Chapter 1: Brief History of Home Hemodialysis

BEGINNINGS OF HOME HEMODIALYSIS

The story of hemodialysis (HD) dates back to 1942 with the development of the first artificial kidney by Willem Kolff in Holland.^1,2 Italian Umberto Buoncristiani then built the first portable artificial kidney with recirculated dialysis fluid that enabled one of his patients to go on vacation with his children.³ In Japan, HD was made available in 1954 by Kishuo Shibusawa who utilized the handmade, modified Skeggs hemodialyzer.⁴ HD entered a new era when Belding Scribner and his colleagues from the University of Washington developed a Teflon arteriovenous shunt in 1960, making repeated blood access possible.^1,5 The first outpatient dialysis unit, the Seattle Artificial Kidney Center (now known as the Northwest Kidney Center), opened only 2 years later in 1962.⁶ HD was only available for patients with acute kidney injury, who dialyzed 6 to 10 hours three times a week.⁴ Home hemodialysis (HHD) was first established in the 1960s at the University of Washington in Seattle.¹

In the early days of HD, given limited resources, there were ethical dilemmas regarding patient selection for HD. Later, in 1963, ethical concerns were raised surrounding the 15-year-old daughter of Albert Babb, who was a friend of Scribner. The young woman did not meet the criteria for in-center HD because of her age. At that time, Babb and Scribner were developing a proportioning HD unit used to make smaller single patient dialysis machines, which would be the precursor to modern-day HD machines.¹ In 1964, this HD equipment was used to perform the first HHD treatment—the patient was Albert Babb’s daughter^1,7 (Figure 1-1).⁴

Even prior to 1964, there were independent efforts in various parts of the world to attempt HHD. In 1961, a Japanese patient was treated at home by using a coil dialyzer in an electric washing machine by Yukihiko Nose.⁸ At that time, the electric washing machine was available in most homes in Japan. Thus, HD was mostly performed in patients’ homes because the size of the machines made them difficult to transport.⁴ With the help of a physician and an electric washing machine adapted for uremic blood, HD was done at home using the thoroughly cleaned electric washing machine (not sterilized) (Figure 1-2).⁴ A disposable coil was suspended inside the washing machine by a strip of surgical bandage and, after establishing extracorporeal circulation, blood flows were monitored by a specially designed air bubble catcher. The standard dialysate powders, in batches, were packed separately as three components: electrolytes, bicarbonate, ...