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Hemodialysis Peritoneal dialysis Scribner. Seattle Artificial Kidney Center
Abstract
Long-term hemodialysis for chronic renal failure first became possible with development of the Teflon shunt by Belding Scribner and coworkers at the University of Washington, Seattle, in 1960. Over the next 4 years, many of the advances in dialysis occurred in Seattle. These included recognition and treatment of complications such as malignant hypertension, gouty episodes due to uric acid accumulation, subcutaneous calcification, anemia, iron overload, and peripheral neuropathy. Technical advances included improving the shunt, and in collaboration with Professor A.L. Babb, development of a proportioning system to make dialysate from concentrate and water and the first automated home hemodialysis machine. Dr. Boen and Dr. Tenckhoff developed automated peritoneal dialysis equipment and peritoneal access devices. The world's first outpatient dialysis center, the Seattle Artificial Kidney Center, was established in 1962, and used an anonymous lay committee to select from medically suitable patients those to be treated by the center. This triage was an important step in the devel
opment of biomedical ethics, and in 1964, Scribner's presidential address to the American Society for Artificial Internal Organs discussed the problems of patient selection,termination of treatment, patient suicide, death with dignity, and selection for transplantation.
Dialysis as a treatment for acute renal failure evolved from Kolff's development of the artificial kidney in the early 1940s. However, efforts to do repeated dialysis for the long-term care of patients with chronic uremia failed because the necessary materials were not yet available. A fortunate combination of circumstances in Seattle changed this in 1960, and for the next decade and longer, many of the technical developments of dialysis occurred there. This paper is a brief chronology of the events that occurred.
Hemodialysis
1953
Dialysis for acute renal failure in Seattle began with the appointment of Belding Scribner (fig. 1 ) as an Associate in Medicine at the recently established University of Washington Medical School.
1957
Scribner and his team studied gastrodialysis as a treatment for uremia, using equipment developed to cycle dialysis fluid in and out of a large intragastric cellophane balloon [ 1 ]. This removed very little nitrogenous material, although enough hydrochloric acid was removed to require replacement to prevent alkalosis. The publication on this...