Nils Alwall – one of precursors of dialysis treatment

Abstract

Nils Alwall (1904-1986) came from a small village in southern Sweden. In 1923 he began his medical studies at the Lund University, to graduate in 1932. During his studies he conducted experimental work and in 1935 defended his doctoral thesis in pharmacology. In 1936 he was awarded the title of associate professor of pharmacology and started clinical practice combined with experimental research in the Department of Medicine at Lund. In 1940 Alwall obtained the position of assistant professor of practical medicine and in 1957 was promoted to professor of nephrology at the world’s first Department of Nephrology. His medical interests were many-sided but mostly related to kidney diseases and replacement therapy after the loss of renal function. From 1941 he worked on the construction of the vertical drum artificial kidney, tested mostly in rabbits, which also enabled ultrafiltration. The dialysis was first applied in September 1946 in a patient with severe uremia, and soon afterwards the first ward for artificial kidney therapy was established. Thenceforward Lund department became the leading center for treatment of acute and later also chronic renal insufficiency. Alwall was also the inventor of the arteriovenous shunt (1943-1948) and the pioneer in the use of renal biopsy (1943). He also inspired creation of the Gambro Company in Lund (1964) which resulted in construction of coil dialyzer (1966) and sheet single-use plate dialyzer (1967). Alwall was also involved in the founding of the International Society of Nephrology (1960), European Dialysis and Transplant Association (1964), and Swedish Society of Nephrology (1964), engaged at leading positions in these organizations, also after his retirement in 1971. He is an author and coauthor of 203 publications.

 

Keywords: Nils Alwall, Dialysis Treatment, artificial kidney

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Nils Alwall and his input into the development of Polish haemodialysis

Abstract

Nils Alwall’s fame and reputation as a pioneer and leader of haemodialysis treatment of patients with chronic renal disease was widespread across Europe in the 1940s, 50s and 60s. Little wonder, then, that his renowned clinic in Lund, Sweden was willingly visited by many doctors from Central-Eastern Europe including those from Poland. The first Poles to meet Alwall in his native Sweden right after WW2 were Maria (nurse) and Bożysław (technical worker) Kurowski. The meeting gave rise to the publication of the first nursing paper in Poland in 1958. Nils Alwall’s archive in Lund holds rich correspondence exchanged with Polish doctors. The first one to establish contacts with the famous Swede was dr. Zygmunt Hanicki from Krakow, who later received one of Alwall’s first dialysis machines enabling him to perform experiments whose results were published in 1949 and 1950. The first longer stay in Lund started in 1957 when dr. Tadeusz Orłowski, the future leader of the Polish nephrology and transplant therapy, made his way to the famous centre. Next, in 1958 the clinic was visited by dr. Zdzisław Wiktor of Wrocław, the future Head of one of the first clinics of nephrology in Europe and the following year dr. Jan Roguski of Poznań also sought to gain experience there. In the meantime, a number of dialysis centres equipped with Alwall-type haemodialysis machines were set up in Poland including the Poznań unit (1958) established by Kazimierz Bączyk, the Warsaw one (1959) by Tadeusz Orłowski and the Krakow centre (1962) by Zygmunt Hanicki. It was in 1960 when dr. Zbigniew Fałda from Warsaw completed his training in Lund. Later, in 1966 the Lund centre hosted dr. Jan Kurkus. Nils Alwall’s first visit to Poland was in 1959 during the Congress of the Polish Society of Internal Medicine in Gdańsk. His second visit to Poland happened in 1970 when he gave two lectures. By the time Nils Alwall retired as many as a few dozen Polish doctors had gained experience in Lund later transplanting it to their centres in Poland confirming the significant impact of the Lund centre on the development of the Polish dialysis therapy.

Keywords: Nils Alwall, dialysis unit, Lund University, history of haemodialysis, Poland

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Nils Alwall- a personal appreciation

Abstract

I first met Nils in 1964 at the founding of the EDTA (sic) in Amsterdam. I was 29, he was 60. Later I worked with him, now retired from clinical work, on committees over the next couple of decades. During this time he assumed Presidency of both the EDTA and the ISN; he was one of the major founders of Nephrology, as well as a pioneer of and major contributor to electrolyte balance, haemodialysis, ultrafiltration and related techniques. He had introduced renal biopsy in 1944, but remained silent on this subject until after Claus Brun published his work 8 years later. Nils studied arteriovenous shunts for repeated dialysis during the 1940s, but was blocked by the red rubber and glass tubing – all that was then available. I was immediately impressed by the quiet modesty of this most original man; but despite this he achieved international fame in Europe, although was never well known in the United States. His Festschrift in 1985 in Nephron amply demonstrated his status. His “rival”Pim Kolff (1911-2009) was in contrast slightly younger, outlived Nils by 20 years, and was a fine communicator and great extrovert. Nils was a physiologist and pharmacologist until 36 years old, only then becoming a clinician. Strangely Nils had performed the first haemodialysis at my alma mater, Guy’s Hospital London, in 1948 on a visit, 15 years before we established a renal unit there. Characteristically, he never told me about this event, and I only discovered the story after his death.

Keywords: Nils Alwall, History of haemodialysis, history of nephrology

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