A Brief History of Dialysis

National Museum of Health and Medicine_kidney

Image courtesy of MilitaryHealth at Flickr.com

Dialysis is a procedure commonly used to help filter the waste present in the blood when the kidneys simply can’t do it. As a medical procedure, it has been around for more than 70 years, helping patients have normal lives or at least livable ones.

Like most medical procedures, dialysis also has a story to be told, one that dates back to the 1940’s when the first dialysis machine was invented by a Dutch physician called Willem Kolff. Since the day this first machine was invented, to nowadays, dialysis has evolved incredibly, reaching the point where many patients are able to live with it for many years and still have regular lives.

In this article, Joe Cosgrove will share a bit of history related to dialysis and the great impact is has had in medical history and the lives of millions of people in time.

The 1940s: The beginning

At the beginning of the 1940’s a physician named Dr. Willem Kolff invented a device that worked as an artificial kidney. Thanks to his invention, Kolff is considered to be the pioneer of dialysis. As a physician, Kolff spent about 10 years of his career developing an artificial kidney in the Netherlands while working at the University of Groningen Hospital. He was first inspired to create this type of artifact when visiting the University Hospital and watching how a young man would irremediably die because his kidneys couldn’t filter waste anymore.

Once motivated to create something that could help those experiencing kidney failure, Kolff decided to go to research about ways to remove waste from the blood once the kidneys stopped working. Then he found an article written by the pharmacologist John Abel in 1913 about hemodialysis in animals. Thanks to this article, Kolff dedicated himself to the cause of developing an artificial kidney for humans.

Kolff had a hard time developing this device since he was sent to a remote hospital to serve at during war. Despite the poor conditions he kept on moving forward and improvised many times with many different materials (including sausage skins) to create something that could remove waste away from the blood.

By the year 1943 and after overcoming a great share of difficulties, Kolff’s invention was finished and was tested without any success on numerous patients, until in 1945, it helped an old woman overcome a uremic coma.

The machine Kolff invented is considered to be the first dialyzer of our times and its structure remained almost untouched for ten years as the best alternative for physicians to treat patients who were suffering from kidney failure. Probably Kolff didn’t know it back then, but his machine turned out to be one of the most important medical inventions in history and helped to save the lives of thousands.

The 1950s: Evolution of the dialyzer

At the beginning of the 1950’s, Kolff’s dialyzer had already been improved and used to treat injured soldiers fighting during the war. It had also been used to treat end-stage renal disease and acute renal failure patients. However, during the middle of the 20th century, not many doctors were optimistic about the usage of Kolff’s dialyzer because they believed a human made machine couldn’t resemble the kidneys’ function and they also found it difficult for the human veins to stand such treatment in the long term.

It was in Boston where a professor named Dr. Belding Scribner came up the idea of plugging the patient to the dialyzer by using flexible tubes made of a new plastic called Teflon. This way the tubes could be introduced inside the arteries and veins, keeping the circulatory access opened thanks to the usage of a tiny device with the shape of a “U”. This u-shaped device was called The Scribner Shunt.

By using this device patient no longer needed to get a new incision when going under the dialysis treatment. Even though this method isn’t used today, it helped other doctors develop new techniques to access the circulatory system that were useful to treat those who had acute kidney failure.

The 1960s: A decade of changes

Scribner was the first person on earth to open a dialysis facility in 1962. Problems started to appear when the number of patients who wanted and needed to be treated exceeded the capacity of the clinic – with only six available machines. Scribner needed to find a way to decide which patients were getting the dialysis done since many of them actually were close to death.

By this moment, Scribner decided to create an anonymous committee of people who could make that decision for him. This committee was composed of local people and doctors who worked in the kidney fields. Although this Solomonic choice created controversy, in time this committee was seen as the first bioethics committee of all time and changed the relationship common people had with the offer of health services.

The Past 60 Years

During the past 60 years, the history of dialysis has gone under several changes, new machines have been developed, new materials have been invented and many people in the world depend on this treatment to survive. We still know medical pioneers like Kolff or Scribner that are concerned about the way medicine evolves and is being practiced.

It is always expected in the future to come for specialists to be able to create new solutions that may help patients live longer, happier and have regular lives despite the fact they need to undergo dialysis treatment several times per week. History is still being written and hopefully, the years to come will be full of great surprises in this important medical field.

Everything You Need to Know About A Dialysis Machine

As Joe Cosgrove has pointed out before in this blog, kidney plays a vital role in the functioning of the human body. Without them, the waste present in the blood couldn’t be removed, and most individuals would die within a few days. Sadly, these bean-shaped organs can fail and when that happens, the best option for patients is to go under dialysis.

Dialysis is a medical procedure that works as an artificial kidney. It takes place when a person’s blood is filtered with the help of a dialysis machine. This machine aims to mimic the regular functions of human kidneys. This way, it is able to remove toxic waste from the blood as well as the extra water that may be present in it.

dialysis_dialysis machine

Image courtesy of Matt Kowalczyk at Flickr.com

Each dialysis machine is built up in a similar way and healthcare providers and technicians know how to operate them in order to help patients filtering their blood. There is a list of parts and components that need to be well known by technicians in order to properly handle the dialysis machine. Below, you will find a list of these components with a brief description of each one of them.

Pumps

The most common type of pump used during dialysis is known as Peristaltic pumps. These are tubes meant to drive different fluids, such as blood, water, saline, and dialysate. This type of tubes is ideal for dialysis since they let a higher volume of fluids flow without letting them be touched by human hands. Also, dialysis pumps are a flexible system that helps to push fluids forward with the help of motors (AC or DC motors) which speed can be regulated by the technician.

Some pumps are connected to a sensory system that allows them to automatically regulate the flowing pressure of fluids depending on the patient’s needs. Nevertheless, in order to properly function, pumps need to be configured in advance based on the type of fluid that is going to pass through them

Valves

Dialysis machines need to have a few electronic valves to operate properly. This happens since dialysis machines need to use variable mixing ratios that are only possible when different valves open and close at different times. This type of valves are solenoids which can be controlled with precision thanks to the action of stepper motors or another mechanism.

Sensors

Most dialysis machines use different types of sensors. This happens because they need to monitor and regulate different parameters that take place during the dialysis procedure. Some of these parameters include motor speed, temperature, oxygen saturation, dialysate pressure, dialysate membrane pressure, and airflow.

Nowadays, dialysis machines usually have digital outputs that allow the technicians to know what is going on during the dialysis procedure. When they don’t have these digital outputs the signal sent by the sensors needs to be amplified and digitized before reaching the controller. In order to be more accurate, a series of ADC resolutions are used and the sampling speed varies.

Cleaning system

A dialysis machine can be used to treat many different patients. This is why it needs to be cleaned before each session and components that are going to be reused must be properly sterilized too. Each machine can be cleaned in a different way, but most of them have the same system.

Technicians need to heat water to high temperatures so it can sterilize the tubes and each part of the dialysis machine when it runs through them. The inner and outer circuit of the machine needs to be cleaned with that water by activating the cleaning mode of the machine. However, there are different types of machines that require this process to be monitored and controlled.

Syringe

The syringe is an external element used to pump substances into the dialysis machine. This procedure is needed since the blood tends to clog the machine’s pumps and a drug called heparin needs to be injected into the tubes to keep them unclogged. The syringe is attached to the pumps in most machines.

renal-dialysis-technician

Image courtesy of wistechcolleges at Flickr.com

Dialyzer

The dialyzer is probably the most important piece of the dialysis machine because it is where the blood is filtered. Here a filtering membrane and a cleaning solution called dialysate can be found. The dialyzer is, in general terms a blood compartment.

Dialysate Solution

The dialysate is a solution made of purified water, an acid and bicarbonate that can be found inside the dialyzer. It is meant to remove waste from the blood thanks to the action of the minerals and electrolytes present in the solution. Dialysate never mixes with the blood; it simply takes waste away with the help of a filtering membrane.

Once the blood is cleaned and filtered thanks to the combined action of both the dialyzer and dialysate, it is pumped back into the patient’s body. This process takes place in the form of a moving current since only one pint of blood can be treated at the time.

Understanding the 5 stages of Chronic Kidney Disease

We do not have to stress out or even define what CKD is because we have discussed it in this blog in several articles and we already know what it is all about.

Instead today we are going to take a deep look at the 5 stages of Chronic Kidney Disease that were developed or designed by the National Kidney Foundation (NKF) in order to understand better Kidney diseases and to give doctors  some sort of guideline that will help them identify the evolution of the kidney disease and know how to give the patient the best care possible for each stage.

FIVE_5 stages of Chronic Kidney Disease

Image courtesy of electricnude at Flickr.com

Let’s take a look at those 5 stages.

Stage 1 and 2:

Somebody that is in stage 1 or 2 of CKD has a small kidney damage and his or her glomerular filtration rate (GFR) is normal or a bit higher than 90 ml/min. in this stage, symptoms are not common and the kidneys are still working normally. If the person is to find out he or she is on stage 1 CKD it is because the person was being tested for other things and the results came out with certain amount of creatinine levels or they discovered blood or protein in the urine or there was an imaging test and the results said there was a kidney damage.

For people that are in this stage the treatment only focuses on a healthy diet including whole grains, fresh fruits and vegetables, no fats or low fat diets, control the intake of sugar and sodium, have a good weight and exercise very regularly, take vitamins recommended by doctors and definitively stop smoking and having bad habits for the body.

When it comes to stage 2, the description is just the same with the disease having no symptoms and the kidney working at a very good level. The only difference here is that the kidney already has a mild damage and it is getting a bit late to discover it or to treat it and the glomerular filtration rate is around 60-89 ml/min.

Stage 3:

Here the person has already a moderate kidney damage. This stage has two parts which are called A and B. in stage 3A the glomerular filtration rate is 45-59 mL/min, and in stage 3B the glomerular filtration rate is 30-44 mL/min.  Here the disease is already noticeable and patients start to feel the symptoms. A condition called uremia appears and secondary complications such as high blood pressure, anemia and bone disease start to appear as well.

The symptoms for this stage are the feeling of being tired all the time, high retention of fluids, extremities start to swell and the patient starts feeling that his or her breath is just not enough, urine changes color to a more reddish, brownish color or it even contains blood which will make it red, lower back pain, problems with sleep and muscle cramps.

In this stage, the kidney is working at a 50% performance and the idea is to help the patient keep their kidneys working as long as possible.

In this stage, a very controlled diet and medications are essential to make the kidney live longer. When it comes to medications ( the diet is very important even since stage 1) in this stage they become essential to control glucose levels and have a very good blood pressure in order to maintain the kidney working for as long as possible. The medications doctors prescribe in this stage are ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers).

Stage 4:

Here the patient has a real problem that needs to be tackled as soon as possible and with the correct treatment. Their glomerular filtration rate is 15-30 ml/min. and treatments are now very viable options. Unfortunately, a patient with stage 4 CKD will have to get a kidney transplant in the near future. In this stage conditions like anemia, uremia, bone disease, high blood pressure, heart complications and cardiovascular diseases start to become present.

The symptoms in this stage are fatigue, hard kidney pain in the lower back, sleeping problems, nausea, vomiting, a  metallic taste in their mouth, bad breath, loss of appetite due to the flavor in their mouth, difficulty in concentrating and numbness or tingling in the toes or fingers.

In this stage, there are 3 different types of treatments which are Hemodialysis, Peritoneal dialysis and, Kidney transplant

Stage 5:

Unfortunately, at this stage, the person has no options and it is a terminal disease called end-stage renal disease (ESRD) that has a glomerular filtration rate of 15 ml/min or less. In this stage, the kidneys no longer work and don’t have the ability to do anything at all. In this stage dialysis or a kidney transplant will be needed to survive.  

It is very important to understand these five stages so patients and doctors can find out about the disease in the early stages and give patients the option of having a very good quality of life.

Be sure to also read this post about how to choose the right treatment in case of renal failure?