Treatment of renal failure with the disposable artificial kidney: Results in fifty-two patients

Abstract

The results of treatment with the coil (disposable artificial) kidney in ninety dialyses in fifty-two patients described in this paper establish this type of artificial kidney as a useful tool for the treatment of uremia. The prefabricated coil kidney is more convenient to set up and easier to use than any other type of artificial kidney yet devised, and is now commercially available. Of twenty-nine patients with acute renal failure, fifteen recovered. Three more might have survived if the present concept of earlier dialysis had been fully applied to them. We now believe that a patient with severe trauma, crushing injury, fulminant infection or intoxication should be given the benefit of dialysis before chemical changes in the blood indicate impending danger. Such a patient may have to be dialyzed every two or three days. Of twenty-three patients with chronic renal failure, thirteen were in improved condition when they were discharged from the hospital. Among the symptoms and signs of uremia that improved during or after dialysis were twitching, convulsions, disturbances in sensorium, vomiting and Kussmaul respiration. Changes in blood pressure during dialysis could not always be avoided. Decreases in blood pressure, when they occurred, were controlled by transfusion of small amounts of blood. Increases in blood pressure, when they occurred, sometimes required the administration of a ganglionic-blocking agent. In five of six patients with intractable hypotension before dialysis, the increase in arterial pressure during dialysis was beneficial and could be maintained. Hemorrhages due to heparin caused no serious problems in this series. (Nasal administration of oxygen and manipulation of other tubes through the nose should be avoided.) Electrolytes were corrected in a manner that could be pre-determined by the composition of the rinsing fluid; the use of standardized rinsing fluids proved satisfactory. Urea clearance rates were determined during eleven dialyses at flow rates of 200 ml. per minute. The average clearance of 105 ml. per minute was lower than that found experimentally (130 to 140 ml. per minute). Larger blood flows, up to 340 ml. per minute, have recently been used, with an increase in clearance After dialysis a decrease of urinary output was insignificant in the patients with acute uremia but was pronounced in some of the patients with chronic uremia. The rate of ultrafiltration with the coil kidney approximates 300 ml. per hour of dialysis but it can be increased to 700 ml. Ultrafiltration is considered advantageous as most patients with uremia are edematous. Four typical case reports are presented: (1) A man in acute uremia due to crush syndrome, whose clinical condition improved after dialysis. (2) A woman with anuria following an extensive abdominoperineal operation in whom early dialysis facilitated management. (3) A woman who was maintained for sixty-three days of virtual anuria; the course in this patient proves that the artificial kidney can replace excretory renal function amazingly well. (4) A man with chronic uremia who after a single dialysis was restored to useful life for six months. The course in this patient demonstrates the possibility of worthwhile temporary improvement with one dialysis, but it also demonstrates the ultimate impotence of all measures in chronic renal disease.