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Maintenance Dialysis After 20 Years

George Dunea, MD
JAMA. 1980;244(1):67. doi:10.1001/jama.1980.03310010053031.
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"In the lay mind, the kidneys seem to join the heart and brain in the inner circle of really vital organs, while the lethal potentialities of diseases of the lungs, liver, stomach, and blood-vessels are less seriously regarded." Thus wrote Sir Douglas Black 20 years ago almost to the very day, quoting Sir Walter Scott's pessimistic view that "when a man makes blood instead of water, he is tempted to think of the possibility of his soon making earth."1 Yet even closer to the graveyard, within living memory, was the luckless person who made no water whatsoever, or whose sclerotic glomeruli reluctantly squeezed out so insubstantial a secretion that life miserably ebbed away until stupor, convulsions, and coma mercifully secured a release from living death.

All this began to change when Quinton et al2 contrived to connect the arterial cannula directly to the venous, "thereby creating a small


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