History of hemodialyzers' designs

Abstract

Accumulation of knowledge requisite for development of hemodialysis started in antiquity and continued through Middle Ages until the 20th century. Firstly, it was determined that the kidneys produce urine containing toxic substances that accumulate in the body if the kidneys fail to function properly; secondly, it was necessary to discover the process of diffusion and dialysis; thirdly, it was necessary to develop a safe method to prevent clotting in the extracorporeal circulation; and fourthly, it was necessary to develop biocompatible dialyzing membranes. Most of the essential knowledge was acquired by the end of the 19th century. Hemodialysis as a practical means of replacing kidney function started and developed in the 20th century. The original hemodialyzers, using celloidin as a dialyzing membrane and hirudin as an anticoagulant, were used in animal experiments at the beginning of the 20th century, and then there were a few attempts in humans in the 1920s. Rapid progress started with the application of cellophane membranes and heparin as an anticoagulant in the late 1930s and 1940s. The explosion of new dialyzer designs continued in the 1950s and 1960s and ended with the development of capillary dialyzers. Cellophane was replaced by other dialyzing membranes in the 1960s, 1970s, and 1980s. Dialysis solution was originally prepared in the tank from water, electrolytes, and glucose. This solution was recirculated through the dialyzer and back to the tank. In the 1960s, a method of single-pass dialysis solution preparation and delivery system was designed. A large quantity of dialysis solution was used for a single dialysis. Sorbent systems, using a small volume of regenerated dialysis solution, were developed in the mid 1960s, and continue to be used for home hemodialysis and acute renal failure. At the end of the 20th century, a new closed system, which prepared and delivered ultrapure dialysis solution preparation, was developed. This system also had automatic reuse of lines and dialyzers and prepared the machine for the next dialysis. This was specifically designed for quotidian home hemodialysis. Another system for frequent home hemodialysis or acute renal failure was developed at the turn of the 21st century. This system used premanufactured dialysis solution, delivered to the home or dialysis unit, as is done for peritoneal dialysis.

Developments in extracorporeal therapy for the poisoned patient

“…Thomas Graham used animal membranes and later cotton treated with albumin to conduct experiments on osmotic pressure as driving force to separate crystalloids (salts) from colloids (albumin). German and French chemists are credited with developing collodion, which was known as guncotton because of its tendency to explode at high temperature, from nitrocellulose dissolved in ether and ethyl alcohol [1]. Adolph Fick published his work on the passive movement of solute across membranes as a result of differences in concentration soon after Graham [2].…”

“…The total length of the tubing was 756 cm, 2 cm in diameter with total membrane surface area of 1.53 cm 2 [2]. But collodion membranes were fragile and needed to be prepared just in time, their porosity depending on how long the material was soaked in alcohol [1,6].…”

“…Thalheimer used cellophane tubes as an artificial kidney to dialyze nephrectomized dogs. Commercial availability of cellophane allowed for its more widespread use as a dialysis membrane [1]. Kolff successfully dialyzed the first human being in 1943 with a rotating drum kidney using a coiled cellophane membrane [7].…”

Development and analysis of an integral fluidodynamic model in hollow fibre for different operational modes

“…The use of HF devices is growing for sea-water desalination, water clarification, artificial kidneys or hemodiafiltration [1,2], biotechnology applications [3] or catalytic bioreactor [4] due to the advantages of these membrane systems, such as high membrane surface:volume ratio; high density of the catalyst that these reactor systems allow in a small reactor volume [5]; the recovery and reuse of the catalyst from the reaction mixture and the possibility of integrating a catalytic conversion, product separation or concentration and catalyst recovery in a single operation [6].…”

Antecubital arteriovenous fistula in hemodialysis; a comparison between side-to-side versus end-to-side venous anastomosis

“…Currently, there are more than one and a half billion CKD patients living worldwide whose proportion is expected to exceed in near future (2). Hemodialysis is encountered as the most common type of treatment for end-stage renal disease (ESRD) patients (3). Vascular accesses should provide an easy and acceptable flow, during hemodialysis.…”