Oral Dialysis

It's an important anniversary for the Brigham and Women's Hospital and as a result there are events planned in all departments of the hospital over the next year. Not to be left out, the Renal Division invited some senior nephrologists to come and talk about their experiences with the world of early dialytic therapies and we had a special Grand Rounds presentation this morning on the topic.

John Merrill was one of the early pioneers of dialysis (and has been called the father of dialysis). He was an advocate for the use of dialysis at a time when many believed that it was unethical and experimental. I realized during the lecture this morning that reviewing the published literature of Dr Merrill would be a good way to learn the history of the dialysis. The first paper that I came across was published in 1949 and describes the early experience using the modified Kolff kidney in the Brigham to treat both AKI and metabolic disorders. My favorite quote from this article comes from a postscript added to the paper by a discussant which suggests an alternative means of dialyzing a patient as an alternative to "in vitro hemodialysis" as HD was then termed:


DR. J. EDWIN WOOD, JR. [Charlottesville, Virginia] : We are fortunate
to hear this excellent presentation and view quantitative results with the
artificial kidney.
It may be interesting to compare results from upper intestinal lavage
with the ones just presented. With a Miller-Abbot tube about three feet
below the pylorus and a Levine tube down to the pylorus we can wash
through and recover a large quantity of suitable lavage fluid in a twentyfour
hour run. Actually, we have been able to remove by this method
as high as 11.9 to 23.2 grams of urea nitrogen in twenty-four hours, and
from 90 to 102.5 mEq of potassium at the same time.
Dr. Thorn's artificial kidney obviously accomplishes the desired result
in a shorter period but intestinal lavage removes enough in twenty-four
hours to warrant serious consideration.

I'm glad that this is not one of the alternatives that we are offering patients today.

(Picture from Flickr user Rob Koopman via Wikipedia)