Chapter 2 History of dialysis
An early pioneer in the development of the technologies and treatment used for maintenance dialysis was Thomas Graham, a professor of chemistry in Glasgow, Scotland. Graham formulated the law of diffusion of gases, known as Graham’s Law, and described the idea of selective diffusion. This selective diffusion, or separation of substances across a semipermeable membrane, gave rise to the term dialysis, which was first used by Graham in 1854 (Cameron, 2002). The science of clinical dialysis was not recognized for at least 50 years after Graham’s death.
Who was credited with constructing the first artificial kidney?
There are several better known groups and individuals who contributed to the scientific development of the artificial kidney. The earliest written account describing the process of filtering substance with the use of an artificial device was in 1913. John Abel and his colleagues, Leonard Rowntree and Bernard Turner, built a device to remove toxicities from the blood known as the vividiffusion apparatus. This device was made out of hollow collodion tubes housed in a glass cylinder in which dialysate was circulated. The collodion tubes had microscopic pores in them that allowed substances to seep out of the tubes and into the circulating fluid. Hirudin, a substance extracted from leeches, was used as an anticoagulant. This was the first artificial kidney and it debuted in 1913 at a medical conference in London. Abel and his colleagues demonstrated the device during a procedure in which salicylic acid was removed from the blood of an animal. The system did not use a pump to circulate the blood, but rather used the force of the heart to pump the blood through the extracorporeal circuit (Cameron, 2002). The process of constructing the dialyzer was arduous and the collodion tubes were very fragile. This device was never used on a human, but it served as a model for future dialyzer development.
When was the first successful treatment performed with an artificial kidney?
Dr. Willem J. Kolff is often referred to as the Father of Dialysis. Kolff was a Dutch physician who in 1943 created the first dialyzer suitable for human use, called the rotating drum dialyzer. Kolff used cellophane, a material not used by previous scientists, to construct the hollow tubes on his device. In his procedure, the patient’s blood circulated in a spiral of cellophane tubing that was wrapped around a wooden drum. The drum rotated through a dialyzing solution housed in a porcelain tank (Friedman, 2009). Kolff only dialyzed patients in acute renal failure, and dialysis with this device required a treatment time of approximately six hours. This artificial kidney was very awkward and employed no safety features, but it was the beginning of success in treating patients as a result of advances in technology. In 1948 Kolff redesigned his device at the Peter Bent Brigham Hospital in Boston along with Dr. Carl Walters and Dr. John Merrill. The Kolff-Brigham artificial kidney was constructed of stainless steel and had a Plexiglas hood. The volume of dialyzer clearance could be modified by adjusting the number of wraps of cellulose tubing. These dialyzers would be used to treat acute renal failure in injured soldiers during the Korean War. Kolff would later develop a disposable coil dialyzer known as the twin-coil dialyzer.
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