A 1965 NBC documentary, "Who Shall Live?", narrated by Edwin Newman, created a stir. The documentary portrayed the highly controversial decision-making process that occurred during the early days of dialysis when only a few patients could be treated, and even then at great cost. The documentary showed faceless black silhouettes of the anonymous committee of community members against a stark white background as they deliberated over cases and selected which patients would receive dialysis treatment. Their decision meant life or death for the end-stage renal disease patients they were reviewing. The committee's authority was final and irrevocable. Ultimately, the serious ethical dilemma of a committee's choosing who would and wouldn't receive medical treatment to extend their lives set in motion a transformation of the healthcare system in this country.
Topics: Hospital Administration
The first hemodialysis machines at the University of Washington weighed about 1,000 pounds. They were bulky and could only treat one patient at a time. Using them cost about $10,000 annually.
During the early days of dialysis, in the 1960s, only a few patients could be treated, and even then at great cost. This was unacceptable to W.J. Kolff, the inventor of the first artificial kidney.
As head of the Department of Artificial Organs at the Cleveland Clinic, Kolff wanted to make dialysis so reasonable that anyone could afford it. In his biography, Inventor for Life, The Story of W.J. Kolff, Father of Artificial Organs, Herman Broers relates how Kolff went in search of a way to allow kidney patients to dialyze at home to relieve the pressure of limited beds in dialysis centers. In 1966, Kolff and his team arrived at a solution.
Before 1960, end-stage kidney disease was always fatal. According to a University of Washington research study: “Use of the artificial kidney—or kidney dialysis—to cleanse the blood of toxic products meant that an artery and a vein were damaged every time the patient was hooked up to the machine. A patient could receive perhaps five to seven treatments before doctors would literally run out of places to connect the machine to the patient and the patient would ultimately succumb to the disease.”
Up to one in four hemodialysis patients will die suddenly. These deaths occur most often during the 12 hours immediately following the hemodialysis session or toward the end of the long 72-hour weekend interval between dialysis sessions.
The causes of sudden death in hemodialysis patients are not known. Many patients do not seem to have the typical high-risk factors such as coronary artery disease and heart failure that are associated with sudden death (SCD) in the general population. Their sudden deaths may be related to symptoms associated with chronic kidney disease itself such as vascular calcification, left ventricular hypertrophy, electrolyte/fluid abnormalities, autonomic dysfunction or inflammation.
Seventy years ago, renal failure meant certain death. The toxins that the kidney normally cleanses from the blood would build up and poison a person until they would fall into a coma and die. Hemodialysis to cleanse the blood did not exist. The artificial kidney invented by W.J. Kolff in Nazi-occupied Netherlands was in its infancy.
Conditions were harsh. When the Netherlands was attacked and occupied by Nazi Germany in May, 1940, the lives of a young doctor, Willem Johann Kolff, and his family were to irrevocably change. Kolff was a resident at the University of Groningen. There, he had watched a young man slowly die of kidney failure. The 22-year-old’s agonizing death ignited a resolve in Kolff to do something to help patients with renal failure. He was going to build an artificial kidney.
In 1998, the American Journal of Kidney Disease sounded a clarion call with the following title on the cover of their journal, “Cardiovascular Disease, An ESRD Epidemic.” 1 Their call was well grounded because cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD).1-2 It accounts for half of the deaths and a third of hospitalizations of dialysis patients.4
In January 2001, 18-month-old Josie King was rushed to the Johns Hopkins Children’s Center with second-degree burns. She had inadvertently stepped into scalding bath water. The child’s mother, Sorrel King, stayed at her child’s bedside as doctors and nurses valiantly administered to the child. A couple of weeks later Josie seemed well enough to be sent home. A celebration was planned, but then everything went downhill. The toddler became acutely sick. Her mother suspected dehydration, but nobody seemed to listen. When they did, it was too late. Josie was battling two infections—one was from a central venous line that led to sepsis. It ultimately took her life.
Compensation for Nephrologists Sees Above Average Increase in 2015Nephrology and hypertension saw the biggest pay increase among medical specialties in 2015, according to the 2016 AMGA Medical Group Compensation and Productivity Survey. Nephrologists saw a 6.7 percent increase in salary.