Figure 2.

An overview of the approach and considerations incorporated into the Roadmap. Milestones were identified in order of complexity: enhanced dialysis (improvements on current approaches), a portable or wearable solution, biohybrid/implantable kidney (including xenotransplantation), and a regenerated kidney. Kidney functions that would have to be replaced were grouped into five categories, including: blood filtration, fluid regulation, electrolyte homeostasis, toxin removal/secretion, and filtrate transport and drainage. How replacement would occur was not prescribed, but rather left to the ingenuity of the community. A number of “system enablers” could facilitate progress. These include, but are not limited to, kidney replacement access advances, developments in biomaterials, new insights into biologic and immunologic modulation, current advances in function, and safety monitoring. It was recognized that alignment with regulatory agencies throughout this development process was critical. It was also recognized that financial incentives and novel payment pathways would be very important to incentivize the innovation needed to accomplish the goals of the Roadmap. Figure is taken, with minor modifications, from the Roadmap (Supplemental Appendix 1). PD, peritoneal dialysis.