Impact:

Although he did not invent hemodialysis – that achievement is credited to Willem Kolff of the Netherlands (and later an adjunct professor at Downstate) who built a crude artificial kidney to save patients during WWII — Friedman was instrumental in making the procedure available to a wide public in this country.

The original techniques for hemodialysis were crude, in that each dialysis session required an incision and sutures. Even with the introduction of the Scribner shunt in the early 1960s, the medical community was not convinced of the procedure’s efficacy and its use was limited. In mid-1964, the United States Public Health Service offered Friedman a $260,000 start-up grant for a demonstration program to prove the efficacy of chronic hemodialysis. The joint Kings County/SUNY Downstate Hemodialysis Program was the first federally-funded dialysis facility, and it became a model for the rest of the nation.

At first, hemodialysis was performed for 12 to 16 hours overnight, two or three times a week. Blood transfusions were required to correct anemia, and infections often occurred as a result of transfusions. Friedman continued to refine and improve dialysis techniques, in effect inventing clinical nephrology as needed. Strategy in Renal Failure, the tactical guide Friedman wrote in 1978, remains a standard text in the field. Friedman helped to change the medical question about dialysis from whether it could keep patients alive to how best to administer dialysis. Friedman elucidated renal syndromes in diabetic patients that lead to end stage renal disease (RSRD), and people with diabetes-related kidney failure, once excluded from hemodialysis entirely, grew quickly to some 20 percent of the hemodialysis population. From 1986 through 1989, Downstate was the only institution in New York State to investigate erythropoietin in renal failure (it was approved by the FDA in 1989). Erythropoietin is a hormone produced by the kidneys that combats anemia by stimulating the growth of new red blood cells. Its deficiency in renal failure is the main reason so many dialysis patients suffer extreme anemia. In 1996 Friedman published a study in the New England Journal of Medicine that conclusively showed that inadequate dialysis in patients with ESRD was a key reason for insufficient response to erythropoietin; increasing dialysis time could prolong survival.

Once dialysis became widespread and home dialysis was feasible, Friedman introduced a “suitcase kidney,” a portable dialyzer that allows patients to travel away from home.  (Individuals undergoing maintenance dialysis are limited in mobility and rehabilitation by the need to conform to a schedule developed by the dialysis center.)

Friedman founded the National Association of Patients on Hemodialysis, now the American Association of Kidney Patients. In 1972, with Friedman’s help – and the help of a Downstate patient who dialyzed himself on the floor of Congress —  the group successfully lobbied Congress for Medicare funding for dialysis. The bill passed, ensuring that virtually any American who needs it can receive the life-saving procedure Friedman helped introduce.