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Industry's contribution to the development of renal care.

Article Excerpt
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When asked to contribute to this issue of the ANNA Journal celebrating the 20th year of the founding of ANNA, I was moved because it is also my 20th year in dialysis and a memorable occasion for me.

A lot has happened in the past two decades. I have seen dialysis grow from the days when patients were selected for dialysis by their ability to pay, their age, or their medical complications. I remember the welfare director of a large eastern state making the decision not to allow home dialysis because he was afraid that others would want home dialysis and that it would become too costly.

We were able to change the attitude of the welfare director through the perseverance of a dedicated nurse and the personal plea from the patient and his family. We had to prove to the state agency that home dialysis was cost-effective and in the patient's best interest.

This was not just a victory for industry, it was an acknowledgment that all parties involved in treating renal failure must work together to achieve change and medical progress. In this chronological review of industry's contribution to the development of renal care, I will describe a number of instances where this team approach was necessary in order for progress to be possible.

Early Attempts at Removing Toxic Substances

Others have referenced the earliest written evidence of attempts to remove toxic substances from the body of man in ancient times by the use of purgatives, hot baths, and oral medications such as beer and other diuretics. The physician at that time probably represented industry because he was the one who prepared the various potions or decided on the course of therapy. The contractors who built the hot baths were also third party to the removal of these toxic waste products. There is no doubt that these ancient treatment approaches were industrial endeavors because the cost of these procedures and the supplies have been noted by the ancient scribes.

Other forms of treatment, such as blood letting and the use of leeches, survived to recent times. It is interesting to note that the American Journal of Nursing recently published an article on how to use the leech in the care of patients who are having problems with blood circulation after surgery. Ancient practitioners were quite perceptive in choosing their therapy techniques.

Invasive Techniques

Christopher Wren, the famous architect, appears to be the first to demonstrate a method of gaining access to the blood stream in the early 1600s. Others would have to solve the problem of blood compatibility. Blood exchanges, cross circulation, or the use of animal blood were tried with unsatisfactory results.

Latta and O'Shaughnessy in England made a historic discovery during the cholera epidemic of 1838. They instilled an isotonic solution into the patient's blood stream. These solutions were boiled in order to keep them free of bacteria. They were able to treat cholera successfully for the first time.

It became obvious to these early investigators that many of the body's problems could be solved if the blood could be properly treated, replaced, or somehow have the toxic substances selectively removed.

Early Diffusion Devices

Abel, Turner, and Reentry (1914) were the first group to actively demonstrate that substances could be selectively removed from the blood in 1912. Their goal was not to develop an artificial kidney as we know it today, but to be able to selectively remove substances from the blood so that specific medical conditions could be studied and treated. This group is most interesting because they could not have performed their experiments without the help of some very unusual industrial suppliers.

Abel relates how it was necessary for Reentry (see Figure I) to attend classes at a nearby glass factory so that he could learn how to blow glass and construct the "Vividiffusion" device,...

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