Allo-Hemodialysis: A Narrative Review of a Novel Approach to Resource-Sparing Kidney Replacement Therapy
8 affiliations
- 1Renal Research Institute, New York, NY 10065, USA
- 2Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- 3Department of Pediatric Nephrology, Soba University Hospital, Khartoum 13314, Sudan
- 4Fresenius Medical Care Deutschland GmbH, 97424 Schweinfurt, Germany
- 5Department of Paediatrics, Western University, London, ON N6A 3K7, Canada
- 6School of Medicine at Chapel Hill, The University of North Carolina, Chapel Hill, NC 25799, USA
- 7Department of History, University of Michigan, Ann Arbor, MI 48109, USA
- 8Virinchi Hospital, Hyderabad 500034, India
Abstract
Conventional hemodialysis (HD) is one of the most resource-intensive therapies in medicine and remains inaccessible to a large share of the world’s population with kidney failure. Allo-hemodialysis (alloHD) is a novel hemodialysis concept in which the blood of a healthy volunteer (“buddy”) replaces manufactured dialysate, flowing counter-currently to the patient’s blood across a conventional dialyzer membrane. Uremic solutes and excess fluid move from the patient into the buddy’s circulation and are cleared by the buddy’s own kidneys, while bicarbonate and water-soluble vitamins diffuse back to the patient. By eliminating water treatment, dialysate production, and much of a conventional machine’s electromechanical complexity, alloHD has the potential to lower the cost, complexity, and environmental footprint of kidney replacement therapy. This review synthesizes the evidence for alloHD, spanning two-compartment urea and acid–base kinetic modeling, ex vivo bench testing of a low-cost prototype, and in vivo porcine studies of acute kidney injury, while describing a modeling extension to severe neonatal jaundice. We summarize buddy safety considerations as well as review ethical issues and caregiver/health-care professional acceptance data. Finally, we position alloHD within the broader movement toward more sustainable and personalized dialysis, and outline the translational steps required before first-in-human study.
Related
- Ventilator-Associated Pneumonia: The Role of Kidney–Lung Crosstalk and Renal Replacement Therapy, a Narrative Review
- Menopause and Alzheimer’s disease: can hormone replacement therapy modify the risk? A narrative review
- Intraoperative failure in valve-sparing aortic root replacement: technique, experience, and the definition of success.
- Follow-up after fertility-sparing surgery for cervical cancer: should human papillomavirus testing be used routinely? A narrative review
- Severe continuous prosthetic mitral regurgitation from chordal rupture after valve-sparing replacement: a case report.
BibTeX
@article{kotanko2026allohemodialysis,
title = {{Allo-Hemodialysis: A Narrative Review of a Novel Approach to Resource-Sparing Kidney Replacement Therapy}},
author = {Peter Kotanko and Vaibhav Maheshwari and Xin Wang and Nadja Grobe and Alhaji Cherif and Xia Tao and Rasha Hussein and Amrish Patel and Joshua Emmanuel Chao and Alexander Heide and Dejan Nikolic and Jiaming Dong and Guido Filler and Maria Díaz-González de Ferris and Nicholas Steneck and Karopadi Shivanand Nayak},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218717},
url = {https://www.mdpi.com/2077-0383/15/21/8717},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Allo-Hemodialysis: A Narrative Review of a Novel Approach to Resource-Sparing Kidney Replacement Therapy
AU - Peter Kotanko
AU - Vaibhav Maheshwari
AU - Xin Wang
AU - Nadja Grobe
AU - Alhaji Cherif
AU - Xia Tao
AU - Rasha Hussein
AU - Amrish Patel
AU - Joshua Emmanuel Chao
AU - Alexander Heide
AU - Dejan Nikolic
AU - Jiaming Dong
AU - Guido Filler
AU - Maria Díaz-González de Ferris
AU - Nicholas Steneck
AU - Karopadi Shivanand Nayak
PY - 2026
DA - 2026/11/08
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218717
UR - https://www.mdpi.com/2077-0383/15/21/8717
AB - Conventional hemodialysis (HD) is one of the most resource-intensive therapies in medicine and remains inaccessible to a large share of the world’s population with kidney failure. Allo-hemodialysis (alloHD) is a novel hemodialysis concept in which the blood of a healthy volunteer (“buddy”) replaces manufactured dialysate, flowing counter-currently to the patient’s blood across a conventional dialyzer membrane. Uremic solutes and excess fluid move from the patient into the buddy’s circulation and are cleared by the buddy’s own kidneys, while bicarbonate and water-soluble vitamins diffuse back to the patient. By eliminating water treatment, dialysate production, and much of a conventional machine’s electromechanical complexity, alloHD has the potential to lower the cost, complexity, and environmental footprint of kidney replacement therapy. This review synthesizes the evidence for alloHD, spanning two-compartment urea and acid–base kinetic modeling, ex vivo bench testing of a low-cost prototype, and in vivo porcine studies of acute kidney injury, while describing a modeling extension to severe neonatal jaundice. We summarize buddy safety considerations as well as review ethical issues and caregiver/health-care professional acceptance data. Finally, we position alloHD within the broader movement toward more sustainable and personalized dialysis, and outline the translational steps required before first-in-human study.
SN - 2077-0383
ER -