Introduction to Six Short Papers on the Present Status of Clinical Hemodialysis
WILLEM J. KOLFF, M.D.
Department of Artificial Organs, and Division of Research
BOTH gradual improvements and sudden innovations have enhanced the usefulness of the artificial kidney in the treatment of uremia; this is true both for acute and for chronic renal failure.
Patients who are very sick, very young, or very old, can now be treated with dialysis and ultrafiltration.
The danger of hemorrhage is no longer a contraindication, since it is possible to heparinize the blood in the machine without prolonging the clotting time of the patient's blood.
Growing experience in the treatment of barbiturate poisoning makes dialysis preferable over conservative management in all really serious cases.
The application of very frequent, daily, or even continuous dialysis makes it possible to reduce levels of urea, creatinine, uric acid, and other retention products to normal or nearly normal levels. This technic relieves the symptoms of uremia such as nausea, vomiting, and twitching, and helps to avoid many of the complications that were formerly expected in patients in renal failure. Most important, this intensive dialysis seems to reduce the chance of infection, particularly of bronchopneumonia.
Large amounts of water can be removed by the artificial kidneys by ultrafiltration. Among the most dramatic clinical results of dialysis are the effects of ultrafiltration upon the dyspnea and cyanosis of patients with pulmonary edema. In our experience a 90-minute dialysis plus ultrafiltration has never failed to improve the clinical symptoms of pulmonary edema, although the patchy design may still be evident on roentgenograms of the chest. A patient with intractable cardiac edema can be treated with . . .