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The two things that
stand out in my mind as the most revolutionary in dialysis are not, in fact,
machines. The first is the internal arteriovenous fistula developed by Cimino
and Breschia. Until its advent, canulation with external shunts were needed
to provide access for chronic hemodialysis. By the now, in retrospect, simple
means of making an internal connection between and artery and vein, repeated,
safe, and usually adequate blodd flows could be achieved without the constant
fear of a patient losing his or her "lifeline" or accidentally bleedig to
death. this was a breakthrough in terms of life prolongation as well as
life quality.
The second that comes to mind is erythropoeitin. Until it became
available, large chronic dialysis units were the largest users of blood in
any major hospital center - including ours, because of the need for
frequent packed cell transfusions to keep the ESRD patient's hct above 20.
The patients didn't die of anemia, but they were grey skinned, cyanotic
with physical exercise, constantly tired, and in most cases barely getting
by. Those pts who, because of their underlying disease (ie polycystic
kidney disease) had higher hcts were easy to pick out of any group of CRF
patients. Epo dramatically changed this life style by creating pink cheeked,
energetic, and more socially involved individuals whose lives no longer
consisted of little more than trips back and forth to a dialysis unit
thrice weekly. There were even wives of dialysis patients who thanked the
staff because for the first time in many years their husbands were
interested in sex again!
While the constant improvements in artificial organs continues on the engineering
front, I believe those things that continue to improve the quality of life
for people dependent upon the technology will be as important in the future
as they have been in the past. |
