*4.6. Challenges/Perspective*

The potential for the addition of liposomes into dialysate to improve clinical management has previously been noted [1]. Although this field holds promise for improvement in treating conditions where there is unmet need, challenges remain. LSPD for hepatic failure is furthest along the development pipeline, though further development hurdles remain. The shelf life of liposomes for use in dialysate is an issue which may impair uptake, though the osmotic shock technique for the preparation of acidic centred liposomes may mitigate this. In dialysis to treat renal failure, the concentration of liposomes used experimentally to increased PBUT extraction is high and may not be transferrable to the clinical situation. Liposome-supported enzymatic dialysis is a very nascent field, requiring further research.

A counterbalance to these limitations on development is the scope of unmet clinical need which liposomes in dialysate may address. With 3 million patients worldwide receiving haemodialysis [27], receiving at least 2 treatments per week, there are in the order of 300 million yearly treatment episodes with potentially improved PBUT extraction using liposomes in dialysate. The developers of LSPD to treat hyperammonaemia in liver failure similarly estimate a significant potential unmet need to drive development [28].
