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What is the future of renal care?

Adelaide was in the world news last month as Australia's first dedicated space centre will be built in Adelaide with the centre providing grants of $1 million per year to develop local space business, and encourage research and development (ABC News, 2017). After many years of development, the new Royal Adelaide Hospital opened last month and is a truly advanced hospital, which includes automated guided vehicles, delivering supplies and food throughout the hospital, that "talk" to lifts, specific doors and portable phones. The hospital has other hi-tech features, including a wireless patient--nurse call system, automated dispensing cabinets for medications, telehealth facilities to reach remote areas and it has been built around patient needs.

With these new advances, it left me considering the future for renal care and what might occur in the not too distant future. The rapidly evolving field of data science offers unparalleled opportunities to enhance the wellbeing of populations and individuals with kidney disease and substantially reduce avoidable health care usage and expenditures (Crowley & Meyer, 2017). Work has begun to unlock the potential of our own cells to generate new patient-matched identical kidney tissues. Research in the field of stem cells continues and rudimentary kidney tissues have been formed, which as research in this area continues will become more architecturally complex and functional (Taguchi et al., 2014). Increased understanding of how the brain stem controls somatic function will lead to enhanced managements for hypertension, obesity, cardiac issues and incontinence. In the future, it will be possible to insert electrodes with "pacemaker" type generators into discrete sets of neurons and use these to modulate the control circuit activities (Freedman et al., 2016).

The world around us is becoming more technologically advanced each year and we are surrounded by sensors, which monitor our activities and guide our selections. It is considered that miniaturised devices will be available while temporary metabolic support is needed such as acute kidney injury. A wearable or implantable artificial kidney device will be able to sense appropriate metabolic parameters and the required fluid removal (Gura et al., 2016). There are so many possible developments in the future that cannot even be considered in this editorial, but it is certain that one day in the future dialysis as we know it will be relegated to the history books as technologies improve.

Finally, I do hope you enjoy reading this issue, which contains articles on a wide variety of topics, including the financial considerations in dialysis treatment, the development of an automated peritoneal dialysis program, conservative management in advanced chronic kidney disease and the use of plastic instead of metal cannula in haemodialysis. There is also a paper highlighting the importance of the KHA-CARI guidelines. Please remember that in 2018 I wish to publish a special edition focusing on Indigenous health issues and so look forward to receiving further articles for this edition.

References

ABC News. (2017). SA creates new space agency as Premier urges PM to announce national agency. http://www.abc.net.au/news/2017-09-21/sa-premier-urges-pm-to-announce-space-agency/8968852

Crowley, S., & Meyer, L. (2017). Sparking innovation to improve the lives of people with kidney disease, Clinical Journal of the American Society of Nephrology, 12(9), 1548-1550.

Freedman, B., Zeidel, M., & Steinman, T. (2016). Technology and the future of kidney care, Nephrology News & Issues. https://www.nephrologynews.com/technology-future-kidney-care/

Gura, V. , Rivara, M., Bieber, S., Munshi, R., Colobong Smith, N., Linke, L., Kundzins, J., Beizai, M., Ezon, C., Kessler, L., & Himmelfarb, J. (2016). A wearable artificial kidney for patients with end-stage renal disease. JCI Insight 1, Oct, 1-11.

Taguchi, A., Kaku, Y., Ohmori, T., Sharmin, S., Ogawa, M., Sasaki, H., & Nishinakamura, R. (2014). Redefining the in vivo origin of metanephric nephron progenitors enables generation of complex kidney structures from pluripotent stem cells. Cell Stem Cell, 14(1), 53-67.

Melissa Arnold-Chamney

The University of Adelaide, SA, Australia

Email: melissa.arnold-chamney@adelaide.edu.au
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Title Annotation:Editorial
Author:Arnold-Chamney, Melissa
Publication:Renal Society of Australasia Journal
Date:Nov 1, 2017
Words:644
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