Willem (‘Pim’) Kolff’s remarkable achievement

Kolff is famously the man who first put the developing theory of therapeutic dialysis into successful practice in the most unlikely circumstances, in Kampen in the occupied Netherlands during World War 2. Influenced by a patient he had seen die in 1938, and in a remote hospital to avoid the Nazi sympathisers who had been put in charge in Groningen, he undertook experiments with cellulose tubing and chemicals and then went straight on to make a machine to treat patients from 1943.

His first 15 patients died, but the 16th, a 67 year old woman with acute renal failure caused by septicaemia, recovered after 11 hours of dialysis.
His rotating-drum kidney was a fearsome beast. Blood ran around cellulose (sausage skin) tubing which was wound round a drum made of wooden slats, dipping into the ‘bath’ of dialysate at the bottom of its turn. The movement of blood was powered by the rotation of the drum rather than a blood pump. The surface area of the dialyzer was respectable by modern standards at over 2m2, but it required up to two units of blood to prime the tubing before each dialysis, and ultrafiltration control was inaccurate and unreliable – achieved by adding variable amounts of glucose to the ‘bath’. Dialysate was made by stirring weighed salts into the tapwater bath. A water pump from a model T Ford powered rotation.

Kolff subsequently moved to the USA and went on to more remarkable things. His design was modified in Boston to make the Kolff-Brigham machine, which was widely used in the early 1950s and which through its use in the Korean war (1950-3) helped to establish the role of dialysis in acute renal failure. The Watschinger-Kolff twin coil kidney introduced the concept of the disposable dialyser, enabled more controllable ultrafiltration, and the Travenol machine that used it became the most widely used machine in the early days of dialysis. Kolff went on to found the ‘Maytag’ programme of dialysis using a coil in a washing machine at the Cleveland clinic, and to design artificial hearts and other bioengineering challenges.

His success with dialysis was dependent on the work of many who investigated its potential since Thomas Graham first described dialysis (and distinguished crystalloids and colloids) in 1861, and on technical developments, notably the development of cellulose tubing, and of heparin (instead of hirudin from leeches) as an anticoagulant. All of his practical experiments were on humans – he recounted that there was only his conscience as a brake. In the 1940s he investigated alternatives too, testing peritoneal dialysis and ‘intestinal dialysis’ too.

Nils Alwall (Sweden) and Gordon Murray (Canada) independently developed haemodialysis techniques and put them into practice shortly afterwards.

Willem Kolff died in 2009 aged 97.

Further info:
Sheldon T. Willem Kolff. BMJ 2009 338:b2027
Henderson LW. A tribute to Willem Kolff MD, 1912-2009. JASN 2009 20:923-4.
J. Stewart Cameron 2002. A History of the Treatment of Renal Failure by Dialysis (OUP)
The early history of dialysis (Edren)
Kolff W. 1947. New ways of treating uraemia. Churchill and Co., London. 

The origin of our photo of one of Kolff’s original rotating drum kidneys is not known. The photo of dialysis in Cleveland in the 1960s is courtesy of (and copyright of) Dr Y Nose.