The artificial kidney: past, present, and future.

World War II can be taken as a turning point after which the introduction and development of several new diagnostic and therapeutic discoveries have revolutionized medicine and improved the expectancy of life for millions. Notable amongst those technological therapeutic achievements is that of the artificial kidney, first used successfully in the closing years of the war. As a result of the improvements that followed, the kidney was the first solid organ whose function could be replaced, at least partially, by a machine. What started then as exploratory efforts to sustain life evolved over the next few decades into life saving replacement therapy for millions worldwide. Chronic maintenance hemodialysis has certainly changed the prognosis of the otherwise fatal end stage kidney disease that had afflicted humans theretofore. Unfortunately, many of the challenges and problems that had to be overcome in making artificial kidney treatment available continue to plague end-stage kidney disease patients on maintenance hemodialysis. Concerted investigative efforts are currently underway to improve the replacement of kidney function with artificial kidneys that better mimic kidney function. This article reviews the beginnings, evolution, and current challenges of the artificial kidney.