A device to augment renal replacement therapy (DART)

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https://research.brighton.ac.uk/en/projects/an-adsorbent-device-to-promote-toxin-removal-during-haemodialysis/

August 2026

 

 

End-stage renal failure is an increasingly prevalent and disproportionately costly condition The majority of patients receiving renal replacement therapy (RRT) undergo haemodialysis (HD) which primarily removes small water soluble molecules. However, most protein bound and larger molecular weight uremic toxins remain in the body, impairing cardiovascular function and contributing to the morbidity and mortality of  HD patients. Adsorbent therapies with the capacity to remove these toxins may solve some of the problems associated with HD. Advances in synthetic carbon technology using multi-modal, highly adsorbent carbons may provide an effective sorbent adjunct to augment RRT.

The DART project is a proof of concept, i4i FPD1 National Institute for Health Research grant designed to develop a novel carbon adsorbent device to sit in line with and augment haemodialysis for the treatment of end-stage renal disease.

This project was followed by the ADEPT project.

Project timeframes

The project ran from June 2010 to August 2011.

Project aims

The project aim was to develop a highly porous, multi-modal, nanoporous synthetic activated carbon in bead and extruded monolith form for use as an adsorbent blood filtration module to augment HD. The materials can be directly blood contacting and are capable of removing middle molecular weight inflammatory cytokines and bacterial toxins in a size range suggesting suitability for removal of protein bound and high molecular weight uremic toxins. The project aims to utilise the tailored nanoporosity of the carbons and superior surface area available for adsorption to investigate the removal of key protein bound and larger uremic toxins not removed by current RRT.

Project findings and impact

Within the DART project novel adsorbent nanoporous activated carbons in bead and monolith form were shown to adsorb protein bound and high molecular weight uraemic toxins. Since bead based adsorbents can induce considerable pressure drop the monoliths were used within an ex vivo model using haemodialysis patient blood samples. It was found that protein bound uraemic toxins indoxyl sulphate and p-cresyl sulphate and high molecular weight cytokine IL6 remained in the blood following haemodialysis but were removed to negligible levels following perfusion through the monoliths without significant albumin losses or negative impact on blood biochemistry.

Research team

Dr Susan Sandeman (PI)

Dr Carol Howell

Dr Gary Phillips

Professor Sergey Mikhalovsky

Output

SR Sandeman, CA Howell, GJ Phillips, Y Zheng, G Standen, R Pletzenauer, A Davenport, K Basnayake, O Boyd, S Holt, SV Mikhalovsky. (2014) An adsorbent monolith device to augment the removal of uraemic toxins during haemodialysis. J Mater Sci Mater Med.  25(6):1589-97

SR Sandeman. Invited speaker. European Society for Artifical Organs (ESAO)/American Society for Artificial Internal Organs (ASAIO) Winter School, Semmering, Austria (1-2011) “Adsorbents that moderate the inflammatory response”  

SR Sandeman. Invited speaker. 4th Joint ESAO-IFAO Congress, Portugal (10-2011).”Characterising advanced nanoporous activated carbons for the treatment of kidney disease”

SR Sandeman. Oral presentation. Annual Congress of the European Society for Artificial Organs (ESAO), Rostock, Germany. (9-12). “An adsorbent device to promote toxin removal during haemodialysis”

Partners

Professor Steve Tennison (MAST Carbon International Ltd)

Professor Stephen Holt (Brighton and Sussex University Hospitals NHS Trust)

Dr Owen Boyd (Brighton and Sussex University Hospitals NHS Trust)