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Healthy Kidney. Image from Kevin O'Neill
The kidneys are a pair of organs located in the back of the abdomen. Each kidney is about 4 or 5 inches long -- about the size of a fist. The kidneys' function are to filter the blood. All the blood in our bodies passes through the kidneys several times a day. The kidneys remove wastes, control the body's fluid balance, and regulate the balance of electrolytes. As the kidneys filter blood, they create urine, which collects in the kidneys' pelvis -- funnel-shaped structures that drain down tubes called ureters to the bladder. Each kidney contains around a million units called nephrons, each of which is a microscopic filter for blood. It's possible to lose as much as 90% of kidney function without experiencing any symptoms or problems. The kidneys also function as a part of the endocrine system, producing erythropoietin and calcitriol. Erythropoietin is involved in the production of red blood cells and calcitriol plays a role in bone formation.
Dr. Willem Johan Kolff (1911-2009)
The History of Dialysis
Dr. Willem Kolff, a Dutch physician, constructed the first working dialyzer in 1943 during the Nazi occupation of the Netherlands. Due to the scarcity of available resources, Kolff had to improvise and build the initial machine using sausage casings, beverage cans, a washing machine, and various other items that were available at the time.
In 1943, Kolff’s invention, although crude, was completed. During the course of the next two years, he treated 16 patients with acute kidney failure but had little success.
Then, in 1945, when a 67-year-old woman in uremic coma regained consciousness after 11 hours of hemodialysis with Kolff’s dialyzer. Her first words? “I’m going to divorce my husband!” Thanks to Kolff, she did in fact follow through on her plan and lived seven more years before dying of another ailment. She was the first-ever patient successfully treated with dialysis.
Kolff’s machine is considered the first modern drum dialyzer, and it remained the standard for the next decade. At the time of its creation, Kolff’s goal was to help kidneys recover. The brave doctor had no way of knowing that his invention was one of the foremost life-saving developments in the history of modern medicine.
After World War II ended, Kolff donated the five artificial kidneys he’d made to hospitals around the world, including Mt.SinaiHospital in New York.
In the late 40s, Kolff came to the US, where he continued his research. At the time, many people in the medical field were scandalized by kidney dialysis, calling it “an abomination.” Kolff and others like him who worked with dialysis were frequently ridiculed. But Kolff didn’t give up.
At Mt.SinaiHospital, he instructed other doctors in the use of his artificial kidney, but the hospital’s administrators were opposed to this type of therapy. Therefore, Kolff and his colleagues were forced to perform dialysis in a surgical suite after hours. Spectators crowded the gallery to watch the “rogues” in action.
The next few years saw many strides in dialysis. Kolff gave a set of blueprints for his kidney machine to George Thorn at the PeterBentBrighamHospital in Boston. This led to the manufacture of the next generation of Kolff’s dialyzer, a stainless steel Kolff-Brigham kidney, which paved the way for the first kidney transplant in 1954....read more
Museum Boerhaave Kolff's Artificial Kidney
The birth of the Rotating Drum Artificial Kidney
“As a young physician at the University of Groningen in the Netherlands in 1938, Dr. Kolff watched a young man die a slow, agonizing death from temporary kidney failure. He reasoned that if he could find a way to remove the toxic waste products that build up in the blood of such patients, he could keep them alive until their kidneys rebounded.
For his first experiment, Dr. Kolff filled sausage casings with blood, expelled the air, added a kidney waste product called urea and agitated the contraption in a bath of salt water. The casings were semipermeable. Small molecules of urea could pass through the membrane, while larger blood molecules might not.
In five minutes, all the urea had moved into the salt water. The concept for building an artificial kidney was born.”
It consisted of 50 yards of sausage casing wrapped around a wooden drum set into a salt solution (Fig. 1). The patient’s blood was drawn from a wrist artery and fed into the casings. The drum was rotated, removing impurities. To get the blood safely back into the patient, Dr. Kolff copied the design of a water-pump coupling used in Ford motor engines. Later he used orange juice cans and a clothes washing machine to build his apparatuses....continue reading
The HomeChoice™ peritoneal dialysis system
behind the development of the HomeChoice™ peritoneal dialysis system is a man some of you may better know as the inventor of the Segway® Human Transporter, Dean Kamen.
As an inventor, he holds more than 440 U.S. and foreign patents, many of them for innovative medical devices that have expanded the frontiers of health care worldwide.
While still a college undergraduate, he invented the first wearable infusion pump, which rapidly gained acceptance from such diverse medical specialties as chemotherapy, neonatology, and endocrinology.
In 1976, he founded his first medical device company, AutoSyringe, Inc., to manufacture and market the pumps. At age 30, he sold that company to Baxter Healthcare Corporation. By then, he had added a number of other infusion devices, including the first wearable insulin pump for diabetics.
HomeChoice APD system
HomeChoice APD system: A cycler that gives you more daytime flexibility
Following the sale of AutoSyringe, Inc., he founded DEKA Research & Development Corporation to develop internally generated inventions as well as to provide research and development for major corporate clients.
Kamen led DEKA's development of the HomeChoice™ peritoneal dialysis system for Baxter International Inc. The HomeChoice™ system allows patients to be dialyzed in the privacy and comfort of their home and quickly became the worldwide market leader.
HomeChoice is an Automated Peritoneal Dialysis (APD) system that has been designed to meet the needs of many patients, including children and adults of different weights and sizes. It is used at night for APD therapy and has been the only pump-based cycler for over a decade with history of proven performance. And because it's small in size, easy to use and won't get in your way, it's ideal for use at home and can easily be placed on your bedside nightstand. It is also highly portable, so it can be used when you travel.
HomeChoice PRO is an Automated Peritoneal Dialysis (APD) system that allows your doctor to remotely monitor your therapy with the use of customized clinical software, and a special data card.
The device is easy to use; you just insert a PRO card into your machine at the start of treatment to capture all the information from that dialysis session. This information can help your doctor determine if your treatment or prescriptions require any changes, which can help make the most of your therapy.
Illustration of Diseased Kidney. Image from archiveshub
Dialysis In medicine, dialysis (from Greek dialusis, meaning dissolution, dia, meaning through, and lysis, meaning loosening or splitting) is a process for removing waste and excess water from the blood, and is used primarily to provide an artificial replacement for lost kidney function in people with renal failure. Dialysis may be used for those with an acute disturbance in kidney function (acute kidney injury, previously acute renal failure), or progressive but chronically worsening kidney function–a state known as chronic kidney disease stage 5 (previously chronic renal failure or end-stage kidney disease). The latter form may develop over months or years, but in contrast to acute kidney injury is not usually reversible, and dialysis is regarded as a "holding measure" until a renal transplant can be performed, or sometimes as the only supportive measure in those for whom a transplant would be inappropriate. Dialysis and altitude - A study found that death rates for dialysis patients are 10%-15% lower for those whose homes are higher than 4,000 feet, compared to those who live at sea level.
Primary Dialysis: Hemodialysis, Peritoneal dialysis and Hemofiltration.
Dialyser, also known as an artificial kidney, used in hemodialysis.
There are three primary and two secondary types of dialysis: hemodialysis (primary), peritoneal dialysis (primary), hemofiltration (primary), hemodiafiltration (secondary), and intestinal dialysis (secondary).
In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer (see image), exposing it to a partially permeable membrane. The dialyzer is composed of thousands of tiny synthetic hollow fibers. The fiber wall acts as the semipermeable membrane. Blood flows through the fibers, dialysis solution flows around the outside of the fibers, and water and wastes move between these two solutions. The cleansed blood is then returned via the circuit back to the body.....read more
Quotidian Dialysis, As the frequency of hemodialysis sessions has always been a concern, it is not astonishing that interest in quotidian (daily) hemodialysis appears to be growing worldwide. The main reasons for more frequent dialysis are to maximize well-being and minimize both intra- and interdialytic symptoms, as well as to improve the treatment of patients with severe underlying medical problems, particularly cardiovascular disease....read more
Artificial kidney is often a synonym for hemodialysis, but may also, more generally, refer to renal replacement therapies (with exclusion of renal transplantation) that are in use and/or in development.
In peritoneal dialysis, a sterile solution containing glucose is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a partially permeable membrane. The peritoneal membrane or peritoneum is a layer of tissue containing blood vessels that lines and surrounds the peritoneal, or abdominal, cavity and the internal abdominal organs (stomach, spleen, liver, and intestines). The dialysate is left there for a period of time to absorb waste products, and then it is drained out through the tube and discarded.....read more
Hemofiltration is a similar treatment to hemodialysis, but it makes use of a different principle. The blood is pumped through a dialyzer or "hemofilter" as in dialysis, but no dialysate is used. A pressure gradient is applied; as a result, water moves across the very permeable membrane rapidly, "dragging" along with it many dissolved substances, including ones with large molecular weights, which are not cleared as well by hemodialysis. Salts and water lost from the blood during this process are replaced with a "substitution fluid" that is infused into the extracorporeal circuit during the treatment....read more
Hemodialysis machine is required to pump the blood at requisite flow. Apart from this, the machine mixes three different components of dialysis solution to make it into a dialysate with physiological concentrations of electrolytes.
The machine also monitors the flow parameters and the pressures in the circuit.
The amount of ultrafiltration ( removal of excess fluid from the body) can be programmed into the machine and current day machines will precisely remove the fluid to the last milliliter.
Secondary Dialysis: hemodiafiltration and intestinal dialysis.
Hemodialfiltration is a combination of hemodialysis and hemofiltration. In theory, this technique offers the advantages of both hemodialysis and hemofiltration.
In intestinal dialysis, the diet is supplemented with soluble fibres such as acacia fibre, which is digested by bacteria in the colon. This bacterial growth increases the amount of nitrogen that is eliminated in fecal waste.
An alternative approach utilizes the ingestion of 1 to 1.5 liters of non-absorbable solutions of polyethylene glycol or mannitol every fourth hour.
Causes & Symptoms of Kidney Disease
In the United States
thetwo leading causes of kidney failure, also called end stage renal disease or ESRD, are diabetes (also called Type 2, or adult onset diabetes) and high blood pressure. When these two diseases are controlled by treatment, the associated kidney disease can often be prevented or slowed down.
Many effective drugs are available to treat high blood pressure. In addition, healthy lifestyle changes, such as losing weight and regular exercise, often help to control, and may even help to prevent, high blood pressure.
Careful control of blood sugar in diabetics helps to prevent such complications as kidney disease, coronary heart disease and stroke. When diabetics have associated high blood pressure, special drugs called angiotensin converting enzyme (ACE) inhibitors may help to protect their kidney function.
Thethird leading cause of end stage kidney disease in the U.S. is glomerulonephritis, a disease that damages the kidneys' filtering units, called the glomeruli. In many cases, the cause of this disease is not known, but some cases may be inherited and others may be triggered by an infection.
Someof the other diseases that may affect the kidneys include infections, kidney stones and inherited diseases such as polycystic kidney disease. The kidneys can also be damaged by overuse of some over-the-counter pain killers and by taking illegal drugs such as heroin.
End stage kidney disease occurs when about 90 percent of kidney function has been lost.
People with kidney failure may experience:
nausea, vomiting, weakness, fatigue, trouble sleeping, confusion, difficulty concentrating, loss of appetite, itchy skin, swollen feet and ankles, puffiness around the eyes, especially in the morning, frequent urinating, especially at night, blood and/or protein in urine. It can be diagnosed by blood and urine tests.
If you know of any U.S. Based Dialysis Provider not yet listed below or if you would like to have your Dialysis Center/Clinic added to this list please contact us with your provider's name, a brief profile and a link to the website at;
• American Renal Associates: American Renal Associates, Inc. (ARA) is a national provider of dialysis services, focused exclusively on joint venture relationships with nephrologists.
• DaVita: DaVita, Inc. is one of the largest kidney care companies in the United States, with corporate headquarters in Denver, Colorado. Their offerings include in-center hemodialysis, in-center nocturnal dialysis, peritoneal dialysis, home hemodialysis, vascular access management, chronic kidney disease education, and renal diet assistance.
• Diversified Specialty Institute: Diversified Specialty Institute is a healthcare group created in 2003 whose purpose is to build and operate hospitals across the nation. The group’s primary task is the operation of over a hundred dialysis clinics around the nation.
• Dialysis Clinic, Inc: Dialysis Clinic, Inc. is a nonprofit medical corporation founded in 1971. It was founded for care and research of patients with kidney disease and supports activities in kidney transplant and dialysis throughout the midwest and south of the USA. It is headquartered in Nashville, Tennessee.
• Fresenius Medical Care: Fresenius Medical Care is the world's largest integrated provider of products and services for individuals undergoing dialysis because of chronic kidney failure, a condition that affects more than 2.1 million individuals worldwide.
• Gambro Healthcare: Gambro is a global medical technology company and a leader in developing, manufacturing and supplying products and therapies for Kidney and Liver dialysis.
• Renal Advantage: Renal Advantage provides patient centered dialysis centers. Our Nephrologists are the top care providers in the U.S.
• The Northwest Kidney Centers: The Northwest Kidney Centers (NKC) is a not-for-profit community based organization whose mission is: "to promote the optimal health, quality of life and independence of people with kidney disease, through patient care, education, and research." NKC partners with the Northwest Kidney Centers Foundation (formerly known as Northwest Kidney Foundation) to raise support to advance this mission.
• Satellite Healthcare: Satellite Healthcare is one of the nation's first and leading providers of kidney dialysis services and a major sponsor of nephrology research.
• U.S. Renal Care: U.S. Renal Care provides patients with a choice of a full range of quality care, including in-center or at-home hemodialysis and peritoneal dialysis services. In addition, the company also manages several acute setting dialysis programs in conjunction with local community hospitals
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