Hemodialysis in the Compact Nations of the US Affiliated Pacific: History and Health Care Implications

Background: The epidemic of non-communicable disease in the Compact nations of the US Affiliated Pacific Islands and the associated renal complications drive the demand for hemodialysis. Limited healthcare budgets and a lack of trained human health resources in these areas make hemodialysis a challenging undertaking that may require significant sacrifices in competing health care priorities. Methods: Two nephrologists who developed hemodialysis in the US Affiliated Pacific Islands provide its history. Cost estimates of hemodialysis for the Compact nations are collected from a 2014 hemodialysis feasibility report. The experiences and outcomes of current hemodialysis centers in the United States and other island nations provide a framework by which to assess the potential benefit and impact of hemodialysis in the Compact nations. Discussion: A consideration of how and why different stakeholders value hemodialysis will be crucial because they will drive the public's response to the institutionalization of any new intervention or the cessation of any existing intervention like hemodialysis. Conclusion: Updated cost estimates for dialysis clinics and data on renal disease rates in the Compact nations will be necessary to make informed decisions about hemodialysis in the current health systems. In the meantime, it is essential to enhance current medical interventions and public health strategies to prevent kidney disease and decrease the risks for kidney failure. Such preventive interventions must be culturally appropriate, effective, cost-efficient, and sustainable in the unique context of the Pacific.

[The dawn of Nephrology and Dialysis in Bologna with Vittorio Bonomini and Pietro Zucchelli]

In Italy, Nephrology and Dialysis born in the 50s. Among the protagonists of those years, there were Vittorio Bonomini and Pietro Zucchelli. In Bologna, they created a school of nephrology of national and international importance that generated many distinguished pupils. In the 60-70s, the author joined the school as student, then as assistant. He describes university life at the time of one of the last barons, Domenico Campanacci. Moreover, it is illustrated the adventurous birth and development of hemodialysis and peritoneal dialysis, under the guidance of Bonomini and Zucchelli. This article pays tribute to those two masters of nephrology and charismatic geniuses who founded our society.

John Dique: dialysis pioneer and political advocate

John Dique (1915-1995) epitomized the internationalism of medicine, the intellectual and manual dexterity of many pioneers of dialysis, and the social concern evinced by many nephrologists. Born in Burma of French, German, British and Indian ancestry; educated in India; an Anglo-Indian who described himself as British without ever having visited Britain; he moved to Australia in 1948 to escape the murderous inter-ethnic conflict that befell multicultural India as it and Pakistan became independent. Settling in Brisbane, he pioneered several novel medical techniques. After inventing some simple equipment to facilitate intravenous therapy, he established a neonatal exchange blood transfusion programme. Then, between 1954 and 1963, he personally constructed and operated two haemodialysis machines with which to treat patients suffering from acute renal failure, the first such treatment performed in Australasia. His patients survival results were, for the era, remarkable. He subsequently helped found the Royal Australasian College of Pathologists and went on to establish a successful private pathology practice. The latter years of his life, however, saw him become a social and political advocate. He fiercely opposed the emerging ideologies of multiculturalism and social liberalism that, he predicted, would seriously damage the national fabric of Western society. Public vilification ensued, his medical achievements disregarded. It does seem likely, however, that in none of the areas that he touched - whether medical, social, or political - has the last word yet been said.

The prehistory of haemodialysis as a treatment for uraemia

Less is generally known about the ideas, events and personalities which drove developments permitting the evolution of haemodialysis as a clinically useful form of palliation and treatment, than its subsequent success and failures. This pre-history of haemodialysis is summarized here. One must remember that with hindsight we can now discern connections between ideas and developments which were not perceptible in their time, and that progress towards any new idea, material or piece of hardware was usually random and undirected, and outcomes uncertain. We must also remember the many blind alleys we can now safely ignore, to give a spurious continuity to the development of ideas. The prehistory of dialysis begins with study of the diffusion of solute and solvent in osmosis in living systems and experimental settings, and the retention of potentially toxic substances in kidney failure, during the 18th and early 19th centuries. These two areas came together in work in the mid-19th century on diffusion of gases and liquids, and showed that natural and synthetic membranes could selectively hinder different solutes. This explained osmosis and allowed semi-permeable membranes to be used and designed. These ideas underpinned the subsequent history of both dialysis using body cavities such as the peritoneum (not discussed here) and ex vivo dialysis of blood. To perform this, new membranes and anticoagulants were needed. These led to the first attempts in animals in 1912-3, and human patients in 1924-8, but only the purification and synthesis of newer materials such as cellulose and heparin allowed practical and successful haemodialysis to evolve in the 1940s.

"Advice to the medical students in my service": the rediscovery of a golden book by Jean Hamburger, father of nephrology and of medical humanities

Jean Hamburger (1909-1992) is considered the founder of the concept of medical intensive care (réanimation médicale) and the first to propose the name Nephrology for the branch of medicine dealing with kidney diseases. One of the first kidney grafts in the world (with short-term success), in 1953, and the first dialysis session in France, in 1955, were performed under his guidance. His achievements as a writer were at least comparable: Hamburger was awarded several important literary prizes, including prix Femina, prix Balzac and the Cino del Duca prize (1979), awarded, among others, to Jorge Luis Borges and Konrad Lorenz.Here we would like to offer a selected reading of a "golden" book, "Conseils aux étudiants en medicine de mon service" ("Advice to the Medical Students in my Service"), the first book dedicated to patient-physician relationship in Nephrology, written when dialysis and transplantation were becoming clinical options (1963). The themes include: the central role of the patient, who should be known by name, profession, life style, and not by disease; the importance of the setting of the care; the need for truth-telling and for leaving hope; the role of research not only in the progression of science, but also in the daily clinical practice.

[Kolff and the artificial kidney]

Willem Kolff (1911-2009), son of a physician, studied medicine in Leiden and specialised in internal medicine in Groningen. It was there that he started attempts to apply the phenomenon of dialysis in patients suffering from renal failure. He built the first prototypes of dialysis machines after his appointment as an internist in the municipal hospital in Kampen, during the Second World War. Indeed, in the first 15 patients he managed to decrease urea levels, resulting in temporary clinical improvement, but eventually they all died. It was not until after the war that dialysis helped a patient survive an episode of acute glomerulonephritis. After 1950 he continued his work on artificial organs in the United States (first in Cleveland and later, after 1967, in Salt Lake City). Although most of his work from then on revolved around the development of an artificial heart, he also contributed to the design of a compact, disposable apparatus for dialysis, the 'twin coil'. Haemodialysis also became feasible for patients with chronic renal failure after the 'Scribner shunt' (1960) provided easy access to the circulation. Peritoneal dialysis is another option. Excess mortality, mainly from cardiovascular disease, is still a largely unsolved problem.

20 years since the establishment of the BANTAO association (Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs)

The Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs (BANTAO) was born in Ohrid on October 9, 1993. The war in former Yugoslavia negatively affected the development of nephrology and also the connections among the nephrologists from the Balkans. However, there was willingness for further mutual collaboration between the nephrologists from the Balkans. The war in Yugoslavia created hate among people, between the newly established countries, and there were problems with the recognition of the names of the new countries, and so, the nephrologists decided to apply the ancient principle of using the names of the cities, instead of the countries, as the founders of the Association. The main goal of BANTAO is to promote scientific and technical cooperation in the fields of renal disease and artificial organs between the regions on the Balkan Peninsula and the world, to give an opportunity for exchange of experience and knowledge among the experts in the area and to engage in collaborative projects in order to demonstrate that cooperation is possible even on the turbulent Balkan Peninsula. The I BANTAO congress was held in Varna from September 22 to 24th, 1995 (President--D. Nenov, Varna). The II congress of BANTAO was held from September 6th to 10th, 1997 in Struga, (President--M. Polenakovic, Skopje). The III BANTAO congress was held in Belgrade from September 18th to 20th, 1998 (President--Lj. Djukanović, Belgrade). The IV congress of BANTAO was held in Izmir from 14th to 16th November 1999 (President--A. Akcicek, Izmir). The V Congress of BANTAO was held in Thessaloniki from September 30th to October 3rd, 2001 (President--P. Stathakis, Athens). The VI Congress of BANTAO was held for the second time in Varna from 6th to 9th October 2003 (President--D. Nenov, Varna). The VII congress of BANTAO was held from September 8th to 11th, 2005 in Ohrid, (President--M. Polenakovic, Skopje). The VIII BANTAO congress was held in Belgrade, 16-19 September 2007 (President--V. Nesic, Belgrade). The IX BANTAO congress was held in Antalya, 18-22 November 2009 (President--A. Basci, Izmir). The X BANTAO congress was held from 13 to 15 October 2011 in Chalkidiki (President--D. Tsakiris, Thessaloniki). The XI BANTAO congress is being held on 26-29 September 2013 in Timisoara (President--A. Schiller, Timisoara). At the VII BANTAO Congress for the first time a CME Course was organized by ERA/EDTA and ISN/COMGAN entitled "Frontiers in Nephrology" with seven distinguished speakers. Very important event in the existence of BANTAO is the appearance of the BANTAO journal in 2003. The BANTAO journal has been published biannually since 2003. In the past 10 years, 20 regular issues; 2 supplements (Antalia and Chalkidiki congresses) have been published. Editors of the journal were as follows: 2003-2005--D. Nenov, Editor; 2005-2009--A. Basci, Editor; 2009--Goce Spasovski, Editor. Until now 332 papers have been published. The BANTAO journal is on EBSCO, DOAJ, SCOPUS. After the First Congress of BANTAO, F. Valderrábano, chairman of the EDTA--ERA Registry, at that time, wrote in Nephrology Dialysis Transplantation (1996) 11:740: "Nephrologists of the Balkan countries meet across political frontiers and war fronts--an example to politicians!

BANTAO

a new European Medical Association overcomes Political obstacles." Despite the difficulties imposed by major events, such as devastating wars and catastrophic earthquakes in many countries of the Balkan Peninsula BANTAO has made considerable progress. The BANTAO Congress was established as the major scientific and institutional forum for Balkan nephrologists, with its own journal, indicating our will to communicate, to collaborate, to get to know each other and to share our difficulties. Now, we expect further successful work of BANTAO.

Willem J Kolff (1911-2009): physician, inventor and pioneer: father of artificial organs

Medical pioneer Willem Johan Kolff was an inspirational father, son, physician and inventor. He founded the development of the first kidney dialysis machine, pioneered advances in the heart and lung machine, laid down the foundations for the first mainland blood bank in Europe and successfully implanted the first artificial heart into humans.

Urology in Stettin (Szczecin). The impact of political changes on progress in urology and medicine

The history of modern hospitals in Stettin is about 280 years long. The history of urology in Stettin (Szczecin), like in Europe, is closely associated with the construction of the useful cystoscope, discovery of X-rays, and progress in radiology and endoscopy. In Stettin, like in many other cities, patients with urological diseases were treated at departments of surgery or departments of internal medicine. On March 1It, 1919, a specialized urology ward with 27 beds was opened in the Municipal Hospital in Stettin. Dr. Felix Hagen from Berlin was the first head of this ward. The main duty of the urology ward at that time was to conduct differential diagnosis and to offer conservative treatment to patients not needing surgery. Cystoscopy, chromocystoscopy, and radiographs were done in the beginning. Later on, retroperitoneal pneumography, pneumopyelography, and retrograde pyelography were added. Urography in the final period enabled a more precise assessment of the kidney prior to surgery. The preparation of patients with benign prostate hyperplasia for surgery was an important element. Therapeutic activities of the urology ward included transurethral procedures such as lithotripsy of bladder stones and treatment of bladder cancer. Urological surgery was done at the surgery ward. Patients with tuberculosis were usually referred to the Tuberculosis Hospital in Hohenkrug (Zdunowo). In 1935, the urology ward in Stettin was closed and incorporated into the surgery ward. During the World War II, just as during the World War I, the Municipal Hospital in Stettin was transformed into a field hospital. The end of the World War II created a new political situation in Europe. Stettin (Szczecin) and West Pomerania became part of Poland. In 1948, the Polish government established the Pomeranian Medical Academy (PAM) in Stettin. During the first 10 years of its existence all urological operations were performed at surgery wards. In August 1955, a 30-bed urology ward affiliated with the Second Department of Surgery was opened in the district of Pomorzany. The head of the new ward was Dr. Alfons Wojewski (1912-1992), surgeon and urologist from Gdańsk (Danzig). In 1962, the ward was transformed into a separate Department of Urology with 62 beds. Prof. Wojewski organized the Department from its foundations, leading it quickly to the level of modern departments in the area of research, teaching, and therapy. After the retirement of Prof. Wojewski, the acting head of the department was Dr. Stanisław Krasoń until his death in 1986. He was followed for almost one year by Dr. Stanisława Spoz. Since May 1987, the head of the Department is Prof. Andrzej Sikorski from Łódź.

[From the washing machine to the RSP: outline of the beginnings of hemodialysis services at the Veterans Hospital in San Juan]

The invention of Dr. Willem Kolff revolutionized the treatment of the patients with end-stage renal disease in the sixties. This milestone coincided with the beginning of nephrology as a medical subspecialty. A group of professionals that included physicians, technicians and nurses took the task of initiating the first dialysis programs in the hospitals of Puerto Rico. The Veterans Hospital served as a research and training center during the first years of hemodialysis in the island. This article summarizes the challenges and genuine efforts of the professionals that built the foundation of what we know today as renal replacement therapy.

[Dr. Kurt Steinitz (1907-1966) and the 60th anniversary of the first hemodialysis in the Middle East]

The 60th anniversary of Israel coincides with the advent of the first hemodialysis in the Middle East. It was performed by Dr. Kurt Steinitz--a Jewish immigrant from Breslau, then in Germany. After spending 9 years at the Istanbul Faculty of Medicine as a clinical biochemist, Steinitz became the director of the chemical laboratory of the Rothschild Hospital in Haifa in 1945. During the spring of 1948, he completed the construction of a hemodialysis machine according to articles published by Kolff (The Netherlands) and mainly by Alwall (Sweden). Three anuric patients underwent hemodialysis. Only the last patient survived. She was a young woman who became anuric after an operation for an extrauterine pregnancy and an incompatible blood transfusion. During the 28th and the 30th September 1948, she had three successful hemodialysis sessions and improved promptly. She lived another fifteen fruitful years. Later, Dr Steinitz' interest shifted to other medical fields, thus leaving the stage of hemodialysis to Prof. David Ullman from the Hadassah Hospital in Jerusalem. Ullman established the first nephrology unit with a regular dialysis service, becoming the pioneer of modern nephrology in Israel.

Nephrology nursing 1915-1970: a historical study of the integration of technology and care

Findings of this study of the role and functions of nurses working with renal dialysis and transplant teams between 1915 and 1970 suggest that many of the activities of dialysis and transplant nurses were assistive and technical in nature. However, further analysis of the characteristics of direct nursing care demonstrates that early nephrology nurses incorporated family support, interpersonal communication, and patient teaching as essential components in order to assist patients and their families in coping with the stresses of receiving these new experimental treatments.

Forty years of vascular access

March 9, 1960, was a milestone marker in end stage renal disease history - the date when a patient received the very first arteriovenous Scribner shunt. This began the era of maintenance or chronic hemodialysis. With long-term dialysis a reality, various new types of vascular access were developed. As the American Nephrology Nurses' Association celebrates its 40th anniversary, this article looks back to see just how far vascular access has come and what might be in store for the future.