First Dialysis Machine — 1943: Kolff Rotating Drum

The first practical artificial kidney was developed during World War II by the Dutch physician Willem Kolff. The Kolff kidney used a 20-meter long tube of cellophane sausage casing as a dialyzing membrane. The tube was wrapped around a slatted wooden drum. Powered by an electric motor, the drum revolved in a tank filled with dialyzing solution. The patient's blood was drawn through the cellophane tubing by gravity as the drum revolved. Toxic molecules in the blood diffused through the tubing into the dialyzing solution. Complete dialysis took about six hours. The Kolff kidney effectively removed toxins from the blood, but because it operated at low pressure, it was unable to remove excess fluid from the patient's blood. Modern dialysis machines are designed to filter out excess fluid while cleansing the blood of wastes.

Blood was drained from the patient into a sterile container. Anticlotting drugs were added, and the filled container was hung on a post above the artificial kidney and connected to the cellulose acetate tubing that was wound around the wooden drum. A motor turned the drum, pulling the blood through the tubing by gravity.

The tank underneath the drum was filled with dialyzing fluid. As the blood-filled tubing passed through this fluid, waste products from the blood diffused through the tubing into the dialyzing fluid. The cleansed blood collected in a second sterile container at the other end of the machine. When all of the blood had passed through the machine, this second container was raised to drain the blood back into the patient.

Kolff-Brigham Dialysis Machine: 1948

George Thorn, MD, of the Peter Bent Hospital in Boston, MA, invited Willem Kolff, MD, to meet with Carl Walters, MD, and John Merrill, MD, to redesign and modify the original Kolff Rotating Drum Kidney. The artificial kidney was to be used to support the first proposed transplant program in the United States. This device was built by Edward Olson, an engineer, who would produce over forty of these devices, which were shipped all over the world.

Cellulose acetate tubular membrane, the same type of membrane that is used as sausage casing, was wrapped around the drum and connected to latex tubing that would be attached to the patient's bloodstream. The drum would be rotating in the dialyzing fluid bath that is located under the drum.

The patient's blood was propelled through the device by the "Archimedes screw principle" and a pulsatile pump. A split coupling was developed to connect the tubing to the membrane, a component necessary to prevent the tubing and membrane from twisting. This connection is at the inlet and outlet of the rotating drum.

The membrane surface area could be adjusted by increasing or decreasing the number of wraps of tubing. The Plexiglas™ hood was designed to control the temperature of the blood. The cost of this device was $5,600 in 1950.

Murphy WP Jr., Swan RC Jr., Walter CW, Weller JM, Merrill JP. Use of an artificial kidney. III. Current procedures in clinical hemodialysis. J Lab Clin Med. 1952 Sep; 40(3): 436-44.

Skeggs Leonards Plate Dialyzer: 1948

Leonard Skeggs, PhD, and Jack Leonards, MD, developed the first parallel flow artificial kidney at Case Western Reserve in Cleveland, OH. The artificial kidney was designed to have a low resistance to blood flow and to have an adjustable surface area.

Two sheets of membrane are sandwiched between two rubber pads in order to reduce the blood volume and to ensure uniform distribution of blood across the membrane to maximize efficiency. Multiple layers were utilized. The device required a great deal of time to construct and it often leaked. This was corrected by the use of bone wax to stop the leak.

The device had a very low resistance to blood flow and it could be used without a blood pump. If more than one of these units were used at a time, a blood pump was required. Skeggs was able to remove water from the blood in the artificial kidney by creating a siphon on the effluent of the dialyzing fluid. This appears to be the first reference to negative pressure dialysis.

Autoanalyzer
This technology was later adapted by Leonard Skeggs to do blood chemistries. It was called the SMA 12-60 Autoanalyzer.

Guarino and Guarino Artificial Kidney: 1952

This artificial kidney was developed to reduce the amount of blood outside of the body and to eliminate the need for pumping the blood through the device.

Guarino used cellulose acetate tubing. The dialyzing fluid was directed inside the tubing and the blood, entering the device from the top, cascading down the membrane. The metal tubing inside the membrane gave support to the membrane.

The artificial kidney ahd a very low blood volume, but it had limited use because there was concern regarding the possibility of the dialyzing fluid leaking into the blood.

Pressure Cooker Artificial Kidney — Inouye & Engleberg: 1952

Von Garrelts had constructed a dialyzer in 1948 by wrapping a cellulose acetate membrane around a core. The layers of membrane were separated by rods. It was very bulky and weighed over 100 pounds.

William Inouye, MD, took this concept and miniaturized it by wrapping the cellulose acetate tubing around a beaker and separating the layers with fiberglass screening. He placed this "coil" in a Presto Pressure Cooker in order to enclose it and control the temperature. In addition, he made openings in the pot for the dialyzing fluid. With the use of a vacuum on the dialysate leaving the pot, he was able to draw the excess water out of the patient's blood. A blood pump was required to overcome resistance within the device.

This device was used clinically and when it was used in a closed circuit, the exact amount of fluid removed could be determined.

Inouye WY, Engelberg J. A simplified artificial dialyzer and ultrafilter. Surg Forum. Proceedings of the Forum Sessions, Thirty-ninth Clinical Congress of the American College of Surgeons, Chicago, Illinois, October, 1953; 4: 438-42.

Kiil Dialyzer: 1960

These Kiil boards were produced in Norway under the direction of Fred Kiil, MD. Three or more of these boards were used with two sheets of membrane sandwiched between each pair of boards. The membrane was Cuprophan™. The grooves in the boards directed the blood between the layers of membrane and the dialysate outside the membrane envelope in opposite directions from one end of the boards to the other.

The priming volume was less than 300 cc. When a shunt was used, the blood could be pumped through the device with blood pressure only; no blood pump was needed. Excess fluid was removed by the use of negative pressure on the dialysate effluent line.

This type of device was used for overnight, unattended hemodialysis that was pioneered by Belding Scrbner, MD, and his group in Seattle, WA. A totally monitored dialysate system was required to automatically mix the dialysate and to control temperature and conductivity. This delivery system was developed by Albert Babb, PhD, while at the University of Washington.

Kiil F. Development of parallel-flow artificial kidney. Acta Chir Scand. 1960; Suppl 253: 142-150.

Drake-Willock Model 4002 with Kiil Dialyzer: Mid 1960s

In 1964, Charles Bernard Willock's young daughter invited a friend home. She brought along her father, Richard Drake, MD, a nephrologist, who told Willock about a patient who needed $30,000 for dialysis treatments. The patient had sold his house to pay for the life-saving therapy, but his wife left him with the money. Drake told Willock what was needed to administer the treatments, and Willock designed the machine "in about an hour," according to an article in The Oregonian. He built the prototype out of parts in his basement, spending only $250 for new parts.

A few months later, the first machine was used on a patient at Good Samaritan Hospital. Then Drake and Willock founded the Drake Willock Co. to manufacture the machines in Milwaukie, OR. Five hundred machines were sold during their first year of operation. Eventually, they were manufacturing about 300 machines a month with international sales of more than $12 million in 1977, the year the company was sold.

Used with permission from iKidney.

Milton-Roy Model A — First Machine Used for Nocturnal Home Hemo: 1964

This machine was developed from the prototype "Mini-1" machine designed by Albert "Les" Babb for his best friend's daughter, Caroline Helm. It was called the Mini-1 because Dr. Babb had designed a much larger system, "The Monster", for the University of Washington prior to this home patient version.

The Model A was built by the Milton Roy Company in St. Petersburg, Florida in 1964. It was designed to perform nocturnal home hemodialysis. It was done in a wooden veneer to have a furniture appearance for the home. It featured automatic hot water (90 degrees C) disinfection, automatic alarm checks, solid-state (diode) logic, and acoustic tile inside to reduce noise.

This instrument became the first of a series of negative pressure single patient systems culminating in the 9th generation, the Baxter Arena introduced in 2002.

Twardowski, Zbylut J., Laudatio: Albert L. Babb, Hemodialysis International, Volume 7, Number 4, 2003.

Automatic PD Cycling Machine: 1964

S.T. Boen, C.M. Mion, F.T. Curtis and G. Shilipetar developed an automated device to do peritoneal dialysis at home. It utilized a 40-liter bottle that was filled and sterilized at the University of Washington. The bottles were delivered to the patient's home and returned to the hospital after use.

A cam cycler timer was used to meter the peritoneal fluid into and out of the peritoneal cavity. A heater plate heated the solution to body temperature and the effluent from the peritoneum was measured.

Fred Boen, MD, used the "repeated puncture" method for access. This required that a physician go to the patient's home and surgically place a 14F trocar in the patient's abdomen. The patient's helper would be trained to remove the trocar after the peritoneal dialysis treatment.

Boen ST, Mion CM, Curtis FK, Shilipetar G. Periodic peritoneal dialysis using the repeated puncture technique and an automatic cycling machine. Trans Am Soc Artif Intern Organs. 196; 10: 408-14.

Capillary Artificial Kidneys (Hollow Fiber Dialyzers): 1964-1967

Richard Stewart, MD, was given a grant to explore the medical applications of cellulose acetate capillary fibers. His group determined that this technology would have a practical application as an artificial kidney.

The original "Capillary Kidney" demonstrated that substances could be selectively removed from the blood as well as excess water.

Stewart et al developed larger versions for clinical use. They set as their criteria that the device must be as efficient as the "Twin Coil Dialyzer," but it must have a lower priming volume and be more reliable.

The clinical model shown here was first used at the University of Michigan in Ann Arbor, MI, and later at the Marquette School of Medicine in Milwaukee, WI. The "Capillary Artificial Kidney" has become the standard for hemodialysis today.

Travenol RSP: 1967

This fully integrated dialysis delivery system was developed by Travenol Laboratories for use by hospitals and for home dialysis. The initial cost of the system was $1,400, and over 3,500 of these devices were produced and used all over the world.

The machine required that the bath be mixed each time. The reservoir contained 120 liters of water and concentrate. Many centers used ordinary tap water. The treatment time was six hours and the patient was treated from one to three times a week depending on the condition of the patient.

This type of machine utilized the coil type dialyzer and it was later modified to use the hollow fiber dialyzer. The "Travenol RSP" is the term used to describe this hemodialysis system. It means single pass recirculating hemodialysis machine.

Teflon Dialysis Cannulas (Shunts)

Belding Scribner, MD, at the University of Washington in Seattle, WA, asked Wayne Quinton, a biomedical engineer, to help him develop a permanent access to the blood stream for patients who had kidney failure. Scribner was convinced that he could chronically treat a patient with kidney failure if a permanent access was available.

Quinton developed a vessel access using Teflon™ tubing. This material was successful because of its non-stick properties that prevented the blood from adhering to it and clotting.

They were able to demonstrate that a permanent access was possible and that they could chronically dialyze a kidney failure patient.

Later they would use silicone tubing for the external segment in order to act as a shock absorber and to provide more comfort and safety for the patient. This device was worn by a chronically-dialyzed kidney patient.

Quinton W, Dillard D, Scribner BH. Cannulation of blood vessels for prolonged hemodialysis. Trans Am Soc Artif Intern Organs. 1960 Apr 10-11; 6: 104-13.

Drake-Willock PD Cycler Machine: 1970s

This PD machine (3 bottles, 2 pumps) was made by Drake Willock. It's identified as Model 6010. It incorporated an RO inside to make the peritoneal solution, so the 40 liter bottles were no longer needed.

The demise of this unit was the introduction of plastic bags of PD solution and CAPD by Baxter in the late 1970s.

Flat Plate (or Parallel Plate) Dialyzer

This type of dialyzer used sheets of membrane mounted on top of plastic support screens, and stacked in layers. Dialysate would flow between some of the pairs of membranes, and blood between other pairs. The design was low-cost, and allowed for very little resistance to flow, so fewer anti-clotting medications were needed. In time, this model was entirely replaced by the hollow fiber dialyzer.

Cordis Dow Seratron Dialysis Machine: 1979

Cobe Centry 2 Rx

Extracorporeal Single Patient System

C-DAK Artificial Kidneys (Hollow Fiber Dialyzers)

The first presterilized, ready to use "Capillary Artificial Kidney" was made with a new capillary membrane called Cuprophan™.

The dialysis community was looking for artificial kidneys with increased efficiency. The way this objective was accomplished was by using more fibers in the device. As a result, the size of the artificial kidney began to grow. Later models of this type of device would utilize a thinner wall membrane that would allow for fewer fibers and a smaller size artificial kidney.

Variety of Dialyzer Models No Longer on the Market

Automated Peritoneal Dialysis Cycler

The Baxter (Travenol Laboratories back then) "Automated Peritoneal Dialysis Cycler" introduced in 1984. When patients got tired of doing their own exchanges, Baxter automated the process so it would all happen at night. No-one called it the Automated Peritoneal Dialysis Cycler—too many words. It was called simply the PacX because the tubing setup made a X on the front panel.