How modern renal dialysis started with old car parts

Willem Kolff (Callie Jones)

These days, renal dialysis is regarded as a routine, albeit lifesaving, procedure. The honour of performing the first renal dialysis goes to George Haas (1886–1971) who worked in Giessen, Germany, and who used goldbeaters’ skin as a membrane in experiments with animal blood.

He carried out a number of experiments to dialyse the blood of uraemic patients, but the dialyses were too short to have a significant therapeutic effect.  

Recently the death was announced, at the age of 97, of the inventor of modern renal dialysis, a Dutch doctor called Willem Kolff.

In addition to being a medical doctor, Kolff had a comprehensive knowledge of engineering and was something of an inventor. He also had a vivid and unusual imagination.

The Netherlands had been invaded by Germany in May 1940 and Kolff devised various ingenious ways of fighting back. The Nazis were rounding up able-bodied men to work in their labour force in Germany and Kolff devised ways of giving the appearance of jaundice and of mimicking internal bleeding.

It is said that, because of Kolff, several prominent members of the Dutch resistance were deemed to be of no use to the occupying forces on the grounds of sickness.

Kolff had the care of a number of patients suffering from renal failure. He reasoned that such patients could be saved if urea could be removed from the blood. If the blood were to be passed over a selectively permeable membrane immersed in a salt solution, the urea would be extracted by diffusion.

Working at the local hospital in the small town of Kampen in the Netherlands in collaboration with his colleague Hendrik Berk, Kolff devised the rotating drum dialyser, the forerunner of the modern artificial kidney.

The rather crude equipment used in the dialyser included the water pump from an old Ford car, and many metres of Cellophane sausage tubing, which acted as the selectively permeable membrane.

The equipment was tried on a number of patients, with limited success. However, in September 1945, a 67-year-old woman, Sofia Schafstadt, was admitted to the Kampen Hospital suffering from acute cholecystitis with jaundice and acute renal failure with anuria, which it was considered had been caused by treatment with a sulphonamide.

She went into a coma, and Kolff and Berk connected her to the dialyser. After 11 hours’ dialysis, she regained consciousness and her health improved dramatically. Normal diuresis started within a few days and she made a good recovery — the first patient whose life had been saved by renal dialysis. She died some six years later from an unrelated cause.

Ironically, considering Kolff’s activities during the war, Mrs Schafstadt had been a Nazi sympathiser who was imprisoned after the war. She had been admitted to Kampen Hospital from the prison.

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