Willem Johan Kolff constructed the first artificial kidney; however, it was not very useful clinically because it did not allow for removal of excess fluid. Alwall modified a similar construction to the Kolff kidney by enclosing it inside a stainless steel canister. This allowed the removal of fluids, by applying a negative pressure to the outside canister, thus making it the first truly practical device for hemodialysis. On September 3, 1946, Alwall treated his first patient in
acute kidney injury, who responded well to the treatment but died of
pneumonia a short while after. Alwall also was arguably the inventor of the
arteriovenous shunt for
dialysis. He reported this first in 1948, where he used such an arteriovenous shunt in rabbits. Subsequently, he used such shunts, made of glass, as well as his canister-enclosed dialyzer, to treat 1,500 people in
kidney failure between 1946 and 1960, as reported to the First International Congress of
Nephrology held in Evian in September 1960. As of 2007, two patients for which kidney replacement therapy was initiated by Alwall in 1968 and 1971, respectively, have survived for over 35 years on hemodialysis. These patients represent two of the longest known survivors on hemodialysis worldwide. == Later life ==