From the second the first dialyzer was invented by Abel, Rowntree, and Turner 115 years ago, it should have been clear that dialysis- which cleans the blood of most of the toxins that accumulate when the subject has kidney failure, was, at best, incomplete.
Sure, over the years, we made the purification more complete, we made the dialysate more physiologic- but while toxin removal is a major function of the kidneys, it’s not the only function. And, we still don’t remove all the toxins necessary to render the patient as well off as s/he would be if their kidneys were functional.
As Willem Kolff, one of the pioneers of modern dialysis (he developed what was called the wash-tub process of dialysis during World War II; this became known as coil hemodialysis), once stated: “If we are going to keep patients alive by artificial means, we then incur the responsibility to see that it is a good life and an enjoyable life.”
That’s the problem. Dialysis lets patients stay alive- but there is zero restoration of patient health. Nor does the system provide rehabilitation for the patient. Consider this fact: Worldwide, 1 in 10 folks suffers from Chronic Kidney Disease (CKD) [Global Kidney Health Atlas data, this is available at the International Society of Nephrology, if you are a member]- and 9 out of 10 who have CKD are totally unaware they are at risk. (The US is about middle of the road, with 14% of our population so afflicted; Belgium and Saudi Arabia soar to 24%, Germany is at 17%, the UK is 16%.) And, those with CKD are 20X as likely to die of other causes (primarily cardiovascular) than directly from kidney failure.
A major initiative (Standardised Outcomes in Nephrology- SONG) around the world is determining (the survey will not be complete until later this year; the findings will be presented shortly thereafter) that patients want to be free of fatigue, able to travel, able to work, and to have significant free time not connected up to the dialysis apparati. (Not surprising, what the patients are really saying is that they want their lives to be normal!)
Which leads many researchers to develop devices that are more portable, more wearable. The problems with machines that have been announced (NxStage dialysis machine, Victor Gura’s wearable device) is that they are not there yet.
Logistic problems- such as restricting flow (the tubing kinks) as the person moves, leaks from the blood lines- are just small problems. The fact is the wearable device is too large, too complex, and requires too much effort to assemble.
What’s really needed is the political process to cease blocking the use of stem cells. So, we can produce a true replacement kidney. So, the patient will be restored to health.
Now.
Interesting that the most common approach will let someone stay alive but doesn’t actually improve health. It’s a tricky subject because I’ve always been of the mindset that I would rather have quality of life than a prolonged one. But the more tragic thing is when we know that successful remedies are available, like stem cells, but usage is blocked by red tape.
I’m with you 100% on that, Megan. It’s why I have DNR and Living Will instructions.
I recommend everyone consider what they are willing to consider living- and ensure that their wishes get followed.
I can only hope these breakthroughs come to pass in the next few years.
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They could come about relatively quickly- if we removed the political constraints against their use, Alana…
That’s the big first step…