How the artificial kidney machine was created

Historical basis of hemodialysis

Acute and chronic kidney failure can lead to death if left untreated. The disease is as old as mankind. In ancient Rome and later in the Middle Ages, uremia was treated with hot baths, stimulation of sweating, bloodletting, and enemas. Now, the procedure is based on the physical processes of osmosis and diffusion.

The first scientific descriptions of hemodialysis appeared in the 19th century and are attributed to the Scottish chemist Thomas Graham. He became known as the «father of dialysis». Osmosis and diffusion are common natural phenomena that became popular techniques in chemical laboratories. They were used to isolate dissolved substances and to remove water from solutions through semipermeable membranes. Far ahead of his time, Graham pointed out in a paper the potential use of these phenomena in medicine. Now, hemodialysis is an extracorporeal procedure designed to filter uremic substances from the blood.

The beginnings of dialysis

A historical description of dialysis was first published in 1913. D. Abel, L. Rowntree, and B. Turner performed dialysis on animals under anesthesia. Blood was directed outside the body through tubes of semipermeable collodion membranes. It is not known exactly whether the scientists planned to use the procedure to treat kidney failure from the beginning. However, modern medicine still uses the basic elements of Abel's machine during dialysis. Before blood is sent to the dialyzer, the ability to coagulate must be temporarily inhibited. Abel and his colleagues used hirudin, a substance identified as an anticoagulant element in the saliva of leeches.

Georg Haas, a German doctor from the city of Giessen, conducted the first dialysis treatments involving humans. Until 1928, he experimented on patients, but they did not survive, likely due to their critical conditions and the procedure's lack of effectiveness. Haas's dialyzer also used a collodion membrane. Like Abel, Haas initially used hirudin in his dialysis sessions, but this caused allergic reactions. Over time, Georg switched to heparin, a universal mammalian anticoagulant. After developing effective methods to purify heparin, it was approved as an essential anticoagulant and is still used today.

Historical facts about the successful use of artificial kidney

On March 17, 1943, Dutch internist Willem Kolff performed the world's first successful hemodialysis using an artificial kidney. The patient was 29-year-old Janna Skreiver. In 22 minutes, Dr. Kolff cleared two hundred milliliters of blood from urea, significantly alleviating the patient's condition.

Willem Kolff created the device in 1942. Manufacturing was ordered at a factory that made enameled dishes. The first device was constructed in the form of a tank and a light stainless steel drum made from the aluminum wreckage of a downed German bomber. A cellophane tube was filled with blood and wound on the drum, which rotated in a bathtub filled with a solution. The rotation was achieved using the motor of a Singer sewing machine, which failed during the procedure. The inventor's wife had to rotate the drum by hand for 15 minutes.

To form a membrane for blood purification, Dr. Kolff chose American cellophane, which was used in sausage production. The material was inexpensive but strong. Kolff filled the tube with blood and urea and rinsed it in saline. Complete purification of an adult's blood required 10 meters of cellophane. To create his invention, Kolff bought up all the cellophane tape stocks in the capital.

Drum Kidney

Willem Kolfe's rotating drum kidney crossed the Atlantic and arrived at a hospital in Boston that was owned by Peter Brent Brigham. The hemodialysis machine underwent significant technical improvements. The device subsequently became known as the Colf-Brigham artificial kidney. Between 1954 and 1962, the device was delivered to 22 hospitals around the world.

Earlier, the rotating drum kidney was field-tested under extreme conditions and proved helpful during the Korean War. Dialysis treatment significantly improved the survival rate of soldiers suffering from post-traumatic kidney failure, providing additional time for medical procedures.

Dialysis and ultrafiltration

In addition to filtering uremic toxins, the natural kidney has another important function: removing excess water. When the organ fails, its function is replaced by an artificial kidney, known as a dialyzer. The process in which pressurized plasma water is pushed out of the patient through the dialyzer membrane is called ultrafiltration.

In 1947, Neils Alwall published a scientific paper that described a modified dialyzer. The device would be able to perform dialysis and ultrafiltration better than the Kolf kidney. The cellophane membranes used in the device could withstand more pressure when placed between two protective metal grids. All the membranes were arranged in a sealed cylinder to create different pressure gradients.

Creating vascular access

In 1960, Belding Scribner made a breakthrough in dialysis in the United States with what would later be known as the Scribner shunt. This method provided a simple way to access the circulatory system, facilitating its use within months. The shunt was mounted on a plate attached to the patient's body. One cannula was surgically implanted into a vein, and the other into an artery. The cannulas were connected to form a circulating circuit, later called a "shunt." It was opened and connected to a dialyzer during the treatment procedure.

In 1962, shunts were made from flexible materials. In 1966, Michael Brescia and James Cimino made a significant breakthrough in vascular access. They created a connection between an artery and a vein in the arm through a surgical procedure. This technique prevented the vein from being exposed to significant arterial pressure and swelling, making it easier to place the needle during repeated access. The technique reduced the risk of infection and allowed for long-term hemodialysis. The arteriovenous fistula is still used for dialysis patients today.

Modern dialysis

Dialyzers are now made of a synthetic material, polysulfone, which is well tolerated by patients and provides high filtration efficiency. The latest hemodialysis machines monitor patients' conditions to detect critical situations at an early stage. The advantages of modern equipment include:

• effective monitoring systems;

• computerized data management;

• user-friendly operation;

• online technologies;

• networks and specialized software;

• research on the unique attributes of patients with chronic renal failure.

The treatment of kidney disease has now become technologically advanced and highly effective. Current challenges include managing the large number of patients and addressing complications caused by long-term use of dialysis.

Types of dialysis

What is dialysis?  It is a procedure that artificially removes metabolic waste products and excess water from the body. There are two main types of this technique:

1. Hemodialysis is the most common method of treatment, used in the advanced stages of kidney disease. This process is carried out with the help of an artificial kidney machine.

2. Peritoneal dialysis is an effective method of treatment, in which the metabolism between blood and dialysis solution occurs through the peritoneum.

After evaluating the advantages and disadvantages of each method, the patient, their family members, and the nephrologist decide on the type of procedure. The main factors in this decision are: the cost of treatment, age, residual kidney function, comorbidities, distance from residence, and the patient’s mobility.

Hemodialysis has certain contraindications, including significant drops in blood pressure, decompensated cardiovascular conditions, low blood coagulation, cancer with metastases, acute inflammation of internal organs, and psychoemotional disorders.

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