An Artificial Kidney For 15 Patients

When 500 far-out medical investigators gathered in Chicago last week for the annual meeting of the American Society for Artificial Internal Organs, they spent much of their time discussing something that is far too big ever to be implanted as an internal organ: the artificial kidney. And the biggest news about it was a plan to make it still bigger, so that a machine that is now about the size of a home washing machine will take on the dimensions of a laundry. It will also, its developers hope, wash out the metabolic poisons from the blood of as many as 15 kidney-disease victims at once.

12-Hour Treatments. Nowhere has the artificial kidney received more attention than in Seattle, where Dr. Belding H. Scribner pioneered in adapting the machine to treat patients whose own kidneys have almost completely shut down. These patients excrete such a small volume of urine that it cannot carry a full load of the body's waste chemicals. Without the repeated treatment, they could not live more than two or three weeks. With it, some have lived as long as four years, and they are back at work or running their households.

Permanently implanted in these patients' forearms are two plastic tubes, one leading into an artery, the other into a vein. Once or twice a week the patients go to the hospital, where the tubes are hooked up to the artificial kidney. Their blood flows through one of its chambers, and body poisons pass through a cellophane sheet into the second chamber's purifying bath ("dialysate"). The average treatment lasts twelve hours.

The trouble is that the life-saving program is hideously expensive. It is not so much the first cost as the upkeep. To treat eleven patients, the Seattle Artificial Kidney Center at Swedish Hospital has a staff of two fulltime physicians and one halftime, plus five nurses and five technicians.

Diluted 35 Times. One way to cut costs by about 15% from the present $10,000 a year per patient, Engineer Lars Grimsrud told the artificial-organ enthusiasts, is to use a central, 150-gallon tank of purifying fluid instead of individual, 100-gallon tanks for each patient. In the central tank of the "monster," as the Seattle machine is called, the fluid is highly concentrated, and the machine dilutes it with as much as 35 times its own volume of water to get the right mixture for each patient. Patients still have personalized equipment at their bedsides: pumps to deliver the right amount of fluid from the monster, and the sandwich-like filter.

At University Hospital, doctors have already used "the monster" for as many as three patients at once.

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