Dialysis equipment and dialysate, past, present and the future

From the beginning of the first described hemodialysis in 1889, history has shown an exponential evolvement of systems that have resulted in greater safety, efficiency, and broader utilization. It took 60 years, 1947, for the technology to be used in a clinical setting in North America, treating acute renal failure. Commercial interests became involved in the mid 1950s, resulting in the "twin coil" dialyzer, costing five times the current cost of similar membranes. The entry of commercial entities created a rapidly escalating technology in dialysis delivery systems to be used in the chronic recurring dialytic procedure: blood pumps, pressure monitors, needles, dialysate delivery, ultrafiltrate control, membrane design and configuration, dialysate composition. All of these have, for the most part, required trained staff and increasingly comfortable facilities to accommodate the rather static thrice-weekly hemodialysis procedure. The future will likely see more home dialysis, more frequent dialysis, better on-line monitoring, with attention to those factors which have allowed the greatest cause of morbidity, cardiovascular disease, to be controlled.