ESKD patients residing in rural and remote geographic locations have higher mortality than patients closer to in-center hemodialysis clinics creating a serious and unacceptable health disparity. While home hemodialysis eliminates travel to in-center hemodialysis clinics, very few rural and remote patients perform home hemodialysis because it requires patients and caregivers to perform complicated tasks associated with life threatening risks. Furthermore, the large volume of dialysate (~120 liters) and the resources (high purity water and water filtration systems) to create dialysate severely limit home hemodialysis, especially for rural and remote ESKD patients. iHemo will enable more rural and remote ESKD patients to perform home hemodialysis therefore reducing long travel, missed treatments, and consequently eliminate the mortality health disparity plaguing rural and remote ESKD patients. In addition to iHemo's implanted HemoCartridge simplifying the tasks and significantly reducing the risks of home hemodialysis, the iHemo's zeolite-based external dialysate system will specifically enable both rural and remote ESKD patients to operate iHemo in resource limited environments because it requires as little as 2 liters of water per dialysate session. This project will demonstrate the feasibility of iHemo to eliminate the health disparity by achieving the following aims: Aim 1: Identify a zeolite with clinically acceptable urea adsorption capacity and Aim 2: Prototype the zeolite-enabled external dialysate system for integration with the implanted HemoCartridge.