Dialysis: Almost 70 decades of hard work and progress

Like many other medical procedures and aids, dialysis has been around for a while. For the past 70 decades, it has helped thousands (if not millions) of individuals whose kidneys stopped working properly.

Kidneys can fail due to a wide variety of reasons. Sometimes genetics get in the way and make them stop working, or certain environmental conditions or experiences change the way they work and lead individuals to a kidney failure or a chronic kidney disease. This has happened to humans for as long as they have existed and it will probably keep on happening for as long as we are on earth.

Regardless the reason why kidneys fail, for those whose bodies are not able to filter the waste that runs in the blood, undergoing dialysis procedures becomes necessary.

Nowadays, this is a solution easy to picture. But, has anyone asked how we managed to make it until this point? Years of sacrifice and medical progress had to get in the way for us to be able to know dialysis as it works today.

In this article, Joe Cosgrove will share some historical facts related to dialysis.

Back in the 40’s

Dialysis is a 20th-century invention. It was first invented by Dr. Willem Kolff back in 1943 when this young doctor from the Netherlands decided to construct the first artificial kidney or dialyzer.

The process of developing this kidney was long and took Dr. Kolff more than 10 years. It started when he was a student at the University of Groningen Hospital, in his natal country. Kolff watched how a young man died in a painful and slow way because his kidneys fail and there was nothing to be done. This situation inspired Kolff and moved him to create an artifact that could work as the kidneys.

Kolff read every book available at the University’s library that talked about the kidneys and how the filtered waste from the blood. This is how bumped into an article written in 1913 by a famous pharmacologist named John Abel. In this article, Abel described the hemodialysis process in animals. Abel’s work inspired Kolff to create an artificial kidney.

When Kolff was doing his first experiments, the World War II started, forcing him to work at a Dutch hospital in a remote location once the Nazis overtook the country. This hard conditions never stopped him and he kept on working on the artificial kidney project.

kolff artificial kidney 1946_dializer_dialysis

Image courtesy of rob koopman at Flickr.com

Eventually, he came up with a device made with sausage skin, a washing machine, orange juice cans and other items that would allow him to filter waste from the blood. His invention took place under the Nazi domain and risking his life to make it possible.

By 1943, Kolff’s kidney was finished and ready to be tested. Until 1945, 16 patients were treated unsuccessfully. It wasn’t until that same year that a woman with a uremic coma was successfully treated and regained consciousness.

This is how Kolff’s dialyzer became the first one in history successfully used to treat kidney diseases. It became part of the standard treatment for kidney failure for the next 10 years.

There is hope in the 50’s

In the years to come, Kolff’s invention was improved to treat both acute renal failure and chronic stage renal disease. This was a rough path since most doctors in the 50’s believed that patients with kidney problems couldn’t undergo dialysis for long periods of time and that no man could come up with an artificial kidney that could replace the functions of a real one.

Another challenge that had to be faced back then was the strong damage veins and arteries of patients were suffering. This makes hard for patients to take the treatment for long periods of time.

It wasn’t until Professor Dr. Belding Scribner at the University of Washington came up with the idea of connecting plastic tubes to the dialyzer, and inserting one of these tubes into the patient’s arteries and veins, that would remain open for as long as the treatment lasted. These tubes had the shape of a U that would work as a bypass.

Later in time, this device was improved with a new material called Teflon and operated as a dialysis bypass that allowed patients to be treated for longer periods of time, extending their lives until an organ was available for a transplant.

From the 60’s to today

Dialysis Machine_Dialysis on children_joe cosgrove

Image courtesy of Amber Case at Flickr.com

Dialysis patients became numerous and facilities couldn’t serve all of them. Committees would decide who was going to dialysis and who had to wait. This is how bioethics committees were created and healthcare treatments became fairly available for many individuals who needed them. Portable dialysis machines were created and people could undergo dialysis at their homes.

During the past five decades, dialysis machines have been improved by technology. Kidney medicine has also evolved in a way kidney conditions can be treated with multiple alternatives. Some people use the peritoneal dialysis treatment and some other decide to undergo the hemodialysis one. Regardless the options, it is thanks to doctors like Kolff and Scribner that dialysis treatment became real.

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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.