2.0 The History of Haemodialysis

Nicola Thomas, RN, BSc (Hons), MA. PhD, Professor of Kidney Care, London South Bank University, UK nicola.thomas@lsbu.ac.uk

Debbie Fortnum, Editor EDTNA/ERCA Brand Ambassador Australia/New Zealand, Clinical Nurse Manager Dialysis, SCGH Perth, Australia
deborah.fortnum@health.wa.gov.au 

Introduction

The introduction of Haemodialysis (HD) as a life-saving treatment for end-stage kidney disease was not the result of any large-scale research programme. It started from the activities of a several pioneering individuals in the USA and later across Europe.

How did dialysis begin?

  • 1854 – Dialysis used experimentally.
  • 1920 – George Haas, Germany: First human trial for dialysis.
  • 1930’s – William Thalhimer used cellophane to make a dialyser.
  • 1940’s – William Kolff built a rotating drum dialyser.
  • 1948 – First successful dialysis on Kolff machine in 1948 in Mount Sinai USA.
  • 1956 – Dialysis equipment commercially available. Cost $ 1200 plus $ 60 per treatment. Mainly used for acute (temporary) dialysis.
  • 1960 – Dr. Belding Scribner devised external shunt for vascular access so chronic (long-term) dialysis could happen.

Photographs of the Kolff drum, Kiil dialyser and other machinery used in the early days of dialysis can be seen here  https://homedialysis.org/home-dialysis-basics/machines-and-supplies/dialysis-museum

2.1 How did home dialysis start?

  • 1961 – Dr. Stanley Shaldon reported a patient dialysing at the Royal Free Hospital in London was able to self-care by setting up his own machine, initiating and terminating dialysis; so Home Haemodialysis in the UK became possible.
  • 1964 – Arterial leg shunts allowed the patient to have both hands free for the procedures. First patient to be have overnight Home Haemodialysis1.
  • 1970’s – Large Home Haemodialysis programs developed in UK & USA.
  • 1980’s – Peritoneal dialysis programs developed and expanded.

2.2 The story of the pioneers of early Home Dialysis

In February 2017, a group of staff who were involved in the early days of dialysis came together to recall their experiences. Dr. Rosemarie Baillod, who worked alongside Dr. Shaldon, explained how the machines were developed.

“I had to develop alarm systems and I had to go to a shop called Radio Spares, and I had to buy relays, light bulbs and little alarms……..we got some monitoring from Cambridge Monitors – if the pressure went too high it would alarm, if it went too low it would alarm, and it was in a box about 2 feet square, it looked very smart. The first time we arrived at the patient’s home – everything leaked!”

Dr. Baillod also explained how patients were chosen at the Royal Free Hospital, London.

“I used to have to go and present 4-6 people every month from different hospitals…..I would get telephone calls and then meet the patient and family…..I would then have to present each case to a selection board….dialysis would never have existed if we did not push the borders as we did at the beginning.”

Sally Taber nurse explains

“The patients had a cooked breakfast, but during the day had to have a whole cup of jam and a whole cup of cream….if they did not eat it, we had to put a tube down.”

Ann Eady, a nurse who also cared for her husband on home dialysis, said

“It is hard work…you are constricted, but there are benefits….you can travel, and the well-being of patients was vastly increased.”

Joy Foo, explained how the training patients was very satisfying

We are nurses and we taught people from the street, who knew nothing about medicine and we send them home….that was the most rewarding part.”

Lesley Pavitt remembers it in a similar way and recalls ….

“The patients had things (dialysis) done to them for months and years in other hospitals and then they came to us and we were able to give them the skills to take control of their life again..…and that is an incredibly empowering thing.”

2.3 How much Home Haemodialysis is done today?

Home Haemodialysis is increasing again but the levels are still low in many countries.

  • USA 1.8% of patients
  • New Zealand 15.6%
  • Australia 9.4%
  • Denmark 5.5%
  • Finland 4%
  • Sweden 2.8%
  • The Netherlands 2.4%
  • UK 2.1%

Acknowledgements

I would like to thank Gunnar Malmström for the information and photographs provided for the Case Study.

References

1. Baillod RA, Comty CIlahi M et al. Proceedings of the European Dialysis and Transplant Association 2. Amsterdam: Excerpta Medica, 1965:99