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The discovery of an effective treatment for renal anemia
In 1986 recombinant erythropoietin is the product of years of research Anaemia was a major cause of morbidity in patients with end stage renal disease until recombinant erythropoietin became available at the end of the 1980s. Before long-term dialysis was available, haemoglobin (Hb) levels fell to a mean of about 8 g/dl (80 g/l) at…
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Surprises from the 1994 Modification of Diet in Renal Disease (MDRD) study
Low-protein disappoints; attention drawn to proteinuria and blood pressure The MDRD study was a landmark trial set up to prove the importance of dietary protein in slowing the progression of kidney failure. This had been shown in animal models but human studies were not so clear. It was combined with using two different blood pressure…
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Twins in transplantation
Groundbreaking – and lucky to have one John Merrill shows the Herrick twins an early dialysis machine On December 23rd 1954, 24 year-old Richard Herrick became the first successful kidney transplant recipient in Boston, Massachusetts. He was lucky both to be in Boston, and to have an identical twin brother Ronald who was prepared to…
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Diets for chronic uraemia
1949-1993: Addis to Giovannetti It didn’t work for her: a 46 year old female patient who stopped her diet. Note that it was lowering urea but not creatinine. From Shaw et al 1965, by kind permission of OUP. Low protein diets were shown to prolong the life of uraemic rats in experiments in the 1930s,…
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The record holders
A few patients have been on renal replacement therapy for over 45 years The Royal Free programmeThis photograph of ‘The Lucky Thirteen’ taken in 1965 shows patients treated at the UK’s first centre for long-term dialysis at the Royal Free Hospital, London, with their consultant Dr Stanley Shaldon (centre, front row). Olga Hepple, left of…
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Transplantation takes off in the mid 1960s
Years of experimentation finally pay off Roy Calne (white coat) with dogs Tweedledee, Titus and Lollipop, recipient of the first successful long-term organ transplant, using azathioprine (Copyright of and withpermission from Sir Roy Calne – link to source) Transplantation only began to be a real prospect for patients with chronic renal failure in the mid…
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Diet for acute renal failure in the 1940s
The beginning of the multidisciplinary renal team In 1949 Thomas Addis described the anarchy that existed in recommendations for the management of acute glomerulonephritis. He argued for protein restriction, as was becoming accepted for chronic uraemia, but it was in acute renal failure (ARF, or AKI) that real progress was being made. An Edinburgh diet…
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Who shall live? Patient selection for dialysis
Dustman before Duke? Title from the 1965 NBC documentary about dialysis in Seattle The first patient with end stage renal failure deliberately taken on for dialysis was Clyde Shields, who was started on treatment by Dr Belding Scribner in Seattle in 1960. A couple of years later several more patients were being kept alive in…
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The Korean War 1950-3: acute dialysis finds its place
War medicine tests science and dialysis In June 1950, North Korea invaded South Korea. After a rapid advance, their army was repulsed by American and Commonwealth reinforcements, but in November China joined the war and the battle lines moved back and forth until settling around the 38th parallel marking the border. Fighting continued until an…
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Hepatitis outbreaks run through renal units: 1964-72
Staff as well as patients die, and new patients are turned down in affected centres From about 1964 there was increasing excitement that dialysis might become a major life-saving treatment for chronic renal failure, not just for acute renal failure. Transplantation was also in its infancy, but despite some promise, overall success rates at this…
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Dropsy, nephrosis, nephrotic syndrome
The first effective treatment for a kidney disease, 1950. Dropsy is an ancient word (first recorded about 1290 AD) meaning oedema. Generalised oedema can be caused by heart or liver or kidney disease, or by malnutrition. In all of these it was a pretty bad sign in ancient medicine as it meant that the patient…
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The birth of home dialysis
The first home haemodialysis, 1964 In the early 1960s dialysis was still a very new technology. It was high-tech, life-saving and dramatic. That you can run the the blood of conscious patients through a machine to replace a critical body function is still pretty amazing today. The idea of sending patients home to look after…
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Dialysis for endstage renal failure in the UK
Good news travels quickly 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.…
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Dialysis for endstage renal failure (ESRF, ESRD)
The obstacles started to fall in 1960 On the 9th March 1960, Clyde Shields, a Boeing machinist in Seattle, was started on haemodialysis despite having chronic kidney failure. He was the first long-term dialysis patient and the beginning of a revolution. He survived with transplant until 1971, but he is unlikely to have suspected at…
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The first randomised controlled trial in dialysis
In 1980 the NCDS led to the first minimum standards for dialysis The National Cooperative Dialysis Study (NCDS) reported in March 1980. It led to the widespread acceptance of minimum standards for ‘dialysis dose’ worldwide. However few people have read the full study. It is hard to find in libraries, and you can’t get it…