The history of dialysis

Life, death and a “washing machine”

Although experiments with dialysis are said to have occurred thousands of years ago, dialysis as we know it has its roots in the 20th century.

The 1940s: Inspiration, war and progress

Dr. Willem Kolff is considered the father of dialysis. This young Dutch physician constructed the first dialyzer (artificial kidney) in 1943.

The road to Kolff’s creation of an artificial kidney began in the late 1930s when he was working in a small ward at the University of Groningen Hospital in the Netherlands. There, Kolff watched helplessly as a young man died slowly of kidney failure. Kolff decided to find a way to make a machine that would do the work of the kidneys. The young doctor searched the university library for information on removing toxins from blood and stumbled across an article about hemodialysis with animals published in 1913 by John Abel, a renowned pharmacologist at Johns Hopkins University. Abel’s writing inspired Kolff, and he became committed to the development of an artificial kidney.

At about the same time that Kolff began his research, World War II erupted. Once the Nazis overtook the Netherlands, Kolff was sent to work in a remote Dutch hospital.

Despite challenging conditions, the young physician pressed on. Although materials were scarce, Kolff possessed the resourceful spirit of the true inventor and improvised, using sausage skins, orange juice cans, a washing machine and other common items to make a device that could clear the blood of toxins. Amazingly, he carried on his experiment under Nazi scrutiny, risking his own life by forging documents so that he could continue his work. Kolff was able to get his wife and colleagues to help, even though it meant they too were putting themselves in danger.

In 1943, Kolff’s invention, although crude, was completed. During the course of the next two years, he treated 16 patients with acute kidney failure but had little success. All that changed in 1945, when a 67-year-old woman in uremic coma regained consciousness after 11 hours of hemodialysis with Kolff’s dialyzer. Her first words? “I’m going to divorce my husband!” Thanks to Kolff, she did in fact follow through on her plan and lived seven more years before dying of another ailment.

Kolff’s machine is considered the first modern drum dialyzer, and it remained the standard for the next decade. At the time of its creation, Kolff’s goal was to help kidneys recover. The brave doctor had no way of knowing that his invention was one of the foremost life-saving developments in the history of modern medicine.

After World War II ended, Kolff donated the five artificial kidneys he’d made to hospitals around the world, including Mt. Sinai Hospital in New York. Because of this unselfish act, doctors in many countries were able to learn about the practice of dialysis.

In the late 40s, Kolff came to the US, where he continued his research. At the time, many people in the medical field were scandalized by kidney dialysis, calling it “an abomination.” Kolff and others like him who worked with dialysis were frequently ridiculed. But Kolff didn’t give up.

At Mt. Sinai Hospital, he instructed other doctors in the use of his artificial kidney, but the hospital’s administrators were opposed to this type of therapy. Therefore, Kolff and his colleagues were forced to perform dialysis in a surgical suite after hours. Spectators crowded the gallery to watch the “rogues” in action.

The next few years saw many strides in dialysis. Kolff gave a set of blueprints for his kidney machine to George Thorn at the Peter Bent Brigham Hospital in Boston. This led to the manufacture of the next generation of Kolff’s dialyzer, a stainless steel Kolff-Brigham kidney, which paved the way for the first kidney transplant in 1954. During the Korean War, Kolff-Brigham dialyzers were instrumental in the treatment of injured American soldiers.

The 1950s: Solutions, accesses and hope

By the 1950s, Willem Kolff’s invention of the artificial kidney had solved the problem of acute renal failure, but it was not seen as the solution for patients with chronic end stage renal disease (ESRD). In mid 20th century America, doctors believed it was impossible for patients to have dialysis indefinitely for two reasons. First, they thought no man-made device could replace the function of kidneys over the long term. In addition, a patient undergoing dialysis suffered from damaged veins and arteries, so that after several treatments, it became difficult to find a vessel to access the patient’s blood.

The answer for ESRD patients came from a young professor of medicine at the University of Washington, Dr. Belding Scribner. Scribner came up with the idea of connecting the patient to the dialyzer using plastic tubes, one inserted into an artery and one into a vein. After treatment, the circulatory access would be kept open by connecting the two tubes outside the body using a small U-shaped device, which would shunt the blood from the tube in the artery back to the tube in the vein.

The Scribner Shunt, as it was called, was developed using the newly introduced material, Teflon®. With the shunt, it was no longer necessary to make new incisions each time a patient underwent dialysis. Although the Scribner Shunt is no longer used today, it was the first step to improved methods of access to the circulatory system, enabling dialysis to prolong the lives of ESRD patients. Scribner’s invention also gave hope to those who needed kidney transplants, since it allowed patients to survive longer periods while waiting for an organ to become available.

The 1960s: Committees, controversy and futures

In 1962, Scribner started the world’s first outpatient dialysis facility. Immediately the problem arose of who should be given dialysis, since demand far exceeded the capacity of the six dialysis machines at the center. In another brilliant move, Scribner decided that the decision about who would receive dialysis and who wouldn’t—a matter of life and death for the patients involved—would not be made by him. Instead, the choices would be made by an anonymous committee composed of local residents from various walks of life plus two doctors who practiced outside of the kidney field. Although his decision caused controversy at the time, it was the creation of the first bioethics committee, which changed the approach to accessibility of health care in this country.

Scribner went on to develop a small, portable dialysis machine that could be operated by family members. The portable unit allowed people to undergo dialysis in their own homes, making it easier to maintain their daily routines and freeing up machines in dialysis centers.

Kolff ultimately became the world’s top biomedical engineer and was instrumental in the development of the heart-lung machine and the artificial heart. At age 93, he continues work today on the artificial eye and the artificial ear.

The past 60 years has been a time of incredible advancements in the world of kidney medicine. Thanks to the efforts of Kolff and Scribner and other medical pioneers like them, people with chronic kidney disease are now able to live full and productive lives.

 


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