BIOENGINEERED ARTIFICIAL KIDNEYS: ADVANCES IN TISSUE ENGINEERING AND ORGAN REGENERATION

Abstract

Chronic kidney disease (CKD) is a growing global health challenge, with end-stage renal disease (ESRD) imposing substantial morbidity, mortality, and socioeconomic burden. Current renal replacement therapies, dialysis and kidney transplantation, are limited by incomplete physiological replacement, reduced quality of life, and a persistent shortage of donor organs. These limitations have driven the development of bioengineered artificial kidneys as transformative alternatives. This review synthesises recent advances in bioengineered artificial kidneys, with a focus on tissue engineering, organ regeneration, and biohybrid device technologies, while critically examining translational barriers and future directions. We integrate findings from recent clinical, engineering, and regulatory literature to evaluate progress across key domains, including kidney structure-function constraints, cell sourcing strategies, biomaterials and scaffolding, nephron biofabrication, vascularisation and immune integration, and implantable versus extracorporeal systems. Preclinical validation, clinical translation, and regulatory considerations are also assessed. Significant progress has been made in stem cell-derived kidney organoids, decellularised extracellular matrix scaffolds, organ-on-chip platforms, and silicon-based filtration membranes. These technologies have enabled more physiologically relevant models of renal filtration and transport, improved vascularisation strategies, and early-stage implantable and wearable bioartificial kidney devices. While fully functional, transplantable bioengineered kidneys remain a long-term goal, hybrid and adjunctive technologies are approaching clinical feasibility. Continued interdisciplinary collaboration, coupled with advances in precision bioengineering, regulatory alignment, and scalable manufacturing, will be essential to translate artificial kidney technologies into meaningful clinical impact.