9780198515470

A History of Dialysis

by
  • ISBN13:

    9780198515470

  • ISBN10:

    0198515472

  • Format: Hardcover
  • Copyright: 2002-09-05
  • Publisher: Oxford University Press

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Supplemental Materials

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Summary

This book tells the extraordinary story of how the function of the first - and so far almost the only - human organ was replaced by a machine, and the "artificial kidney" entered medical and public folk-lore. A practical artificial kidney, or dialyser, came about by advances in sciencefollowed by the acquisition of new synthetic materials which made the application of these ideas possible. However it was the dedication and persistence of a number of talented pioneers who pressed ahead against professional opposition to achieve success, first in the treatment of temporary,recoverable kidney failure, and then permanent renal shut-down which made it a success. The apparent high cost and limited availability of this form of treatment immediately raised ethical questions which had never been questioned before, centering around equity of access to treatment, when and iftreatment could be denied, and - worst of all - the agonising decision of when, once established, it should be stopped. Spiralling costs as the true number of people with kidney failure became evident raised major political and financial questions, which were addressed in different countries indifferent ways which reflected - but also helped change - patterns of how medical care is provided. In developed countries, the problem could be solved by allocating a disproportionate amount of money to the treatment of relatively few kidney patients, but in the developing world the cost oftreatment still limits its availability, as it does all forms of modern health care. Nevertheless, today almost one million people world-wide are maintained alive following terminal kidney failure, two thirds of them by various forms of dialysis and the remainder bearing kidney transplants, almost always placed after a period on dialysis. The story is also the sum of the oftenheroic lives of these hundreds of thousands of patients, a few of whom have today been maintained alive and active for more than 35 years, and many of whom suffered known, but also unexpected complications as a result of their treatment.

Table of Contents

Why a history of dialysis?
1(7)
Replacement of body function by mechanical means
8(7)
The science of dialysis: `uraemic toxins'
15(9)
The science of dialysis: osmosis, diffusion and semipermeable membranes
24(8)
Osmosis diffusion and dialysis
24(4)
Dialysis membranes in the laboratory
28(4)
Anticoagulants and extracorporeal circuits: the first haemodialysis
32(12)
The beginnings of anticoagulation
32(1)
In vivo dialysis in animals
33(11)
The search for new dialysis membranes: the peritoneum and the beginnings of peritoneal dialysis
44(17)
The search for better dialysis membranes
44(2)
The use of the peritoneal membrane in situ for dialysis
46(15)
The first haemodialyses in humans: the introduction of heparin and cellophane
61(13)
The work of Georg Haas
61(3)
Heparin and its controversial discovery: the disputed role of Jay Maclean
64(2)
Howell's role in the discovery of heparin
66(1)
The first use of heparin for haemodialysis
67(1)
A new membrane: celluiose
68(6)
The first practical dialysis machines: Kolff, Murray and Alwall
74(21)
Willem Kolff
74(6)
Gordon Murray
80(7)
Nils Alwall
87(8)
Peritoneal and intestinal dialysis after the Second World War
95(15)
Peritoneal dialysis
95(8)
Intestinal dialysis
103(2)
Dialysis be other routes
105(5)
The rise of the concept of acute renal failure; the flame photometer, urologists and nephrologists
110(10)
The spread of dialysis treatment for acute renal failure (1947--1960)
120(37)
Europe
120(11)
Latin America
131(2)
North America
133(8)
Peritoneal dialysis in the 1950s
141(5)
Intestinal dialysis in the 1950s
146(1)
Dialysis treatments at the end of the 1950s
147(10)
New designs of artificial kidney
157(22)
Many new dialysers
157(3)
New materials determined the new designs
160(1)
The twin-coil kidney
161(2)
Involvement of industry
163(1)
Flat-plate parallel-flow dialysers: the Skeggs-Leonards, MacNeill and Kiil kidneys
164(7)
Capillary dialysers
171(8)
The role of dialysis technology in the founding of nephrology
179(8)
New materials and new methods of access I: long-term haemodialysis becomes possible
187(13)
The external arteriovenous shunt
187(6)
The arteriovenous fistula
193(1)
The growth of dialysis units
194(1)
Home haemodialysis
195(1)
The beginning of dialysis monitoring
196(4)
New materials and methods II: long-term peritoneal dialysis becomes possible
200(9)
The beginnings of long-term peritoneal dialysis
200(2)
New catheters and Cycling machines
202(3)
Clinical use of peritoneal dialysis in the 1960s
205(1)
Peritoneal dialysis for acute renal failure in the 1960s
205(4)
Dialysis patients in the 1960s and 1970s: old and new complications
209(20)
Long-term dialysis patients in the 1960s and 1970s
209(2)
Complications of patients on long-term dialysis from uraemia and other causes
211(5)
The hepatitis plague: blood-borne viruses
216(3)
The psychology of long-term dialysis
219(1)
Summing up long-term dialysis in the 1960s and 1970s
219(1)
Patients going into acute renal failure
220(9)
The 1970s and 1980s: new technical advances and some new problems
229(29)
Dialysis dysequilibrium
229(1)
Dialysis leukopaenia
229(1)
Access for haemodialysis
230(1)
New membranes for haemodialysis
231(2)
New haemodialysis strategies: shorter or longer? More or less frequent?
233(3)
Sequential ultrafiltration
236(1)
Back to bicarbonate
236(1)
Dialysate regeneration
236(1)
Haemoperfusion using adsorbent materials
237(2)
Ultrafiltration and haemodiafiltration
239(3)
Clinical uses of haemofiltration techniques
242(3)
The `middle molecule' hypothesis
245(1)
The quantification of dialysis: the dialysis index, URR and urea Kt/ V
245(2)
Dialysis for conditions other than uraemia
247(11)
A detective story: the rise and fall of aluminium poisoning---and a penalty of halfway technology: the rise and rise of dialysis amyloidosis
258(15)
Aluminium posioning: dialysis dementia
258(5)
The rise and rise of dialysis amyloidosis
263(10)
Peritoneal dialysis transformed: CAPD
273(14)
Peritoneal dialysis 1970--1978
273(1)
CAPD
273(3)
CAPD becomes the major treatment choice
276(1)
Social and fiscal aspects of CAPD
277(2)
Peritonitis - a continuing problem
279(1)
How much CAPD? New styles of CAPD
280(1)
Sclerosing encapsulating peritonitis
281(1)
New dialysis fluids
282(5)
Good news and bad news: treatment of renal anaemia, the rising tide of diabetics with end-stage renal failure and withdrawal from dialysis
287(22)
The treatment of renal anaemia
287(6)
The rising tide of diabetic nephropathy
293(6)
Prevention at last?
299(1)
Suicide during dialysis and withdrawal from dialysis
300(9)
The growth of long-term dialysis for long-term renal failure in its fiscal and sociopolitical context
309(19)
The United States
311(6)
The United Kingdom
317(11)
Conclusions: dialysis today---and tomorrow?
328(19)
Basic dialysis technology: more of the same
328(2)
Dialysis: social and financial context and the `dialysis industry'
330(6)
Dialysis patients then and now
336(2)
Has dialysis a future?
338(3)
Can we prevent renal failure?
341(1)
Envoi
342(5)
Index 347

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