Hemodialysis (HD) is a life-sustaining medical procedure that filters waste products and excess fluid from the blood, taking over the function of failing kidneys. The technology was invented in the early 1940s, marking the beginning of a new era for people suffering from kidney failure, a condition that had previously been universally fatal. The first truly practical device emerged from a slow process of scientific discovery and engineering breakthroughs.
The Scientific Foundations and Early Attempts
The theoretical underpinnings of hemodialysis trace back to the mid-19th century with the work of Scottish chemist Thomas Graham. In 1854, Graham established the principles of diffusion and osmosis, demonstrating how substances could be separated across a semipermeable membrane. He coined the term “dialysis” to describe the separation of solutes from colloids using a parchment membrane, laying the conceptual groundwork for the artificial kidney.
The first attempt to apply these principles to living organisms occurred in 1913 by American researchers John Abel, Leonard Rowntree, and Bernard Turner. They developed a device called the “vividiffusion” apparatus, which successfully removed toxins from the blood of animals. To prevent the blood from clotting within the device, they used hirudin, an anticoagulant derived from the saliva of leeches.
Following this, German physician Georg Haas performed the first human dialysis treatments in Giessen, Germany, beginning in 1924. Haas used collodion tubes as the semipermeable membrane in his dialyzer, which was a modified version of Abel’s apparatus. Although he successfully performed dialysis on a few patients by 1928, the treatments were not effective enough to save their lives, primarily due to the severity of the patients’ conditions and the limitations of the technology at the time.
Willem Kolff and the First Functional Dialyzer
The breakthrough moment arrived with Dutch physician Dr. Willem Kolff, who successfully constructed the first functional artificial kidney in 1943. Working in Kampen during the Nazi occupation of the Netherlands, Kolff relied on salvaged and improvised materials. He was motivated by the tragic death of a young patient from kidney failure, vowing to replicate the kidney’s filtering function.
Kolff’s design was a rotating drum artificial kidney, which used 20 meters of cellophane tubing wrapped around a wooden drum. The cellophane, sourced from sausage casings, acted as the semipermeable membrane. The drum was partially submerged in a large tank of dialysate fluid, and a motor rotated the drum to circulate the blood and dialysate.
The initial clinical results were discouraging, as the first 15 patients treated with the crude device succumbed to their kidney failure. However, Kolff achieved the first undisputed success in September 1945, after the war had ended. An 11-hour dialysis session on a 67-year-old woman in a uremic coma successfully cleared the toxins from her blood, allowing her to regain consciousness and live for seven more years.
Developing Hemodialysis for Chronic Care
Kolff’s rotating drum was designed for acute kidney failure, intended to keep a patient alive until their kidneys recovered. A significant limitation was the procedure’s inability to safely remove excess fluid, known as ultrafiltration, necessary to manage fluid buildup. Furthermore, accessing the patient’s bloodstream repeatedly was a challenge, as the surgical incision required for each treatment quickly destroyed available veins and arteries.
Progress was made in 1947 when Swedish physician Nils Alwall introduced a modified dialyzer that enclosed the membrane in a steel canister, allowing for the application of higher pressure to control ultrafiltration. Later, the development of the Kiil dialyzer in the 1950s—which used parallel layers of membrane—improved the efficiency and safety of the procedure. These advancements increased the viability of hemodialysis, but it still could not be used for long-term, chronic treatment.
The final obstacle to long-term dialysis was overcome in 1960 by Dr. Belding Scribner and his team in Seattle, Washington. Working with engineer Wayne Quinton, Scribner developed the arteriovenous shunt, often called the “Scribner Shunt.” This innovation used Teflon tips permanently implanted in an artery and a vein, connected by a loop of silicone tubing when not in use. This shunt provided a reusable access point to the bloodstream, officially ushering in the era of chronic hemodialysis. The first patient treated with this technique, Clyde Shields, lived for an additional eleven years.