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1 Why a history of dialysis? 1 2 Replacement of body function by mechanical means 8 3 The science of dialysis: 'uraemic toxins' 15 4 The science of dialysis: osmosis, diffusion and semipermeable membranes 24 Osmosis diffusion and dialysis 24 Dialysis membranes in the laboratory 28 5 Anticoagulants and extracorporeal circuits: the first haemodialysis 32 The beginnings of anticoagulation 32 In vivo dialysis in animals 33 6 The search for new dialysis membranes: the peritoneum and the beginnings of peritoneal dialysis 44 The search for better dialysis membranes 44 The use of the peritoneal membrane in situ for dialysis 46 7 The first haemodialyses in humans: the introduction of heparin and cellophane 61 The work of Georg Haas 61 Heparin and its controversial discovery: the disputed role of Jay Maclean 64 Howell's role in the discovery of heparin 66 The first use of heparin for haemodialysis 67 A new membrane: cellulose 68 8 The first practical dialysis machines: Kolff, Murray and Alwall 74 Willem Kolff 74 Gordon Murray 80 Nils Alwall 87 9 Peritoneal and intestinal dialysis after the Second World War 95 Peritoneal dialysis 95 Intestinal dialysis 103 Dialysis be other routes 105 10 The rise of the concept of acute renal failure; the flame photometer, urologists and nephrologists 110 11 The spread of dialysis treatment for acute renal failure (1947-1960) 120 Europe 120 Latin America 131 North America 133 Peritoneal dialysis in the 1950s 141 Intestinal dialysis in the 1950s 146 Dialysis treatments at the end of the 1950s 147 12 New designs of artificial kidney 157 Many new dialysers 157 New materials determined the new designs 160 The twin-coil kidney 161 Involvement of industry 163 Flat-plate parallel-flow dialysers: the Skeggs-Leonards, MacNeill and Kill kidneys 164 Capillary dialysers 171 13 The role of dialysis technology in the founding of nephrology 179 14 New materials and new methods of access I: long-term haemodialysis becomes possible 187 The external arteriovenous shunt 187 The arteriovenous fistula 193 The growth of dialysis units 194 Home haemodialysis 195 The beginning of dialysis monitoring 196 15 New materials and methods II: long-term peritoneal dialysis becomes possible 200 The beginnings of long-term peritoneal dialysis 200 New catheters and cycling machines 202 Clinical use of peritoneal dialysis in the 1960s 205 Peritoneal dialysis for acute renal failure in the 1960s 205 16 Dialysis patients in the 1960s and 1970s: old and new complications 209 Long-term dialysis patients in the 1960s and 1970s 209 Complications of patients on long-term dialysis from uraemia and other causes 211 The hepatitis plague: blood-borne viruses 216 The psychology of long-term dialysis 219 Summing up long-term dialysis in the 1960s and 1970s 219 Patients going into acute renal failure 220 17 The 1970s and 1980s: new technical advances and some new problems 229 Dialysis dysequilibrium 229 Dialysis leukopaenia 229 Access for haemodialysis 230 New membranes for haemodialysis 231 New haemodialysis strategies: shorter or longer? More or less frequent? 233 Sequential ultrafiltration 236 Back to bicarbonate 236 Dialysate regeneration 236 Haemoperfusion using adsorbent materials 237 Ultrafiltration and haemodiafiltration 239 Clinical uses of haemofiltration techniques 242 The 'middle molecule' hypothesis 245 The quantification of dialysis: the dialysis index, URR and urea Kt/V 245 Dialysis for conditions other than uraemia 247 18 A detective story: the rise and fall of aluminium poisoning-and a penalty of halfway technology: the rise and rise of dialysis amyloidosis 258 Aluminium posioning: dialysis dementia 258 The rise and rise of dialysis amyloidosis 263 19 Peritoneal dialysis transformed: CAPD 273 Peritoneal dialysis 1970-1978 273 CAPD 273 CAPD becomes the major treatment choice 276 Social and fiscal aspects of CAPD 277 Peritonitis - a continuing problem 279 How much CAPD? New styles of CAPD 280 Sclerosing encapsulating peritonitis 281 New dialysis fluids 282 20 Good news and bad news: treatment of renal anaemia, the rising tide of diabetics with end-stage renal failure and withdrawal from dialysis 287 The treatment of renal anaemia 287 The rising tide of diabetic nephropathy 293 Prevention at last? 299 Suicide during dialysis and withdrawal from dialysis 300 21 The growth of long-term dialysis for long-term renal failure in its fiscal and sociopolitical context 309 The United States 311 The United Kingdom 317 22 Conclusions: dialysis today-and tomorrow? 328 Basic dialysis technology: more of the same 328 Dialysis: social and financial context and the 'dialysis industry' 330 Dialysis patients then and now 336 Has dialysis a future? 338 Can we prevent renal failure? 341 Envoi 342 Index 347