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...everything you need to know about doing dialysis at home.
Here we present a chronological tour of dialysis from the beginning.
All photos by Jim Curtis; descriptions courtesy of Baxter.
The first practical artificial kidney was developed during World War II by the Dutch physician Willem Kolff. The Kolff kidney used a 20-meter long tube of cellophane sausage casing as a dialyzing membrane. The tube was wrapped around a slatted wooden drum. Powered by an electric motor, the drum revolved in a tank filled with dialyzing solution. The patient’s blood was drawn through the cellophane tubing by gravity as the drum revolved. Toxic molecules in the blood diffused through the tubing into the dialyzing solution. Complete dialysis took about six hours. The Kolff kidney effectively removed toxins from the blood, but because it operated at low pressure, it was unable to remove excess fluid from the patient’s blood. Modern dialysis machines are designed to filter out excess fluid while cleansing the blood of wastes.
Blood was drained from the patient into a sterile container. Anticlotting drugs were added, and the filled container was hung on a post above the artificial kidney and connected to the cellulose acetate tubing that was wound around the wooden drum. A motor turned the drum, pulling the blood through the tubing by gravity.
The tank underneath the drum was filled with dialyzing fluid. As the blood-filled tubing passed through this fluid, waste products from the blood diffused through the tubing into the dialyzing fluid. The cleansed blood collected in a second sterile container at the other end of the machine. When all of the blood had passed through the machine, this second container was raised to drain the blood back into the patient.
George Thorn, MD, of the Peter Bent Hospital in Boston, MA, invited Willem Kolff, MD, to meet with Carl Walters, MD, and John Merrill, MD, to redesign and modify the original Kolff Rotating Drum Kidney. The artificial kidney was to be used to support the first proposed transplant program in the United States. This device was built by Edward Olson, an engineer, who would produce over forty of these devices, which were shipped all over the world.
Cellulose acetate tubular membrane, the same type of membrane that is used as sausage casing, was wrapped around the drum and connected to latex tubing that would be attached to the patient’s bloodstream. The drum would be rotating in the dialyzing fluid bath that is located under the drum.
The patient’s blood was propelled through the device by the “Archimedes screw principle” and a pulsatile pump. A split coupling was developed to connect the tubing to the membrane, a component necessary to prevent the tubing and membrane from twisting. This connection is at the inlet and outlet of the rotating drum.
The membrane surface area could be adjusted by increasing or decreasing the number of wraps of tubing. The Plexiglas™ hood was designed to control the temperature of the blood. The cost of this device was $5,600 in 1950.
Murphy WP Jr., Swan RC Jr., Walter CW, Weller JM, Merrill JP. Use of an artificial kidney. III. Current procedures in clinical hemodialysis. J Lab Clin Med. 1952 Sep; 40(3): 436-44.
Leonard Skeggs, PhD, and Jack Leonards, MD, developed the first parallel flow artificial kidney at Case Western Reserve in Cleveland, OH. The artificial kidney was designed to have a low resistance to blood flow and to have an adjustable surface area.
Two sheets of membrane are sandwiched between two rubber pads in order to reduce the blood volume and to ensure uniform distribution of blood across the membrane to maximize efficiency. Multiple layers were utilized. The device required a great deal of time to construct and it often leaked. This was corrected by the use of bone wax to stop the leak.
The device had a very low resistance to blood flow and it could be used without a blood pump. If more than one of these units were used at a time, a blood pump was required. Skeggs was able to remove water from the blood in the artificial kidney by creating a siphon on the effluent of the dialyzing fluid. This appears to be the first reference to negative pressure dialysis.
This technology was later adapted by Leonard Skeggs to do blood chemistries. It was called the SMA 12-60 Autoanalyzer.
This artificial kidney was developed to reduce the amount of blood outside of the body and to eliminate the need for pumping the blood through the device.
Guarino used cellulose acetate tubing. The dialyzing fluid was directed inside the tubing and the blood, entering the device from the top, cascading down the membrane. The metal tubing inside the membrane gave support to the membrane.
The artificial kidney ahd a very low blood volume, but it had limited use because there was concern regarding the possibility of the dialyzing fluid leaking into the blood.
Von Garrelts had constructed a dialyzer in 1948 by wrapping a cellulose acetate membrane around a core. The layers of membrane were separated by rods. It was very bulky and weighed over 100 pounds.
William Inouye, MD, took this concept and miniaturized it by wrapping the cellulose acetate tubing around a beaker and separating the layers with fiberglass screening. He placed this “coil” in a Presto Pressure Cooker in order to enclose it and control the temperature. In addition, he made openings in the pot for the dialyzing fluid. With the use of a vacuum on the dialysate leaving the pot, he was able to draw the excess water out of the patient’s blood. A blood pump was required to overcome resistance within the device.
This device was used clinically and when it was used in a closed circuit, the exact amount of fluid removed could be determined.
Inouye WY, Engelberg J. A simplified artificial dialyzer and ultrafilter. Surg Forum. Proceedings of the Forum Sessions, Thirty-ninth Clinical Congress of the American College of Surgeons, Chicago, Illinois, October, 1953; 4: 438-42.
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