Cimino-Brescia y los pioneros de la hemodiálisis / Cimino-Brescia and the pioneers of haemodialysis

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A tribute to Dr Willem J. Kolff: innovative inventor, physician, scientist, bioengineer, mentor, and significant contributor to modern cardiovascular surgical and anesthetic practice.

Dr Willem J. Kolff was surely one of the greatest inventors/physicians/scientists/bioengineers of the last few hundred years. He was knighted (Commander of the Order of Oranje-Nassau) in 1970 by Queen Juliana of the Netherlands. In 1990, Life magazine published a list of its own 100 most important figures of the 20th century. Kolff stood in 99th place as the Father of Artificial Organs. Dr Kolff forged a path of innovative thinking and creativity that has had a huge impact on the quality of human life. His contributions to the development of the artificial kidney and dialysis, the heart-lung machine, the membrane oxygenator, potassium arrest of the heart, the AH, mechanical cardiac assistance, and other artificial organs, and his support and mentoring of hundreds to thousands of anesthesiologists, surgeons, and bioengineers throughout the world, have had a significant impact on anesthesiology and the medical community.

[Kolff and the artificial kidney]. / Kolff en de kunstnier.

Willem Kolff (1911-2009), son of a physician, studied medicine in Leiden and specialised in internal medicine in Groningen. It was there that he started attempts to apply the phenomenon of dialysis in patients suffering from renal failure. He built the first prototypes of dialysis machines after his appointment as an internist in the municipal hospital in Kampen, during the Second World War. Indeed, in the first 15 patients he managed to decrease urea levels, resulting in temporary clinical improvement, but eventually they all died. It was not until after the war that dialysis helped a patient survive an episode of acute glomerulonephritis. After 1950 he continued his work on artificial organs in the United States (first in Cleveland and later, after 1967, in Salt Lake City). Although most of his work from then on revolved around the development of an artificial heart, he also contributed to the design of a compact, disposable apparatus for dialysis, the 'twin coil'. Haemodialysis also became feasible for patients with chronic renal failure after the 'Scribner shunt' (1960) provided easy access to the circulation. Peritoneal dialysis is another option. Excess mortality, mainly from cardiovascular disease, is still a largely unsolved problem.

The wonderful apparatus of John Jacob Abel called the "artificial kidney".

Hemodialysis, which now provides life-saving therapy to millions of individuals, began as an exploratory attempt to sustain the lives of selected patients in the 1950s. That was a century after the formulation of the concept and determination of the laws governing dialysis. The first step in the translation of the laboratory principles of dialysis to living animals was the "vividiffusion" apparatus developed by John Jacob Abel (1859-1938), dubbed the "artificial kidney" in the August 11, 1913 issue of The Times of London reporting the demonstration of vividiffusion by Abel at University College. The detailed article in the January 18, 1914 of the New York Times, reproduced here, is based on the subsequent medical reports published by Abel et al. Tentative attempts of human dialysis in the decade that followed based on the vividiffusion apparatus of Abel and his materials (collodion, hirudin, and glass) met with failure and had to be abandoned. Practical dialysis became possible in the 1940s and thereafter after cellophane, heparin, and teflon became available. Abel worked in an age of great progress and experimental work in the basic sciences that laid the foundations of science-driven medicine. It was a "Heroic Age of Medicine," when medical discoveries and communicating them to the public were assuming increasing importance. This article provides the cultural, social, scientific, and medical background in which Abel worked, developed and reported his wonderful apparatus called the "artificial kidney."