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Home dialysis

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Abstract

The first clinical use of the artificial kidney by Kolff in 1943 made it possible to prolong life by hemodialysis. Initially, this procedure was used mainly for patients with acute renal failure, since no permanent access to the blood stream was available. Long-term treatment of patients with chronic renal failure was made possible in 1960 when Quinton et al1 developed the arteriovenous shunt. However, infection, clotting, and sacrifice of blood vessels continued to be major problems. Repeated access to the circulatory system was improved in 1966 when Brescia et al2 described the technique for making a subcutaneous arteriovenous fistula. Saphenous vein loops3 and bovine heterografts4 have made long-term hemodialysis possible for patients with thrombosis of superficial veins.

Although the results of chronic hemodialysis were encouraging, it soon became apparent that the cost of hospital dialysis, even on an outpatient basis, was prohibitive. Consequently, the first Artificial Kidney Center was established adjacent to a community hospital in Seattle, Washington.5 Limited care dialysis facilities are now in existence throughout the world. Home dialysis began to decrease the expense of chronic therapy; it was first used in Boston in 1963,6 in Seattle and London in 1964,7, 8 and at the Cleveland Clinic in 1966.

Patient selection and clinical data

On January 1, 1975, the National Dialysis Registry reported that 12,977 patients were on chronic hemodialysis, 3,712 of whom were on home dialysis programs. This paper reports 8 years’ experience with home dialysis patients.* Between January 1, 1966 and December 31, 1973, 129 patients. . .


 

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