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First reports in German literature on the effective removal of uremic toxins by means of extracorporeal hemodialysis in bi-nephrectomized, acute uremic dogs were given by Heinrich Necheles and Georg Haas. These methods were viewed with great scepticism by Georg Ganter who criticized in particular the extensive operative procedure by use of the femoral artery and vein, the size and fragility of the dialysers, as well as the potential toxic effects of the anticoagulant hirudin. As an alternative approach, he suggested the use of the peritoneum as an especially large endogenous dialysis membrane. In 1923, in experiments on ureter-ligated guinea pigs and rabbits, he demonstrated that the single or repeated instillation (after effective draining) of physiological NaCl solution improves both the symptoms of uremia and the blood urea nitrogen level. In patients this new procedure was implemented only sporadically and in the form of a single fluid instillation after a first observation in a uremic patient where a pleura exudate was substituted: in a female patient with acute uremia as a consequence of a ureter occlusion, due to uterus carcinoma, and in a patient with a diabetic coma. In spite of these limited experiences, Ganter was convinced of the superiority of his method over the troublesome hemodialysis therapy and recommended its broader clinical application.
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