When was the first artificial kidney used in humans?
Thomas Graham (1805–1869), a physical chemist whose seminal work on osmotic forces of fluids paved the way to hemodialysis, has been dubbed the father of modern dialysis.
His studies on the behavior of biological fluids across a semipermeable membrane presaged the development of an artificial kidney and formulated the scientific basis of clinical dialysis, specifically that blood flowing in a semipermeable membrane that is in contact with an electrolyte solution (dialysate) allowed for the diffusion of small molecules from blood into the dialysate.
The first use of dialysis in vivo, so called vividiffusion, was in rabbits and dogs by John Jacob Abel (1857–1928) and his associates at Johns Hopkins in 1912 and 1913. His primitive attempts at dialyzing a few patients were utter failures, but it was his machine that was first dubbed an “artificial kidney” by a correspondent of the London Times . Tentative attempts at dialysis of humans were undertaken by Georg Haas (1886–1971) in Giessen in the 1920s, using collodion membranes and hirudin as anticoagulant that had also been used by Abel. Collodion and hirudin had to be prepared fresh, were not standardized, were difficult to sterilize, and soon led to the abandonment of clinical dialysis.
Practical dialysis became possible in the early 1940s as a result of two new substances: a cellulose acetate (cellophane) membrane and a new anticoagulant heparin. Three early pioneers to use the new membrane and anticoagulant in clinical dialysis were Gordon Murray (1884–1972) in Canada, Niels Alwall (1906–1986) in Sweden, and Willem Kolff (1911–2009) in the Netherlands; but it was Kolff working in Kampen under the tensions and difficult conditions of war-torn Holland who achieved the first clinically successful hemodialysis in humans. Kolff’s “rotating drum hemodialyzer” was a wooden, pumpless drum, wrapped 30 times with 130 feet of cellophane tubing (connected to the circulation) immersed in a ceramic bathtub containing a saline solution. Beginning in 1942, Kolff experimented with his artificial kidney. His first 16 patients never recovered and went on to succumb to kidney failure. Only 2.5 years later did his first patient, Sofia Maria Schafstadt, survive. Ironically, she had been a Nazi collaborator who was actually imprisoned. She had cholecystitis, developed septicemia, and was treated with one of the recently available sulfonamides. Her acute kidney injury was a result of sulfonamide crystal precipitation in the tubules, a common side effect of these early wonder antibacterial drugs then in use.
