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.

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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

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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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How to reduce the chances of suffering renal failure

There is a worrying statistic in America: one in almost three Americans is on the verge of suffering any type of kidney disease due to diabetes, hereditary aspects, high blood pressure or kidney failure. Joe Cosgrove has previously pointed out several aspects on how to effectively reduce the chances of suffering any type of renal disease and how to cope with the dreary effects of both dialysis and other treatments for renal failure; however, here is a word of advice for those individuals who want to increase the chances of getting the most out of their kidneys while keeping them healthy.

First of all, and despite it being quite obvious, the vast majority of individuals are born with two kidneys. What people do not know, however, is that they can live just using one. On a daily basis, the kidneys can filter up to 200 liters of blood: in this process, they can also remove up to 2 liters of waste, water, and toxins. In fact, water and waste products often leave the body in the form of urine, thusly allowing the kidneys to regulate the body’s fluids and its levels. Kidneys are also responsible for producing and releasing hormones that are key in regulating blood pressure, producing more red blood cells and maintaining solid and healthy bones.

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Since the human body tends to wear off over time, the kidneys are not the exception. The kidneys stop working as they should slowly over the course of time, which is why most people often realize they suffer from any sort of kidney disease until it is too late. It is difficult to prevent it, since detecting it during early stages is no easy task. Thus, protecting the kidneys is something every individual should aim to irrespective of whether they have hereditary conditions or not:

Get Checked

Everyone is open to suffering from any type of kidney disease regardless of whether they keep a healthy lifestyle, or have hereditary conditions, or not. People who believe they are at risk for any type of kidney disease should not overlook the importance of getting their kidneys checked by their primary physician or a nephrologist. Since the kidneys do not show early symptoms of damage, most people tend to adopt a relaxed stance when it comes to taking the time to scheduling an appointment with their physicians. That is why prevention and checking often walk alongside each other.

Nonetheless, it is quite easy to check the kidneys. The first test is a urine test that aims to find the presence of albumin (a protein) in the fluid. Whenever an individual has got protein in their urine it is quite possible to assert that that individual is showing early symptoms of kidney failure. When there is just too much protein in the fluid, it means that the kidneys are failing and are starting to leak albumin or protein in this case. The second test aims to find creatinine in the blood flow. Creatine is one out of many different types of waste products that can be found in the body. It comes from muscle metabolism, and healthy kidneys remove it. This test is also used to determine an individual’s glomerular filtration rate, which is a statistic that is commonly used to reflect how well the kidneys filter waste products from the blood flow.

Control sugar levels

And control blood pressure as well. High blood pressure and diabetes are known for being two major causes of all sorts of kidney disease. Since the kidney is somewhat of a vascular organ—as it contains a myriad of different blood vessels—, diseases that affect these vessels such as diabetes and high blood pressure can ultimately inflict damage to the organs. In fact, even a minor degree of high blood pressure and diabetes can result in terrible kidney damage. As mentioned above, individuals, regardless of their current condition, should control both aspects in order to avoid falling victim of early kidney disease.

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Control weight

Keeping a healthy lifestyle is as important as the two aforementioned aspects. Weight plays a vital role in overall kidney health. Overweight, for instance, forces the body to work much harder in order for it to successfully filter all the waste products and meet metabolic needs. Besides, obesity and having excess weight can lead to the development of diabetes and pressure-related complications. Thus, it is quite important for individuals to maintain a healthy diet and a healthy lifestyle, working out from time to time and paying special attention to their weight. Weight loss and exercise is key when it comes to reducing the risk of developing both conditions. In fact, smoking also helps increase the chances of suffering any type of renal disease and high blood pressure, and it also worsens any condition. Quitting smoking, therefore, is crucial.

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The mildly-invasive procedure that helps end-stage renal disease patients

As previously described by Joe Cosgrove, there are several stages of renal disease; there are, in fact, different treatments for each patient. However, to all those patients currently undergoing hemodialysis after being diagnosed with end-stage renal disease, unrestrained and free blood circulation is practically the whole world for them.

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The process of hemodialysis, as previously mentioned in this blog is all about having a machine replace an individual’s kidneys. It mimics the human kidney function by pumping blood from an individual’s body all the way through a series of tubes, thusly cleansing it by getting rid of all the accumulated waste so that it can be returned to the body via an additional tube. This machine, also commonly referred to as a hemodialyzer, requires an additional procedure in order to create an easy access into the patient’s blood flow. When a vein or an artery develops a blockage while providing or carrying blood from or to an individual’s dialysis access area—which is usually a leg or an arm—, the process becomes less efficacious and successful, and, in turn, patients are more prone to experience all sorts of difficulties.

Nonetheless, an almost minimally invasive treatment for all those patients who require long-term management of vein access while undergoing dialysis has been developed. The procedure, also known as an angioplasty and stent, poses a very good opportunity for all those individuals who have to undergo the dreary effects of being on dialysis. It is, in short, the perfect opportunity to improve an individual’s quality of life.

In America, there are up to 470,000 people who have any sort or degree of irreversible kidney failure or end-stage renal disease. Most of them need as soon as possible either constant dialysis or, even worse, a transplant in order to survive. The vast majority, all those patients undergoing dialysis, require somewhat of an additional maintenance procedure: either an angioplasty and stent—the process being described in this article—, or a balloon angioplasty. They are required to undergo this additional procedure up to twice a year in order to keep the body with a proper and adequate blood flow to access the entry area.

The main issue relies on a physician’s ability to perform successful percutaneous interventional procedures, or, better said: any catheter-based interventional proceeding. If an individual is to improve their quality of life when undergoing this type of dialysis heavily relies on this. Prior to developing catheter-based procedures, individuals suffering from any degree of end-stage renal disease would come into operating rooms for different procedures such as open procedures that would leave patients weak, thusly making the healing process long and dreary, not to mention that patients would need to stay at the clinics. That was, of course, not the best case scenario for those individuals on dialysis thrice or four times a week. This serves as the most plausible and accurate explanation for such high dropout rates: it was quite easy, not to say understandable, for them to abandon the process.

Additionally, all of these catheter-based proceedings allow physicians to easily and seamlessly access any sort of blockage or narrowing (also known as stenosis) that could be reached through another process or routine operation. In the past, many of these blockages ended up being untreated due to the impossibility for a physician to access them; however, as a result, the scientific community decided to create a much better dialysis access with its own blood flow so that blockages would be left untreated.

This mildly-invasive procedure, in term of time, seems to be a much fitter choice for individuals under the aforementioned conditions. Patients require only a few hours of their time in the clinic. Not to mention that the outcome surpasses in adaptability the old-fashioned way: it is much more adaptable and adequate to an individual’s lifestyle. After several trials in the past, patients seem to be much happier in comparison with the resulting outcome of the old way.

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During the procedure, or, rather, during its course, physicians must accurately determined whether they are facing a blockage or a narrowing. This suggests that the procedure demands a lot of decision-making skills from a nephrologist. They must also determine the degree of the scenario they are facing: how severe it is and, most importantly, which seems to be the best way to open it and, moreover, keep it open. In addition, they also have to ponder what catheter they need or seem to be more adequate for that specific case; however, be that as it may, patients, regardless of complications—everything has got complications and physicians are required to avoid them—, the possibility of improving an individual’s quality of life is compelling enough for them to consider consulting with their primary nephrologist. Dialysis and renal disease are perhaps amongst the least satisfactory scenarios; however, there have been many developments and advancements regarding this topic: today, people have more than just one option to treat their conditions.

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