Do-It-Yourself Kidney

Michigan Scrap Dealer Albert Blumenfeld knew, only two months ago, that some way must be found, and found quickly, to overcome his progressive kidney failure, or he would die of uremic poisoning. One diseased kidney had been removed 16 years ago, and now the other was failing fast. Yet last week Blumenfeld was very much alive; he was whacking tennis balls to his son at his Southfield home, and talking about going back to bowling. After months with no appetite for his bland and tasteless salt-free diet, the 49-year-old businessman was eating high off the hog--all because of an 8-in. by 8-in. by 5 in. box costing $85: the filter unit of a new take-it-home-and-do-it-yourself artificial kidney.

Blumenfeld was a candidate to be come one of the 45,000 Americans annually who die of kidney failure. For while he is the type of patient whose life can be saved by an artificial kidney, none was available; every one that he could locate in the Midwest was booked for months ahead. The entire U.S., he learned, has facilities for continuous treatment of only 200 to 300 of a possible 10,000 patients who might be saved. Then the Michigan Kidney Foundation told him of a new home artificial kidney devised by the University of Maryland's Dr. William G. Esmond. One quick phone call and Blumenfeld and his wife started driving down to Baltimore.

In the Den. After five days of tests, Internist Esmond implanted twin Teflon tubes in Blumenfeld's left forearm--one in an artery, the other in a vein. Then he hooked his patient up to the machine. Blumenfeld's heart action propelled his blood to the compact, low-price filtering unit; inside the box, without the aid of a pump, it circulated through a plastic-wrapped sandwich containing many channels for the blood while the dialyzing fluid (cleansing solution) flowed steadily down by gravity feed from a 50-gal. tank past the other side of the plastic.

Poisonous waste products and urea passed from Blumenfeld's blood through the cellophane into the dialysate to be carried down the drain. After the first session, the urea reading in Blumenfeld's blood dropped from 110 to the low 50s. It has since dropped to the low 30s--about double the normal, but not life-threatening. Back home in Southfield, the Esmond kidney was installed in the paneled den where Blumenfeld relaxes on a rollaway bed for an eight-hour treatment twice a week.

Home dialysis on a repeat basis is not new: Seattle's pioneering Dr. fielding H. Scribner and Boston's Dr. John P. Merrill inaugurated it two years ago with far more expensive machines. The

Cleveland Clinic's Dr. Willem J. Kolff, who invented the first artificial kidney and has designed one that is widely used in hospitals, is now working on a do-it-yourself model that he thinks should sell for no more than $150.

Despite the progress they have made in home dialysis, doctors still disagree widely on exactly how much skilled help a patient needs. The Scribner team thinks a registered nurse needs up to three months' training, but an educated and well-motivated family member might need longer. Dr. Merrill takes the precaution of sending a specially trained nurse to train a family member, and requires periodic checks by a physician. Dr. Esmond sent a senior medical student to Southfield with the Blumenfelds for a couple of weeks to get them initiated and indoctrinated. Foreseeing no further problems, Student Sheldon Brotman went back to Balti more last week for graduation.

Hourly Injection. Simplified as it is, the Esmond machine demands exacting care and maintenance. Every hour during the dialysis, the patient must have a shot of anticlotting heparin injected into one of the tubes carrying his blood. Awake, he can do the job himself; if he sleeps, his wife can do it. Like all kidney-failure patients on dialysis, Blumenfeld must have a blood transfusion every month, mainly to replace red blood cells; nature's kidney produces a vital factor for making these, but the artificial kidney cannot.

Ironically, Albert Blumenfeld was both willing and able to pay the higher costs of other available machines; he just happened to hear of Dr. Esmond's "Dialung" first. Six other patients in the Baltimore area are also using it. A 38-year-old social security employee feels so good after 31 months on the machine (including 20 home dialyses) that he intends to put off going back to work, return to college instead and finish getting his degree.

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