LARGE-SCALE HEMODIALYSIS

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Abstract
“When heparin was available to prevent clotting outside the body and when cellophane membranes became useful as excellent dialyzing membranes, the construction of an artificial kidney became a purely mechanical task”(l). Thus has the earliest successful practicioner of clinical dialysis described the essential problem in developing hemodialysis, over the last twenty years, as a more effective and more widely used tool for the palliation of renal failure. For all of the truth contained in this statement, the fact remains that this 'purely mechanical task' has by no means been completed. Nor, however much the achievement of a cheap, effective hemodialysis procedure rests on mechanical design, can the task be considered to have been isolated from developing medical knowledge and, even more importantly, from the contemporary economics of medical care. The purpose of this paper is twofold: to survey twenty years of effort expended in dialyzing system design, that we may see where we stand with respect to our mechanical task and to integrate mechanical possibilities with contemporary medical and economic factors, that the most fruitful direction for dialyzing system development may be seen more clearly. The principal potential application of hemodialysis is in the treatment of chronic renal failure, where some estimates, said to be conservative, suggest that in a short time as many as one million dialyses might be required annually in this country(2). The purpose, location, and frequency of dialysis significantly affect the mechanical nature of the optimum system. This paper concentrates on the design of dialysis systems for the treatment of chronic uremia.

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