Christopher Robin Blagg (1931-2022)  MB ChB FRCP

In 1958, just back from National Service, Chris Blagg by chance found himself thrust into the role of lead physician in Frank Parsons’ haemodialysis service for acute kidney injury in Leeds. Then just a year old, this was the first established dialysis service in the UK. But Blagg made his lasting reputation in establishing long term dialysis services in Seattle, USA from 1963 working alongside Belding Scribner. Blagg’s roles in supporting patient independence, home dialysis, and in obtaining US government funding for dialysis, have had lasting impacts.

Chris Blagg graduated from Leeds Medical School in 1954. Returning there from National Service in 1958 as the Department of Medicine’s newest recruit, he found that there was no lead physician for the dialysis programme. The newcomer’s plan to train in thyroid disease was put on one side.

Acute dialysis at this time was very long, very labour intensive, hands-on, and all-consuming – “we didn’t have a technician at that time and for two years Frank and I did it all ourselves with some help from urology registrars.” The most common causes of AKI were post-trauma, post-surgery (often with crystallising antibiotics or transfusion mismatches), or following illegal abortion or pre-eclampsia. News from Seattle of success with the Scribner shunt, which permitted repeated vascular access, making chronic dialysis a realistic possibility led to attempts to dialyse patients in Leeds for more than a few sessions, but with little success. To learn more Blagg obtained in late 1963 an NIH/MRC fellowship to spend 16 months in Seattle He returned to Leeds, where Scribner visited in 1966, and invited him back to Seattle. Blagg spent the rest of his life there.

The first four patients in Seattle had been treated under an NIH research grant. To continue the programme, the Seattle Artificial Kidney Center (later Northwest Kidney Centers) had to be established. Alongside the local programme, Blagg also ran a remote home treatment service between 1965 and 1969 for wealthy patients elsewhere in the US and the rest of the world, working with Dr Joe Eschbach, best known for his work on renal anaemia and erythropoietin. In 1971 Blagg became director of the Seattle Kidney Center, a post he remained in until 1998.

Illustrating both the harsh realities and the inventiveness of the time, he recounted how their strict criteria for acceptance on to dialysis (only those aged 18-45 years) led to a 15 year old girl with lupus being turned down in 1964. Through engineering connections in the nuclear industry, a single-patient proportioning machine was invented that enabled her to dialyse at home. This was the beginning of a burgeoning home programme.

By 1965-6, technical challenges were becoming equalled in magnitude by ethical and funding issues. A TV documentary ‘Who Shall live?’, and magazine articles about the Seattle programme, led to it becoming considered as the classic resource-allocation ethical dilemma. A significant part of Blagg’s work was political,   winning grants and government support to keep the programme going. But the frontier-pushing and exploration continued, including extended testing of the potential of peritoneal dialysis for home treatment. Fred Boen came to Seattle at the end of 1961 with experience of acute PD. He was joined in 1964 by Henry Tenckhoff, inventor of the soft cuffed peritoneal catheter, and for a time there was a parallel automated home peritoneal dialysis programme. Infections led to its suspension until the big metal dialysate-generating machines were replaced by the sterile bags and techniques of CAPD.

By 1972, 130 patients were being treated in Seattle by haemodialysis, 90% on home haemodialysis, and most overnight, an idea credited to Stanley Shaldon from the Royal Free Hospital in London. At $4-5,000 per annum, home dialysis was estimated to cost a third to a quarter of in-centre treatment.

As more patients were receiving prolonged treatment the long term complications of dialysis became evident. Neuropathy and its response to dialysis, the importance of sodium balance, ectopic calcification and bone disease, renal anaemia, and the psychosocial consequences were all reported. Blagg describes awareness of the adverse cardiovascular consequences emerging in the early 1970s, when a number of patients had received 5-10 years of treatment.

Though they played a substantial part in the campaign for government funding for dialysis, Blagg and Scribner remained somewhat at odds with the explosion of numbers that occurred after the United States Congress approved Medicare cover for dialysis in 1972. In particular, Blagg felt that it led to poor patient decisions and education; that the payment structure led to an emphasis on centre-provided dialysis that engendered ‘learned helplessness’; and that commercialisation led to suboptimal care, including short treatments. In a 2008 interview he stated that: ‘it’s probably because I come from Britain, … I’m all in favour of a single payer system’.

Chris met his wife Jean (Thomas) as a nurse in Leeds. They were married in 1953 and had four children. Jean died in 2014.

Scribner and Blagg were immediate colleagues for eight years, and worked together to some degree until Scribner’s retirement in 1991.  Blagg wrote the most personal, fond biographies of ‘Scrib’ as an engagingly eccentric, popular doctor, and extraordinary innovator and pioneer. He also wrote the definitive account of the remarkable history of dialysis in Seattle. A history in which Scribner and Blagg had shared much, although Blagg with characteristic modesty rarely mentioned his own part in all that was achieved.

 

Neil Turner

 

Sources:

Blagg C 2008 – interviewed by Dugan Maddux for the Oral History of Nephrology Project. http://www.voiceexpeditions.com

Crowther S M, Reynolds L A, Tansey E M. (eds) 2009. History of dialysis in the UK: c. 1950–2000, Wellcome Witnesses to Twentieth Century Medicine, vol. 37. London: The Wellcome Trust Centre for the History of Medicine at UCL. Available from http://www.histmodbiomed.org/witsem/vol37.html

Blagg CR 2006. Belding Hibbard Scribner, the individual: a brief biography. J Nephrol 19 (suppl 10) S127-131.

Blagg C 2017. From Miracle to Mainstream: creating the world’s first dialysis organization. Early years of Northwest Kidney Centers. ISBN 978 069286 9727

Last Updated on April 7, 2023 by John Feehally