About the History of the Artificial Kidney
English version of the German presentation "Von der Geschichte der Künstlichen Niere"
"About the History of the Artificial Kidney" will only consist of the German abstract followed by the latter part of the presentation, where the personal experience of the author with his newly discovered conservative therapy using Sodium Bicarbonate is being outlined.
Abstract
Already during World War I (1914 – 1918) the development of a medical device was initiated in order to eliminate “Uremic Toxins” from patients with Acute Renal Failure. Many of the heavily wounded soldiers eventually died from renal failure in addition to those patients who acquired the mostly lethal ending Kidney-disease called “Field-Nephritis” which was due to the catastrophic hygienic conditions during the trench warfare.
Analytic methods had to be developed in order to measure the accumulation of retention products due to renal failure and to judge the efficiency of any eliminating procedure. Simultaneously, technical procedures and devices needed to be constructed in order to evaluate the theoretical knowledge about the laws of Osmosis and Diffusion. These were first tried in the laboratory, then in animal experiments and lastly in the hospital on human patients.
Georg Haas (1886 – 1971) was probably first to perform animal experiments on rabbits and dog at around 1915 in at this time German town Straßburg. Later, due to WorldWar I, in 1928 he conducted clinical trials on patients in the University Hospital in Gießen, Germany. Hower, due to the narrow-mindedness and prejudices of his environment his achievements were not recognized.
Only after the first successful Artificial-Kidney-Treatment was performed by Willem Johan KOLFF in 1945 in Kampen, Netherlands, dialysis was again taken up in Europe, in Sweden by Nils ALWALL (1904-1986) and in Germany by Dr. Curt MOELLER (1910 – 1965). Although both the Swedish and the German devices were in the beginning superior to the Artificial Kidney Machine developed by W.J. Kolff, it was due to the Korean War and due to the continuing efforts of W.J. Kolff, meanwhile working at the Cleveland Clinic in USA and because of the economic superpower of the United States that the Dialysis-Machines made in the USA by the Travenol-Company including the so called Twin-Coil-Kidney were used world-wide.
The present day situation and the most recent developments in the field of Artificial-Kidney/ Dialysis will be shown. The health-care economic background and consequences are being outlined.
In view of the authors discovery of an alternative, conservative therapy by which the majority of both Acute and Chronic Renal Failure can be treated the exclusive and uncritical use of Dialytic Therapy for Renal Failure of any origin appears however questionable.
End of Abstract
Latter part of presentation: personal experience
The excessive complexity of the various processes that take place during the dialysis procedures requires knowing and permanent engagement with the contraptions of the dialysis equipment. However, it also led to loss of scientific competence in medical health professionals and specialists of nephrology about renal diseases, renal failure and the pathophysiology thereof. Scientific publications and discoveries remained unobserved or were ignored. Which is also true for the following:
80 to 90 % of all Dialytic Treatments could have been avoided. They could have been replaced by a discovery made accidentally on a patient with Acute Renal Failure (ARF).
A comparatively simple, conservative method had been found to treat Acute (ARF) and Chronic Renal Failure (CRF) without Dialysis. As a result in ARF “restitutio ad integrum” of renal function did occur in most cases and similarly in CRF renal function could be permanently improved, whereby dialysis procedures became obsolete.
History
In 1976 the author was called to the department clinic of Urology in Munich, TUM as a special consultant because of an elderly patient who had undergone complicated but successful surgery for renal stone disease (urolithiasis). However, the patient was in Acute Renal Failure (ARF), e.g. he produced hardly any urine any more. The urological staff had already applied every therapy that seemed to be indicated according to textbook, but without any success.
According to the medical opinion expressed by the author, it seemed to be unavoidable to perform acute dialysis treatments for the patient who was dangerously fluid overloaded. The statistical mortality of 60 to 80 % associated with this therapy had also to be laid open to his treating physicians of Urology - who were terrified in view of the prominent personality of their patient.
During the thorough clinical examination of the patient by the author, signs and symptoms indicating the presence of a profound acidosis could be observed, e.g. deepened respiratory breathing and a urine-pH in the acidotic range.
This finding was confirmed by repeated blood- measurements which could only be carried out on a special laboratory instrument in the laboratory of Nephrology. Thus, the author had to oscillate between the two clinical departments. Meanwhile an intravenous infusion-therapy with 8.4 % Sodium-Bicarbonate-Solution had been started, which was the textbook-therapy of acidosis.
However, the patient received the double or threefold quantity of the prescribed amount of the NaHCO3-solution. It had been overlooked that the rolling-clamp of the infusion-line had remained open. This was considered to be very dangerous. Therefore a diuretic drug (LASIX) was administered in order to eliminate the excess of bicarbonate. Shortly afterwards the MIRACLE occurred:
The patient started to pass enormous amounts of urine, which reached more than 20 Liters until the next morning.
Obviously the most feared dialysis treatment was no longer necessary and the patient recovered within a few days from his kidney failure as he was able to excrete both fluids and wastes normally.
The physiology and the Renal Reabsorption and Excretion of Bicarbonate had already been described and published by the American Physiologist Robert F. Pitts in 1949 and was contained in every Textbook of Renal Physiology. However, these findings had so far never been applied in clinical Medicine for the therapy of renal failure.
From 1976 onward the author used the procedure based on the physiological principles of R.F. Pitts as a routine therapy for all cases of Acute and Chronic Renal Failure that he encountered in the University Hospital r.d.Isar in Munich. Until the year 2000 the clinical experience of more than 300 cases of Acute Renal Failure, successfully treated without Dialysis was published in about 20 German and International English papers and presented in numerous symposia and meetings. As a practical consequence more than thousand liters of the specially designed intravenous substitution fluid, “The KOPP’s Solution “ was produced in the pharmacy of the University Hospital r.d.Isar, Munich. It was needed to substitute the high polyuric urine output of patients after the restart of renal function.
The same procedure as used for the therapy of Acute Renal Failure (ARF) was also sucessfully used since 1976 for the therapy of Chronic Renal Failure (CRF), with few exceptions depending on the aetiology of CRF, e.g. polycystic kidney disease. See literature in www.kf-kopp.de
In many CRF-patients chronic dialysis therapy could thus be avoided.
Socio-economic aspect
In Germany (BRD) presently 70.000 Patients are on Chronic Intermittent Dialysis Treatment (CIDT)
According to DGfN (Deutsche Gesellschaft für Nephrology, 2014) Acute Renal Failure Patients( ARF) are not contained in this survey.
Ca. 160 Dialysis Treatments per Patient per Year are required at a cost of € 50.000,- Amouting to € 3.500.000.000,- for 70.000 Patients
= € 3,5 Billion per Year in the Fed. Rep. of GERMANY for Chronic Renal Failure Patients on Dialysis
At least 80 to 90 % of these expenses could have been saved BECAUSE: Dialysis was avoidable
Two electronic devices would greatly facilitate the alternative conservative therapy:
1. pH-Meter for the self-measurement of Urine-pH
2. pH-Meter for the automatic measurement of Urine-pH in the Hospital and ICU
Availability of the I.V. substitution fluid (KOPP’s Solution) would greatly facilitate clinical therapy.
Bicarbonate-preparations, prescription free, cheap and easy to swallow should be available > Compliance
Diabetes Mellitus I & II
The proportion of diabetic patients who are chronically treated with dialysis has risen meanwhile to about 50 % of all CRF- dialysis-patients. Diabetic vascular lesions in combination with hypertension are the cause not only for renal failure but also for blindness, diabetic gangrene of the lower limb etc.
Metabolic acidosis is always present in the diabetic organism as a consequence of both the insulin-deficit and renal insufficiency. Substitution of this acidosis by means of either oral or intravenous administration of sodium-bicarbonate improves the diabetic metabolic situation due to the vasodilatation in the arterial microcirculation attributable to the so called Thurau-Effect.
The daily substitution of a sufficiently high dose of NaHCO3 is required, so that a certain surplus of NaHC03 is being excreted with the urine. Urine- pH-measurements will show a clearly alkaline urine with a pH at 7.5 to 8.0. Renal function remained stable, whereby the need of dialysis could also be avoided. Deficient compliance is however a particular feature of this patient group. Therapeutic advice is rapidly ignored and forgotten. Healthcare professionals in diabetology usually are neither aware nor informed about the possibilities of Bicarbonate-Substitution in diabetics.
Summary
The therapy of Acute and Chronic Renal Failure presently is based worldwide on dialytic procedures only. The Bicarbonate-Method is being ignored in spite of the number of evidence based scientific clinical and experimental publications.
The Bicarbonate-Method is based on the clinical combination of
- the physiological conditioning of nephrons according to R.F.Pitts by a maximum supply of sodium-bicarbonate and
- the pharmacological blockade of the nephron with a loop-diuretic.
The maximum possible physiological diuresis, the Bicarbonate Alcaline Polyuria (BAP) is thereby produced. The required elimination of fluid and uremic retention products is thereby possible.
In the case of ARF the Bicarbonate-Method can lead to the complete restitution of renal function.
In CRF a sufficient and permanent improvement of renal function can be obtained. Except for the rare cases of irreversible renal damage or untreatable renal disease (polycystic kidney) dialysis or transplantation will remain the therapeutic choice.
Dialysis-therapy of Acute Renal Failure is still consistently associated with a high mortality of at least 50 %. Chronic Dialysis for terminal renal failure requires 4 to 6 hours 3 times weekly Artificial Kidney time. The difference in the quality of life between Dialysis and the Bicarbonate-Method is therefore obvious. Patient compliance is however necessary to be successful with Bicarbonate.
The history of the Artificial Kidney might take a historical turn, if patients would insist on a conservative trial with sodium bicarbonate before any dialysis procedure. In most cases, dialysis would be avoided.