Roadmap outlines priorities for next-generation kidney replacement therapies

The Roadmap revisits priorities identified in a 2018 initiative, including filtration, fluid regulation, electrolyte balance and toxin removal. It describes research into biomimetic membranes, cellular and biohybrid systems, organ-on-chip technologies, microbiome modulation and sorbent-based toxin removal, alongside portable, wearable and implantable devices and cell-based therapies.

The authors identify shared challenges across engineered approaches: securing blood access, preventing clotting and infection, developing durable and compatible materials, and enabling physiological regulation through sensing or biofeedback. Biological approaches such as xenotransplantation and stem cell regeneration are also discussed, with safety, equity and scalability among the outstanding concerns.

Despite experimental and technical progress, few advances have reached clinical use, and none is in routine practice, the article states. The Roadmap calls for patient and care-partner involvement throughout research, along with investment, regulatory clarity and collaboration among developers, policymakers, regulators and investors to improve translation. This is a review and roadmap, not a report of clinical trial results; it does not establish the safety or effectiveness of any specific emerging therapy.