A History of Dialysis

by Cameron, J. Stewart

• ISBN13: 9780198515470
• ISBN10: 0198515472
• Format: Hardcover
• Copyright: 2002-09-05
• Publisher: Oxford University Press

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