Will Nephrologists Use a Wearable Artificial Kidney?

Abstract

Willem Johan Kolff, despite shortages of materials under the oppressive World War II German occupation of the Netherlands in 1942, designed and fabricated the world's first practical artificial kidney. In his 1947 recounting of initial trials of the artificial kidney, aptly titled “New Ways of Treating Uraemia,” Kolff restricted treatments to those who had acute kidney injury, believing that “chronic nephritis is no indication for treatment with the artificial kidney, although an acute exacerbation of a chronic uraemia might be an indication in some cases” ( 1). Tentatively limiting dialysis to 50 ml of blood withdrawn from a vein, Kolff gradually increased the volume of blood aliquots to 100 ml in intermittent treatments that lasted as long as 17 h at estimated urea clearances of 140 ml/min and removed as much as 268 g of urea during a single dialysis session. Lacking pressure control of circulating blood within the dialyzer, fluid was extracted by raising dialysate osmolality with glucose added to the salt and bicarbonate mixture. Sixteen patients underwent hemodialysis between March 1943 and July 1944, 15 of whom died; a sole survivor may have benefited from dialysis. After a 14-mo hiatus enforced by the last battles of World War II, Kolff, on September 11, 1945, performed an 11.5-h dialysis on 80 L of blood, enabling his 17th patient, a 68-yr-old woman in coma attributed to the hepatorenal …