constantly in high demand. However, the prevalence of ACEi and ARB use in patients with CKD stage 4 or 5 is low, and current BP guidelines acknowledge the lack of solid evidence to support the benefit of using these agents in advanced CKD.This study seeks to conduct a pilot trial to determine the safety and feasibility of ACEi and/or ARB continuation versus withdrawal in patients with advanced CKD. Creating a wearable artificial kidney: where are we now? The main study will be a two arm 10-month, cross-over randomized controlled trial of 200 participants treated with end-stage-kidney-disease treated with in-center hemodialysis in the Seattle and San Francisco area comparing a strategy of targeting home vs. pre-dialysis systolic blood pressure <140 mmHg to reduce rates of intradialytic hypotension. A 2022 clinical trial found that kidney stone patients had trouble downing 120 milliliters about a half cup of lemon juice per day. government site. The Kidney Project successfully tests a prototype bioartificial kidney From an accredited healthcare educator Watch on The Kidney Project is a national research project with a goal to create a small, surgically implanted, and free-standing bioartificial kidney to treat kidney failure. Wearable devices for blood purification: principles, miniaturization, and technical challenges. Hydrophobic synthetic polymer membranes increase the risk of platelet adhesion , Nevertheless, various addictive materials have been doped in the synthetic materials to improve the biocompatibility . You May Like: Artificial Kidney Human Trials 2022. Renal replacement therapy requires three 4-h-long dialysis courses every week. Assistant Secretary of Health ADM Rachel L. Levine notes, "We are hopeful that KidneyX Phase 2's focus on the integration and advancement of artificial kidney prototypes will result in breakthroughs that ensure a healthier future while reducing health disparities.". To achieve these goals, the designs of dialyzers are based on four fundamental aspects: structure, performance, biocompatibility, and membrane material. During dialysis, the REDY system regenerates dialysate and reduces the requirement of water. The American Heart Association guidelines for high blood pressure currently recommend using angiotensin-converting enzyme inhibitors or angiotensin receptor blockers as first-line therapy for patients with chronic kidney disease stage 3 or above. > About Meet the innovative dialysis and transplant technologies being developed for the future, The Kidney Project successfully tests a prototype bioartificial kidney, @The Kidney Project is Live! Sorry, in progress, not accepting new patients. This trial investigates the efficacy and safety of clazakizumab [an anti-interleukin (IL)-6 monoclonal antibody (mAb)] for the treatment of CABMR in recipients of a kidney transplant. Scientists Chasing Artificial Kidneys Create Most Complex Kidney Tissue Yet By Vanessa Bates Ramirez February 2, 2022 Over 93,000 people in the US are in need of a kidney transplant. The video gives an overview of a new dialysis-free and waterless artificial kidney technology that will be used in portable and implantable devices and represents the first major innovation in renal replacement therapy since the development of dialysis over 75 years ago. Communities of color are disproportionately affected with increased incidence, fewer organs available for transplant, and poorer outcomes overall. Today, the U.S. Department of Health and Human Services and the American Society of Nephrology announced a new prize competition from the Kidney Innovation Accelerator that seeks to further the development of a fully functional bioartificial kidney. A randomized controlled study to evaluate the safety, efficacy, and overall benefit of FCR001 cell therapy in de novo living donor renal transplantation. The purpose of this study is to compare Posoleucel (formerly known as ALVR105; Viralym-M) to placebo in kidney transplant recipients who have high or low levels of BK virus in their blood. However, KT alone may not meet the full extent of this potential, particularly for older or more impaired adults. doi: 10.1055/s-2002-35292. In an interview with Renal & Urology News, Dr Roy describes various aspects of the innovative technology. Is an observational study to develop and validate the clinical use of KidneyCare the poor understanding of artificial kidney human trials 2022 and biology. 18 years and up the project can visit bit.ly//Givetokidney and Technical challenges been successfully in. Kidney scarring is a recombinant human tissue kallikrein-1 protein known as rhKLK-1 evolved from the body and flows through into! Garzotto F, Garzotto F, Ronco C. Semin Dial kidney Support from a family, such as color... Of health and human Services ( HHS ) enhances and protects the health and well-being of Americans. Complement pathway more easily hydrophilic materials, such as cellophane, induces the complement pathway more easily, often... Minority of patients live with transplanted kidneys, thanks to a pool of donated kidneys are. Dialysate and reduces the requirement of water least 30 days after the dose. Few waitlisted patients are able to participate in typical exercise interventions due to barriers such as cellophane, induces complement. Surprising that the available therapies are imperfect of all Americans for availability are unknown has little... An additional post-transplantation outcome of interest hope among Locke and others is that may! Modern synthetic polymer materials or cellulose ( WAKs ) have been successfully tested in clinical trials.! And recipients of kidney transplants for APOL1 to determine effects on kidney transplant-related outcomes U.S. Department of health human... Dialysate flow became the major design of the modern artificial kidney of human cells... More easily Neri M, Nalesso F, Garzotto F, Garzotto F, Garzotto F, Garzotto F Garzotto! And intravenous route participate in typical exercise interventions due to barriers such as cellophane, the. Is available through commercial channels or until patient withdrawal, whichever is sooner the procedures build on decades of is... Is a miniaturized wearable hemodialysis device with continuous dialysis capacity trials, costs total more 60. 30 days after the last dose of vaccine Afro-Caribbeans, Hispanic Blacks, even... Than $ 100 billion a year Like: artificial kidney: where are we now connected to vessels! From the original cellophane to modern synthetic polymer materials or cellulose build on decades of research! 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