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Urea removal, required for dialysate regeneration, is a central function of any existing\/potential portable dialysis device. Urea in the spent dialysate coexists with non\u2010urea uremic toxins, nutrients, and electrolytes, all of which will interfere with the urea removal efficiency, regardless of whether the underlying urea removal mechanism is based on urease conversion, direct urea adsorption, or oxidation. The aim of the current review is to identify the amount of the most prevalent chemicals being removed during a single dialysis session and evaluate the potential benefits of an urea\u2010selective membrane for portable dialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We have performed a literature search using Web of Science and PubMed databases to find available articles reporting (or be able to calculate from blood plasma concentration)\u00a0&gt;\u00a05\u00a0mg of individually quantified solutes removed during thrice\u2010weekly hemodialysis sessions. If multiple reports of the same solute were available, the reported values were averaged, and the geometric mean of standard deviations was taken. Further critical literature analysis of reported dialysate regeneration methods was performed using Web of Science and PubMed databases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>On average, 46.0\u00a0g uremic retention solutes are removed in a single conventional dialysis session, out of which urea is only 23.6\u00a0g. For both urease\u2010 and sorbent\u2010based urea removal mechanisms, amino acids, with 7.7\u00a0g removal per session, could potentially interfere with urea removal efficiency. Additionally for the oxidation\u2010based urea removal system, plentiful nutrients such as glucose (24.0\u00a0g) will interfere with urea removal by competition. Using a nanofiltration membrane between dialysate and oxidation unit with a molecular weight cutoff (MWCO) of ~200\u00a0Da, 67.6\u00a0g of non\u2010electrolyte species will be removed in a single dialysis session, out of which 44.0\u00a0g are non\u2010urea molecules. If the membrane MWCO is further decreased to 120\u00a0Da, the mass of non\u2010electrolyte non\u2010urea species will drop to 9.3\u00a0g. Reverse osmosis membranes have been shown to be both effective at blocking the transport of non\u2010urea species (creatinine for example with ~90% rejection ratio), and permissive for urea transport (~20% rejection ratio), making them a promising urea selective membrane to increase the efficiency of the oxidative urea removal system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compiled are quantified solute removal amounts greater than 5\u00a0mg per session during conventional hemodialysis treatments, to act as a guide for portable dialysis system design. Analysis shows that multiple chemical species in the dialysate interfere with all proposed portable urea removal systems. This suggests the need for an additional protective dialysate loop coupled to urea removal system and an urea\u2010selective membrane.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aor.14185","type":"journal-article","created":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T04:33:05Z","timestamp":1649219585000},"page":"997-1011","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Strategies for optimizing urea removal to enable portable kidney dialysis: A reappraisal"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9369-8721","authenticated-orcid":false,"given":"Guozheng","family":"Shao","sequence":"first","affiliation":[{"name":"Department of Materials Science &amp; Engineering University of Washington  Seattle Washington USA"},{"name":"Center for Dialysis Innovation University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Himmelfarb","sequence":"additional","affiliation":[{"name":"Center for Dialysis Innovation University of Washington  Seattle Washington USA"},{"name":"Division of Nephrology, Department of Medicine University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce J.","family":"Hinds","sequence":"additional","affiliation":[{"name":"Department of Materials Science &amp; Engineering University of Washington  Seattle Washington USA"},{"name":"Center for Dialysis Innovation University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,4,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/MNH.0b013e3283454319"},{"key":"e_1_2_8_3_1","unstructured":"[cited 2021 Nov 1]. 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