Uribarri J
Mount Sinai School of Medicine, New York, NY 10029, USA.
Mt Sinai J Med. 1999 Jan;66(1):14-9.
Dialysis was first described and used in 1854 to separate substances in aqueous solution based on different rates of diffusion through a semipermeable membrane. In vivo hemodialysis was performed in animals early in the twentieth century. Hemodialysis was first carried out in patients with acute renal failure in The Netherlands during the Second World War and in the United States in 1948. Repetitive hemodialysis for the treatment of chronic renal failure due to end-stage renal disease had to await the development of an acceptable long-lasting vascular access in 1960. The subsequent successful development of a technique to create an adequate arteriovenous fistula in 1972 permitted the rapid growth of dialysis programs, when the cost of this therapy was largely paid for by Medicare. Equipment has been developed to foster home-care hemodialysis and chronic ambulatory peritoneal dialysis. Enhancements in renal replacement therapy included the availability of recombinant human erythropoietin, calcitriol, and effective antihypertensive drugs. Technical advances in hemodialysis followed the use of bicarbonate dialysate, more biocompatible membranes, membranes of higher porosity, and ultrafiltration. Questions remain regarding the evaluation of the adequacy of dialysis which is to be achieved or prescribed. Careful attention to the management of the patient with progressive chronic renal insufficiency is crucial in dealing with the inevitable onset of uremia and the initiation of dialysis and/or renal transplantation. The cost of renal replacement therefore represents a great societal burden. A better understanding of how to prevent onset and progression of specific nephropathies along with the availability of new and more effective equipment for renal replacement therapy has a high priority.
透析最早于1854年被描述并应用，用于根据物质在水溶液中通过半透膜的不同扩散速率来分离物质。20世纪初在动物身上进行了体内血液透析。第二次世界大战期间，荷兰率先在急性肾衰竭患者中开展了血液透析，1948年美国也开始了此项治疗。由于终末期肾病导致的慢性肾衰竭的重复性血液透析，直到1960年可接受的长期血管通路技术出现才得以实现。1972年随后成功开发出一种建立足够动静脉内瘘的技术，使得透析项目迅速发展，当时这种治疗的费用主要由医疗保险支付。现已开发出促进家庭护理血液透析和慢性非卧床腹膜透析的设备。肾脏替代治疗的改进包括重组人促红细胞生成素、骨化三醇和有效降压药物的应用。血液透析的技术进步包括使用碳酸氢盐透析液、生物相容性更好的膜、孔隙率更高的膜以及超滤技术。关于要达到或规定的透析充分性的评估仍存在问题。在应对不可避免的尿毒症发作以及开始透析和/或肾移植时，仔细关注进行性慢性肾功能不全患者的管理至关重要。因此，肾脏替代治疗的费用是一项巨大的社会负担。更好地了解如何预防特定肾病的发生和进展，以及获得新的、更有效的肾脏替代治疗设备是当务之急。
