Title: Dialysis for endstage renal failure in the UK
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Dialysis for endstage renal failure in the UK
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In September 1960 Scribner recounted his first 6 months experience of dialysis via the new AV shunt at the first International Society of Nephrology meeting in Evian, which had just launched its mineral water. (If you haven't already, you might start by reading Dialysis for endstage renal failure in the world. It's the post below this one.) At that meeting was Stanley Shaldon, then Sheila Sherlock’s Lecturer at the Royal Free Hospital in London. He had come to present a paper on diuretics in liver disease, but was impressed by Scribner’s presentation, and by another by Nils Alwall from Sweden, which hinted at the feasbility of long-term dialysis. The Royal Free Hospital had a dialysis machine, set up by urologist John Hopewell specifically to support patients with end stage renal disease in preparation for transplantation, which he was developing there with the aid of Roy Calne. However at this stage the machine had mostly been used for acute renal failure.
Early the following year Shaldon tested the technique he had used to study liver blood flow – Seldinger insertion of vascular catheters into femoral vessels without a surgical procedure – to connect patients to the dialysis machine. He went on to develop maintenance dialysis using this technique and you can see a remarkable Movietone newsreel from 1963 describing this. The Royal Free became the first UK centre to treat chronic renal failure by dialysis.
In December 1963 Newcastle became the second unit in the UK to start treating end stage renal failure by dialysis.
At the second International Society of Nephrology meeting in Prague in 1963, Hugh de Wardener found that Scribner’s patients were still alive, so sent a team to Seattle to learn the technique. They returned to set up a unit specifically for long-term dialysis, the third unit providing it, which began work at Fulham Hospital (a branch of Charing Cross Hospital) in August 1964.
An accepted treatment
The speed of change was dramatic. In the first edition of deWardener’s book on the new specialty (The Kidney) in 1958, the treatment of terminal chronic renal failure was entirely palliative, involving use of chlorpromazine, morphine and paraldehyde. Only six years later in the second edition there was discussion of peritoneal as well as haemodialysis and of transplantation, with the prescient prediction that none of these would be able to meet the new demand for treatment. After the technical hurdles, and professional resistance, finance became the third barrier.
The first episode of the BBC TV programme Tomorrow's World in 1965 featured the Royal Free dialysis programme led by Stanley Shaldon and including some early home haemodialysis, and hospital footage of one of the remarkable long term patients, Robin Eady.
A committee established by the Department of Health, which included de Wardener and David Kerr (Newcastle) recommended the building of a renal unit in each health region throughout the UK to cope. 35 were built within 5 years – a great start, but indeed it did not prove enough, and it was probably only in the 1990s that the UK completely caught up with providing dialysis for all those who could benefit. This progress would probably have been impossible and unaffordable if the results of transplantation had not improved beyond all recognition across the same period. Photo - one of the 35 units - Edinburgh 1969
Further information
Cameron JS 2002. A history of the treatment of renal failure by dialysis. Oxford University Press, Oxford
Wellcome Witness to the History of Medicine 2009.
History of dialysis in the UK.
History of dialysis in the UK.
Cameron JS 2000. The first half-century of the Renal Association, 1950-2000. Download from renal.org/history.
de Wardener HE. 1958, 1964. The Kidney. London, Churchill.
Hopewell J. 2009. The early history of the treatment of renal failure.
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