Monthly Archives: January 2012

A brave beginning

Food depravation, occupation by fascist overlords, and decades before the invention of PCs and the blog are hardly conducive conditions for research, let alone major breakthroughs.  One man thought not.  Willem J Kolff, a physician in Kampden hospital in the Netherlands was perturbed by not being able to do anything for people who went into renal failure.  He knew, if he could just somehow get rid of the toxins for long enough for their kidney’s to recover he may save lives.  In 1943 he built and trailed a dialysis machine(1); – essentially a long tube (30 metres!) of cellophane through which the blood was pumped and what looks like a large washing machine where the urea waste products filtered out of the blood into a rinsing fluid (mainly tap water!).  One important innovation was the use of heparin to prevent blood clotting in the needles.

Miss S with what would now be called End Stage Renal Failure was the first patient.  At just 29 she was dying.   We know nothing more about her, but I salute her and her family for their contribution to science and, ultimately, to the saving of lives.  Miss S would undergo several dialysis sessions which proved that waste products could be removed artificially.  They were successful in preventing further accumulation of waste in her blood for 26 days. Unfortunately, she was terminally ill and died shortly afterwards.  As it turned out the first 15 patients all died.  The sixteenth, though, was the first to undergo dialysis and to live.  She had the acute form of renal failure (now called Acute Kidney Injury, or AKI).  AKI is my area of research and dialysis remains, after nearly 70 years, the only therapy available.

The lessons of the first dialysis machine don’t end at Willem Kolff’s persistence.  It is a wonderful example of cross-fertalisation of ideas.  The second author on the original paper was “H Th J Berk”, director of the Kampden Enamel works.  Berk was responsible for the idea of a horizontal “washing machine.”  Apparently the local Ford dealer provided the ideal pump – from a Model T! The nursing staff and technicians were indispensable.  One, Jan van Noordwijk, at least, found the job kept him out of the hands of the occupiers.

The Kolff Dialysis Machine immortalised in a dutch stamp

1.         Kolff WJ, Berk HT, Welle ter M, van der LEY AJ, van Dijk EC, van Noordwijk J. The artificial kidney: a dialyser with a great area. Acta Medica Scandinavia, vol. 8, p121ff, 1944 .

Kidneys are Kool with a capital K

Minfo: The Kool Kidney

The Kool Kidney

The kidney is still very much a black box to me.  Hence, the box in this mini-infographic (a “minfo”) describing some of the cool stuff our kidneys do.  As you can tell, it is not just a brilliant filter getting rid of waste products but so much more.  Dialysis (with the aid of Nephrologists’ potions) has got to do most of this stuff too.

$100 Dialysis – the vision

$100 dialysis will do for health what the $100 computer did for education.

I have no expertise in dialysis, I’ve only published one paper and a letter that address it directly. What I know is that there are millions the world over with kidney failure whose only hope is transplant or dialysis.  What I see is that dialysis is very expensive – machines and treatments cost tens of thousands of dollars, and that it is only those of us in the so called developed world who have access to them.  This was highlighted by the story of a tongan woman who had come to New Zealand for an eye op (funded from Tonga), who was subsequently found to need life saving dialysis. She was not entitled to it in New Zealand.  There were no dialysis machines in Tonga.  Without a machine she would die.  These people are our neighbours in the pacific, asia, and africa.  Dialysis is conceptually simple, it is a way of filtering waste from the blood. Practically so much waste needs to be filtered, very precisely, whilst maintaining the correct proportions of water and salts, that dialysis is also a substantial challenge.  Extraordinary progress in materials science and the ability to manufacture simple pumps using desktop 3D printers give me hope that $100 Dialysis will be a reality.  Social networking and the internet provide the means by which a vision may be propagated and progressed.  My vision is for a dialysis machine that costs just $100 to manufacture and $100 a year to run, a machine that will save a million lives. I do not see myself as leader of a project, there will need to be dozens of projects led by people far more skilled than I – nephrologists, engineers, nanotechnologists, intellectual property lawyers and the like, simply I hope to light a fire.