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.

Advertisements

What is Peritoneal Dialysis, and which are the available treatments?

Peritoneal Dialysis (best-known as PD,) involves the removal of extra waste products from your blood. In this mode of dialysis, unlike other treatments, such as hemodialysis, the process is performed inside the body. This is a point that grabs the attention of many patients suffering from kidney disease, as it offers more practical conveniences. In contrast to hemodialysis, peritoneal dialysis is performed every day (just the way the kidneys work), and it is the patient who carries it out.

From the medical point of view, it is an advantage that this procedure is performed every day of the week because the blood stays cleaner and it is actually easier to prevent eventual crises. People do not have to wait to go to the hospital or to connect to the machine at home. All that is needed is a catheter which is inserted into the patient’s belly (and by a rather rapid procedure.)

Peritoneal Dialysis_Renal compensation_health

Image courtesy of PresidenciaRD at Flickr.com

In reality, there are two types of peritoneal dialysis. The best-known is continuous ambulatory peritoneal dialysis (CAPD.) In this case, the catheter is connected to a tube, and through it, a cleaning liquid is introduced to start the waste elimination process, such as salts and excess of water in the blood. The cleansing fluid enters and is installed throughout the patient’s abdomen in less than a quarter of an hour, and then the patient’s abdomen lining begins to filter the disposable substances. At the same time, it retains nutrients and other necessary elements for the proper functioning of the organism. The introduction of the liquid should be performed under conditions of total asepsis, as an infection in these circumstances would be very serious and difficult to treat. In case of poor hygiene, peritonitis may occur. Peritonitis occurs when germs enter the peritoneal cavity through the catheter. It may be treated with antibiotics, but the performance of a treatment is extremely urgent. However, if the patient follows the medical recommendations, he or she will have no problem at all.

Recommended: The impact of peritoneal dialysis-related peritonitis on mortality in peritoneal dialysis patients

The cleansing liquid (dialyzer) is left in the patient’s womb for an average of four hours so that the filtration can be effected smoothly. Obviously, each body is different, and, depending on the physiological characteristics, as well as the level of presence of noxious substances to be filtered, it remains more or less time. This treatment offers a lot of freedom since while the dialysis is taking place the patient can do everything that a normal person would do, without having to sit or lie next to a machine for hours. This is carried out in the most natural way possible: Thanks to gravity. It is not necessary to artificially suck the solution, and the patient simply replaces the liquid by the same procedure as it is mentioned above. When the dialysate has done its work, the solution containing all the residues (normally filtered by a kidney) is drained and expelled. The process is then repeated because the functions of the body do not stop, and it is repeated permanently. Hence, its name.

The other procedure is automatic. In this treatment, the patient connects the catheter to a machine, and this catches up with everything. The patient does not need to perform the exchange of new dialysate per used: It is an automatic process that even offers more freedom to patients. The machine works by cycles, like a washing machine. The patient schedules the machine at night, before going to bed, and the rest of the process is performed while the patient is resting. The interesting thing is that this machine is a totally independent equipment that works without connecting it to the drainage or the electricity. The cycling machine is not large, and, therefore, it is easy to transport, in case the patient should travel and carry it in the luggage. That is certainly another advantage.

The Merck Home Manual of Medical Information - Dialysis

Image courtesy of Amber Case at Flickr.com

It is important to keep in mind that this treatment takes more time (overnight, to be precise.) The patient lies down to sleep, and seven or eight hours later, the machine will have cleaned the whole body. Manual functions in this process are minimal, and, in some cases, simply non-existent.

No matter what your choice is for the peritoneal dialysis procedure when it comes to the number of times the dialysis process is performed per day, it is the very same thing. In both cases, it is permanent. The only difference is that in the first one is done manually, while in the second one it is carried out by a machine. In both procedures, insertion of a catheter into the patient’s belly is necessary, and, again, it is not a complicated operation.

These are very good options for patients with kidney failure and are a sign that it is possible to follow a normal life. I hope this information has been helpful to you, and I hope you share it with your friends, especially those who you know need these treatments.

Read also: The Most Common Questions Patients Have About Dialysis, by Joe Cosgrove

The Most Common Questions Patients Have About Dialysis

The kidneys are vital organs in the human body. Their functions are those of secreting hormones, cleaning your blood, absorbing minerals and producing urine among others. They are absolutely necessary to maintain the body’s toxin levels at normal levels, they help regulate blood pressure and even stimulate the production of red blood cells.

renal-dialysis-technician

Image courtesy of wistechcolleges at Flickr.com

As you can probably guess, the kidneys have a lot of responsibility and are organs that work under constant stress. It is expected that when organs such as these stop working like they are supposed to, the consequences are dire, as the body loses its ability to regulate the toxins that are normally cleansed by the kidneys and you begin to feel sick.

Kidney disease is the term utilized to refer to the condition by which the functions of kidneys are reduced in their efficiency or in some cases completely impaired. In cases like this, there are but a few options available for a patient to stay alive. One would be a kidney transplant, and the other would be to receive dialysis treatment. Dialysis is a treatment by which advanced machinery is used to help cover the slack left by kidneys unable to perform their functions and thus remove excess toxins from the patient’s body.

Today in Joe Cosgrove’s blog, we want to talk about some of the most common questions and concerns raised by new patients to dialysis treatment, and by the family members who want to support them during their process.

What are the different types of dialysis?

There are three primary types of dialysis. Hemodialysis and hemofiltration work similarly because they are both concerned with the cleansing of the blood directly. Blood is removed and cleaned in a machine before being pumped back into the body. The difference between both of these methods is that one uses a dialyzer solution while the other uses pressure to separate substances through a permeable membrane.

The third type of dialysis is called peritoneal dialysis and is less efficient than the former methods. In peritoneal dialysis, the blood is not directly but indirectly cleansed by pumping dialyzer into the patient’s abdomen and then removing it after the waste material has transferred to the fluid. The process is repeated several times per session.

How does dialysis work?

Dialysis is a treatment that simulates the process done by the kidneys when they are healthy by removing excess toxins from the blood and keeps the body in balance. A machine is used to extract the blood of the patient (in the case of hemodialysis) and clean it before injecting it back in. Minor surgery is necessary to create a vascular access. Vascular access is a place where the needles and tubes can be easily connected every time the patient needs to undergo the procedure. An access can be created by joining an artery and a vein together into a blood vessel called a fistula or by placing a narrow plastic tube in a large vein near the chest or neck.

In peritoneal dialysis, the blood is actually cleaned inside the body. The doctor places a catheter in the patient’s abdomen so the peritoneal cavity can be filled with fluid and thus excess toxins from the blood can be extracted from blood vessels in the abdomen that come in contact with the dialyzer that is later removed.

hands-walking-stick-elderly-old-person

Image courtesy of Pixabay at Pexels.com

Is it possible to travel?

Traveling is absolutely possible, but it requires a bit more planning that you may be used to. Dialysis can be done by the patient him or herself while traveling with no real risk. There are also many centers around the country and even worldwide that can accommodate your needs while traveling and give you all the care you need. It is imperative to plan properly and to have everything planned well in advance so you can receive the treatment you need.

Does my diet have to change?

The food you eat will depend on many factors like your current health, the stage of your particular kidney disease and the recommendations of your doctor depending on their evaluation of your specific situation. Salt, in general, is to be avoided in large quantities; the same goes for foods that contain too much phosphorus. Anything that can affect your blood pressure has to be eaten in moderation, and it is recommended to eat fewer proteins than usual, especially if you eat lots of meats and animal products.

How often do I have to undergo the treatment?

The frequency of dialysis sessions you require depends mainly on the current state of your kidneys. Some patients with a more advanced condition may require more sessions than someone whose kidneys are still performing partially. Normally, hemodialysis takes places about 3 times a week while visiting the clinic and peritoneal dialysis is usually done at home, several times during the day. As we have mentioned before, one method is more effective than the other, and that is why it requires fewer sessions.