At-home dialysis for the cost of a bag of chips

A new low-carbon-footprint dialysis treatment might soon be available for the cost of a bag of chips.

Sydney-based start-up Ellen Medical Devices has received $427,000 in government funding to develop the award-winning Ellen Medical Dialysis System.

Dialysis replaces normal kidney function by purifying and cleaning the blood when kidneys alone can’t do it. It has been a common and effective treatment for kidney failure for 70 years but the rate of kidney failure is increasing globally.

“The number of people needing treatment for kidney failure is predicted to double to over five million by 2030,” says Ellen Medical Managing Director John Knight, a kidney specialist and UNSW Sydney professor of medicine. “This is not only a preventable human tragedy but a significant market opportunity.”

On top of this, dialysis costs around $85,000 per year. This might be covered by insurance in high-income countries, but the cost is prohibitive for many people in low income countries. In fact, 75% of people who require dialysis around the world can’t afford it, and face death as a result.

“Families try the best they can to pay for the treatment and often they’ll suffer quite severe financial hardship,” says Knight. “They can often lose their house in an attempt to find the money for payment.

“But in the end, they run out of money and the patient will die – not because the treatment doesn’t work, but just because they can’t afford it.

“This lack of dialysis treatment is one of the big health inequities around the world.”

The new funding will take the product through clinical trials to test how effective it will be as a low cost, low-carbon-footprint alternative to current dialysis.

“We think that, while we are mainly aiming for people who are missing out in the poorest countries in the world, the opportunity to reduce the carbon footprint by a factor of 20 means that our system might be very attractive to Australian patients as well,” says Knight.

How does dialysis work?

Normally, a kidney filters out salts, waste and fluids from the blood, which will be excreted from the body as urine. A dialysis machine mimics this process.

First, the machine slowly draws out blood from the body using a catheter. Then, a special fluid called dialysate is mixed with the blood to filter the waste products.

The dialysate comes in a bag and is made of extra minerals and electrolytes – salts and sugars – and bicarb soda mixed with purified water. Any excess is washed down the drain with blood waste products.

The newly cleaned blood is then pumped back into the body.

Depending on the person, this needs to be done 3–5 times every 24 hours and can take up to 40 minutes each time. Every session requires a new bag of dialysate, which contributes to the huge cost of treatment.

The only way to get the bags is pre-filled and delivered to your door – four bags a day can be up to 2 litres/2 kilograms, or 240kg of fluid delivered per month. The distance delivery trucks must travel to deliver monthly dialysate bags contributes to a high carbon footprint.

The Ellen Medical Dialysis System

Many good ideas come about because of simple competitions.

“As a research institute we recognise this medical need, and we ran a global competition called the affordable balances prize,” says Knight. “We had entries from all over the world, and the [dialysis] technology that we’re developing [now] was the prize-winning entry.”

The inventor and prize winner, Vincent Garvey, was working on domestic appliances in Shanghai when he came up with the idea and its underlying concept: instead of looking to complicated medical technology, why not model it on everyday items?

“The concept is very, very simple,” says Knight. “The distiller that makes pure water [for the dialysate] is basically like a kettle on your kitchen bench to boil water for a cup of tea.

“It’s got a few extra bells and whistles, but the technology is really like that of a kettle. We can mass produce it for the same sort of price as you might expect to pay for a good quality kettle in [an appliance store].”

The second part of this innovation is bags that can be filled from home using the purified ‘kettle’ dialysate, instead of being frequently delivered pre-filled.

“Our approach to manufacturing the bags is less like high-tech med manufacturing and more like food manufacturing,” says Knight.

“The bags basically [just have] salt and sugar in them. So, if you think of how much it costs to make a bag of chips or a bag of pretzels, that’s the kind of manufacturing cost we’re looking at.

“A very high volume, mass produced, very low unit cost. We think they’re going to come in between five and 10 times less than current dialysis systems.”

Saving lives and saving the planet

The staggering price drop is essential for equitable dialysis globally but filling the bags from home could also dramatically reduce the carbon footprint of dialysis treatment.

“Currently in Australia, delivering four bags a day to the patient’s home already filled with fluid works out that each patient needs three tonnes of fluid delivered to their home [each year] so they can do the dialysis at home three times [a day],” explains Knight.

“All of the bags for Australia and New Zealand are made in one factory in Western Sydney. That’s fine if you live in Paramatta because the truck can bring you the bags once a month.

“But if you live in Perth or in Auckland, then those three tonnes of fluid have to be taken by truck from [Western Sydney] to your home. That carbon footprint, each year, is huge.

“Our bags were delivered for 20 times less, so our carbon footprint is going to be 20 times less than current systems.

“We’re very proud of that.”