This is maybe going to be better with separate pages for each of the 3 sections

1. Conservative management of AKI

International background (historyofnephrology) outlines UK role

Work at Hammersmith in the 1940s – eventually leading to dismissal of early dialysis approaches not helped by Joekes and Bywaters looking back on their experience with dialysis (pub 1948)

Mention work on renal blood flow in AKI in Oxford

 

2. Haemodialysis (HD) for AKI – 1947-

Content on the way –

Joekes and Bywaters 1948

Leeds – Parsons, 1956

Then RAF Halton and Hammersmith, and the beginning of a rush in 1959: https://historyofnephrology.blogspot.com/2009/02/dialysis-in-uk-in-1959.html

3. Peritoneal Dialysis (PD) for AKI – 1940s and 50s.

• 31 May, 2022
• Andy Stein

A urologist in Colchester, Ronnie Reid, carried out the first reported PD in the UK in March 1946 (Reid, 1946 – pdf). Their patient was a 36 year old woman with AKI following and incompatible blood transfusion. A Foley catheter was used for access, introduced into peritoneum via existing surgical incision (the patient previously underwent renal decapsulation procedure). Twice-normal saline (308 mmol/L Na) was infused with cycling 2-hr dwells. Reid referenced previous experiments in dogs in the 1920s and 30s, and two human cases reported from xxxx in 1938 (Wear et al 1938).

Reid’s patient was only the third person in the world to recover from AKI with supportive PD therapy. Reid was at the first Renal Association meeting in 1950, but did not give a paper to the RA. Interestingly the first use of PD in AKI was by another urology group, in Wisconsin (USA) in 1938 (Wear, 1938). Another advocate of Acute PD in the UK was a physician, RA Pyper in Belfast, who published his experience in 1947 (Pyper, 1947 – pdf). This paper starts with possibly the first UK version of the history of PD, and is worth reading. Was he the first physician to do PD in the UK? Another urologist, CJ Rob at St Thomas’s, also in 1947, also published their experience of PD (Rob, 1947 – paragraph only).

He was followed by other urologists, Ashton Miller in Bristol (Miller, 1949) and Bracey in Peterborough (Bracey, 1951). At that time renal decapsulation was often performed with PD.  This group of early enthusiasts subsequently disbanded, and PD in the UK suffered as a result.

Who picked this up in this post-Reid period? (1950-60) Which other units? Are there any refs?
Did we lose interest? Or was there another reason, eg less able to get equipment relayed to WW2? (seems unlikely if Foley catheters and locally produced solutions).

The 1960s. Resurgence of Interest

There was a resurgence of interest in acute PD (and IPD for longer periods) in the UK, not just by urologists, from 1962-3: Manchester ( Berlyne, 1964), Hammersmith (Pringle, 1964);  St Marys (Thompson, 1964);  Leeds (Smith, 1965); Leeds (Moriarty and Frank Parsons, 1966); and Guy’s (Cameron, 1967).

Pringle and Thompson and colleagues were medical registrars at the Hammersmith and St Marys at the time. They were amongst the first physicians in the 60s to publish in this area. Thompson stated that the peritoneal dialysis fluid and giving set was provided by Baxter Laboratories Ltd. They described 48 PD treatments on 30 patients with a wide range of causes of renal failure.

Cameron et al, at Guy’s, “treated about 260 acute AKI patients with PD over a 4 year period. We began to avoid having set up for acute haemodialysis, and slackened off in 1967 because we by then had a long term dialysis unit and more trained staff” (personal communication, 6.6.22)

John Swinney in Newcastle, in 1966, published a review of the state of play regarding dialysis in Europe and the British Isles. He identified 54 units in Europe (including 19 in the British Isles) carrying out dialysis on 612 patients, of which 140 were in this country (Swinney, 1966). Most were on haemodialysis. Seven were on “chronic peritoneal dialysis’. (presumably ‘IPD’; several days of PD via yet another intermittent puncture every 10-14 days? Tenckhoff described doing this in Seattle? )

Why did chronic PD not really take off in the 1960s? This was partly technical, i.e. community-based CAPD had not yet been developed; partly as it was very labour intensive to keep large numbers of patients on intermittent IPD; and partly, haemodialysis capacity was increasing. Also, at that time there were confusing approaches to delivering PD, alongside a paucity of published evidence. (Yes too many failures and labour intensive – needed HD backup really – could state that alone)

These issues were coupled with the encouragement of conservative or supportive management (strict dietary and fluid restriction); resulting in the widely held perception that PD was not an appropriate long-term therapy. It was not until the late 70s when chronic PD re-emerged in the UK, due to the onset of CAPD.

The 1970s.

Acute Kidney Injury (AKI) and PD

In the 1970s, before CAPD, acute PD was still being used to treat AKI in the UK. Edwina Brown (at Charing Cross) remembers doing acute PD as a pre-registration house officer in 1973 (using rigid catheters). John Feehally (Leicester) has similar memories (DATE?); This method was used for AKI, and as intermittent peritoneal dialysis (IPD) for ESRF, if the kidneys did not recover (whilst patients waited for a HD slot). (ref?) However acute PD was still sometimes used at the Hammersmith Hospital renal unit (London) in 1986 (ANT).

PD is still a good treatment for AKI, but not often used for that purpose in the 2020s. However, the COVID-19 pandemic has reminded us of its potential, especially where haemodialysis is not suitable (coagulation disorders and in children) – Ref to the COVID page.

 

Further reading

• Cameron, JS. A History of the Treatment of Renal Failure by Dialysis. Oxford : Oxford University Press, 2002 (Cameron, 2002).
• Crowther et al. History of Dialysis in the UK: c. 1950–1980. The transcript of a Witness Seminar held by the Wellcome Trust Centre. For the History of Medicine at UCL, London, on 26 February 2008. Edited by S M Crowther, L A Reynolds and E M Tansey (Crowther, 2008).
• Miller, Ashton (1908-92), known as ‘Jerry’
• Miller, Ashton. Peritoneal Dialysis. Brit J Urol. 1962 Dec: 34(4): 465-469 (Miller, 1962).
• Miller, Ashton. Acute Renal Failure in Surgery Conditions: Peritoneal Dialysis. Proc R Soc Med. 1966 Jan;  59(1): 40-42 (Miller, 1966).
• Misra M, Phadke GM. Historical Milestones in Peritoneal Dialysis. Contrib Nephrol. Basel, Karger, 2019, vol 197, pp 1–8 (Misra, 2019).
• Reid R, Darmady EM, Bywaters EGL, Joekes AM. Discussion on advances in the treatment of uraemia. Proc R Soc Med. 1948 Jul; 41(7): 409-26 (Reid, 1948). This is an interesting article in the Section of Urology, with the paper(s?) delivered on January 22, 1948. Ronnie Reid, a urologist in Bristol presented on PD. Michael Darmady (pathologist, Portsmouth), Eric Bywaters (physician, Hammersmith) and ‘Jo’ Joakes  (originally Dutch, trained in the UK; later consultant physician at St Marys then St Peter’s, St Paul’s and St. Phillip’s Hospitals (known as the ‘ 3P’s)) on haemodialysis. The abstract is written in English, French, Greek and Spanish, which was presumably traditional at the time for that society and journal. It is worth reading.
• Reid, R. Transperitoneal Dialysis. Proc R Soc Med. 1948 Jul; 41(7): 413–418 (Reid, 1948).
• Reid, Ronald (1900-1965)
• Turner, Neil. The story of early peritoneal dialysis. Journal of Renal Nursing Vol. 1, No. 2. Published Online: 6 Nov 2014 (Turner, 2014).
• Turner Neil. History of Nephrology Blog. Unsung story of early peritoneal dialysis (Turner, accessed 25.5.22).

Last Updated on July 20, 2022 by Andy Stein