The first hemodialysis performed on a human patient took place in 1924, when German physician Georg Haas connected a uremic patient to a rudimentary blood-cleansing circuit in Giessen, Germany. But that single date undersells the story. Hemodialysis did not spring from one eureka moment; it was assembled over more than a century from advances in chemistry, membrane science, anticoagulation, vascular surgery, and public policy. Each piece had to fall into place before the next could matter, and the gaps between breakthroughs were sometimes measured in decades of frustration.
The Chemistry That Made Dialysis Thinkable
Long before anyone built a machine to clean blood, a Scottish chemist named Thomas Graham laid the scientific groundwork. Working in the mid-nineteenth century, Graham studied how dissolved substances move through membranes. He found that small molecules pass through parchment and similar barriers while larger ones stay behind, and he coined the term “dialysis” to describe this separation process.1PubMed. History of the science of dialysis Graham also introduced the distinction between “crystalloids” (small, fast-diffusing substances that crystallize easily) and “colloids” (larger, slow-diffusing ones), which became foundational concepts in chemistry. He experimented with glass jars, clay, plaster, sheets of parchment, and perforated metal, searching for the ideal semipermeable barrier.2Nephrology Dialysis Transplantation. A Brief History of the Study of Diffusion and Osmosis in the Context of Dialysis
Graham never imagined hooking a patient up to his apparatus. His interest was pure chemistry. But the principle he demonstrated, that waste products dissolved in blood could be coaxed across a membrane into a cleaner fluid and thereby removed, is exactly what every dialysis machine in the world still does today. Others would spend decades figuring out how to do it safely inside a living body.
The First Artificial Kidney Was Tested on Animals
The jump from a chemistry bench to a living creature happened in 1913, courtesy of John Jacob Abel, a pharmacologist at Johns Hopkins University. Abel built what he called a “vividiffusion” apparatus: blood was drawn from an animal, run through tubes made of a semipermeable material, bathed in a saline solution to draw out waste, and returned to the animal’s circulation. When the device was demonstrated at University College London, a reporter for The Times dubbed it the “artificial kidney,” giving the concept a name that stuck.3PubMed. The wonderful apparatus of John Jacob Abel called the “artificial kidney”
Abel’s machine worked as a proof of concept, but it was far from ready for human use. The anticoagulant he used, hirudin extracted from leeches, was impure and unpredictable. The membranes leaked. The blood flow was hard to control. Still, his experiments proved that you could circulate blood outside the body, filter it, and return it without immediately killing the animal. That was a nontrivial accomplishment, and it opened the door for the physicians who came next.
Georg Haas and the First Human Treatments
Georg Haas, an internist at the University of Giessen, performed what is widely recognized as the first hemodialysis on a human patient in 1924. He, too, relied on hirudin as an anticoagulant and used collodion tubes as his membrane material. The treatments were brief, lasting only about fifteen minutes, and the results were modest. Haas continued refining his approach through the late 1920s, but the technology of the era placed severe limits on what he could achieve. His anticoagulants were toxic at higher doses, and his membranes were fragile.4PubMed Central. Celebrating 100 Years of Hemodialysis and the Legacy of Georg Haas
Haas’s work received little attention at the time. He published his results, but the medical community largely shrugged. Patients with kidney failure were considered beyond help, and the idea that a machine could substitute for an organ struck most physicians as fanciful. It would take another world war, a different country, and a very stubborn Dutch doctor to prove them wrong.
Two Enabling Breakthroughs in the Background
Before dialysis could become practical, two problems needed solving, and both were solved by people who were not primarily interested in kidneys.
The first was anticoagulation. Blood clots the moment it leaves the body and touches foreign surfaces. Hirudin, the leech-derived compound Abel and Haas used, was impure, expensive, and caused severe reactions. During the 1930s, Canadian physiologist Charles Best and colleagues developed a purified form of heparin, a naturally occurring blood thinner. By the late 1940s, pharmaceutical-grade heparin was available, giving dialysis engineers a reliable way to keep blood flowing through their circuits without clotting.5Nephrology Dialysis Transplantation. History of Heparin Use in Nephrology
The second was the membrane itself. Cellophane, originally manufactured as food-packaging material, turned out to be an excellent semipermeable membrane for dialysis. It was cheap, widely available, and let small waste molecules through while keeping blood cells and proteins on the blood side. The combination of cellophane membranes and heparin in the late 1930s and 1940s set the stage for rapid progress in dialyzer design.6PubMed. History of hemodialyzers’ designs
Willem Kolff and the Rotating Drum
Willem Kolff, a young Dutch physician working in the Nazi-occupied Netherlands during World War II, built the machine that made dialysis a clinical reality. In 1943, he treated his first patient using a rotating drum dialyzer: a large wooden drum wrapped in cellophane tubing, rotating through a bath of dialysate fluid. Blood flowed through the cellophane, waste products diffused out, and the cleaned blood returned to the patient.7PubMed Central. Dr. Willem Kolff: The Father of the Artificial Kidney
Kolff’s early patients mostly died, not because the machine failed but because they were already at death’s door. His first clear-cut success came in 1945, when he treated a 67-year-old woman in uremic coma. She regained consciousness during dialysis and lived for several more years. That case demonstrated that a machine really could replace a failed kidney, at least temporarily. After the war, Kolff emigrated to the United States and freely shared his designs, sending drum kidneys to researchers in London, Montreal, and several American hospitals. His openness accelerated the field enormously.8PubMed. The development of artificial kidney–from sausage casing to capillary fibers
It is worth noting that around the same time Haas was working on hemodialysis in the 1920s, another German physician, Georg Ganter, was exploring an entirely different approach. In 1923, Ganter demonstrated in animal experiments that flushing saline solution into the abdominal cavity could reduce uremia symptoms by using the peritoneum, the membrane lining the abdomen, as a natural dialysis filter.9PubMed. Georg Ganter–a pioneer of peritoneal dialysis and his tragic academic demise at the hand of the Nazi regime This technique eventually became peritoneal dialysis, which remains an important alternative to hemodialysis today. Ganter’s career was destroyed by the Nazi regime, and peritoneal dialysis developed along a separate track for decades.
The Problem Nobody Had Solved: Repeat Access
Through the 1940s and 1950s, dialysis could save someone from acute kidney failure, a temporary crisis caused by poisoning, trauma, or surgical complications. But it could not help people whose kidneys had failed permanently. The reason was brutally simple: every time a patient was dialyzed, a surgeon had to cut into an artery and a vein to connect the blood circuit. After a few treatments, the patient ran out of usable blood vessels. Chronic kidney failure remained a death sentence.
The solution came from Belding Scribner, a nephrologist at the University of Washington in Seattle. In early 1960, Scribner came up with the idea, reportedly in the middle of the night, of connecting a small U-shaped tube between an artery and a vein in the forearm and leaving it in place between dialysis sessions. Wayne Quinton, an engineer, fabricated the device from Teflon tubing, and surgeon David Dillard implanted the first shunt on March 9, 1960.10PubMed. The 50th anniversary of long-term hemodialysis: University of Washington Hospital, March 9th, 1960 The patient, Clyde Shields, went on to receive dialysis for years, something that had been flatly impossible before.
The Quinton-Scribner shunt was prone to clotting and infection, and it needed frequent revision. But it was the first device that made maintenance hemodialysis for chronic kidney failure a reality.11PubMed. Chronic dialysis and dialysis doctors in the United States: a nephrologist-historian’s perspective A more durable solution followed in 1966, when James Brescia and Michael Cimino reported a surgically created connection between an artery and vein, known as an arteriovenous fistula, that could be punctured with a needle for each treatment and would last much longer.12PubMed. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula The Brescia-Cimino fistula remains the gold-standard vascular access for hemodialysis patients today, more than half a century later.
Who Deserves to Live? The God Committee
Once chronic dialysis became technically possible, a new and deeply uncomfortable problem appeared: there were not enough machines or treatment slots for everyone who needed them. In Seattle, where the Scribner shunt had been developed, a committee of ordinary citizens, not doctors, was formed to decide which patients would receive dialysis. The group, quickly nicknamed the “God Committee” by the press, weighed factors like a patient’s age, occupation, number of dependents, and perceived social worth.13PubMed. The god squad and the origins of transplantation ethics and policy
The committee’s existence horrified many observers. Choosing who lives and who dies based on social merit felt uncomfortably close to playing God, exactly the charge its nickname implied. A 1962 article in Life magazine exposed the process to the general public, sparking a national conversation about medical rationing and the ethics of emerging technology.14PubMed Central. The Evolving Ethics of Dialysis in the United States: A Principlist Bioethics Approach The controversy is considered one of the founding episodes of modern bioethics as a discipline. It forced the medical community, and American society more broadly, to grapple with what happens when life-saving technology exists but is not available to everyone.
The 1972 Medicare Decision That Changed Everything
The ethical crisis of rationing helped drive a remarkable political outcome. In 1972, the United States Congress passed Public Law 92-603, which extended Medicare coverage to virtually all Americans with end-stage renal disease, regardless of age. It was an extraordinary move: kidney failure became the only specific diagnosis that qualified a patient for near-universal government health insurance.15PubMed. A historical perspective of how public policy shaped dialysis care delivery in the United States
The program transformed dialysis from a scarce, rationed therapy into a widely available one, at least in the United States. It also turned out to be far more expensive than anyone predicted. Initial cost estimates were based on a small patient population, but as dialysis became freely available, the number of people receiving it grew dramatically. The Medicare ESRD Program has saved thousands of lives, but its costs have exceeded every original projection and resisted containment efforts ever since. The program’s structure also shaped how dialysis clinics operate in the U.S., encouraging the growth of large for-profit dialysis chains that now dominate the market.
Machines Get Smaller and Smarter
The dialyzers patients used in the 1960s were bulky, cumbersome devices that required large volumes of dialysate and long treatment times. A major leap forward came from an unlikely source: Dow Chemical. A federally funded project at Dow’s facility in Walnut Creek, California developed the hollow fiber dialyzer, which replaced flat membranes and collapsed tubing with thousands of tiny capillary fibers bundled together.16PubMed Central. Dialysis in the 1960s and the first hollow fiber dialyzer Blood flows through the inside of these fibers while dialysate flows around the outside, creating an enormous surface area for waste removal in a compact package. Hollow fiber dialyzers became the dominant design and remain so today.
The dialysate fluid itself also evolved. Early machines used simple saline or acetate-based solutions. Modern dialysate is precisely formulated by mixing purified water with acid and bicarbonate concentrates, carefully correcting the patient’s electrolyte balance and blood acidity during each session.17PubMed Central. Basics of base in hemodialysis solution: Dialysate buffer production, delivery and decontamination Water purity standards became a major concern as well, since patients are exposed to hundreds of liters of dialysate per week, and even trace contaminants can accumulate dangerously.
Continuous Therapies for the Sickest Patients
Standard hemodialysis sessions last three to five hours and happen several times a week. For critically ill patients in intensive care, those abrupt shifts in fluid and waste levels can be destabilizing. In 1977, Peter Kramer in Göttingen, Germany, performed the first continuous arteriovenous hemofiltration, a slow, gentle form of blood purification that ran around the clock. The technique used the patient’s own blood pressure to drive filtration through an external circuit, removing fluid and solutes gradually rather than in a concentrated burst.18PubMed Central. Continuous Renal Replacement Therapy: Forty-year Anniversary
The early version had limitations, particularly its reliance on arterial access and relatively low clearance rates in highly catabolic patients. These shortcomings prompted the development of pump-driven venovenous techniques that did not require arterial cannulation, and eventually hybrid methods combining filtration with diffusion for better waste removal.19PubMed. History and development of continuous renal replacement techniques Today, continuous renal replacement therapy is a staple of intensive care units worldwide, used for patients who are too hemodynamically unstable to tolerate conventional hemodialysis.
A Technology That Is Still Not Available to Everyone
For all the engineering triumphs of the past century, access to dialysis remains shockingly uneven across the globe. A large international survey found that dialysis was accessible to more than half of people with kidney failure in about three-quarters of countries studied, but the numbers varied enormously by income level. In high-income countries, accessibility was nearly universal. In low-income countries, only about a third of nations could offer dialysis to more than half of those who needed it.20The Lancet. Global kidney health: a report of the International Society of Nephrology Global Kidney Health Atlas
Home-based dialysis, which can lower costs and improve flexibility for patients, faces its own barriers. Even in middle-income countries where some form of dialysis exists, home therapies are often unavailable or impractical due to infrastructure gaps, training limitations, and supply-chain problems.21PubMed Central. Home Dialysis The result is that millions of people with kidney failure in lower-income settings die from a condition that has been technically treatable for nearly a century. The challenge has shifted from “can we build the machine” to “can we get the machine to the people who need it.”
Living on Dialysis
The history of hemodialysis tends to focus on hardware and heroes, but the experience of the patients themselves is its own story. Standard in-center hemodialysis typically requires three sessions per week, each lasting several hours, at a clinic that may or may not be conveniently located. Patients often feel washed out after treatments, and the rigid schedule constrains work, travel, and social life. Cognitive effects are a recognized concern as well: advanced kidney failure and the dialysis process itself can affect memory, attention, and mental sharpness, a cluster of issues that researchers have only recently begun to study systematically.22Frontiers in Neurology. “Is It Removed During Dialysis?”—Cognitive Dysfunction in Advanced Kidney Failure—A Review Article
Home hemodialysis and nocturnal dialysis, where patients treat themselves at home or dialyze overnight while sleeping, represent efforts to reduce this burden. These options have existed since the 1960s but never became dominant, partly because in-center dialysis was easier for clinics to manage and, in the U.S., more straightforwardly reimbursed by Medicare. Interest in home therapies has been growing again in recent years, driven by evidence suggesting they can improve quality of life and by policy changes encouraging their use. Whether that momentum leads to meaningful shifts in how most patients experience dialysis remains an open question, shaped as much by economics and regulation as by technology.