Home hemodialysis

The January/February 2006 issue of the BCMJ [48(1):14-15] contains a report by the BC Provincial Renal Agency (BCPRA), included in Pulsimeter, stating that as a result of the home hemodialysis program launched in 2004, considerable cash savings have been made by training patients with end-stage kidney failure to carry out the procedure themselves at home, rather than having it done by nurses in expensive hospital dialysis units.

This is good news, but may I re mind you that, as reported in the CMAJ,[1] the home hemodialysis program in BC was in fact launched 36 years earlier, in 1968, by a team from St. Paul’s Hospital who successfully trained two patients, one in Vancouver and one in the Interior, and their families in the procedure. In 1969, they were sent home to hemodialyse, where they thrived for several months before succumbing to complications. This initiative was repeated soon after by a team from VGH and, later, by others in BC as well as elsewhere in Canada. These two patients were the first British Columbians to do home hemodialysis but not the first in the world.

Home hemodialysis was pioneered simultaneously in 1963 by Stanley Shaldon’s team in London, England, of which I was a junior member,[2,3] John Merrill in Boston,[4] and Belding Scribner and associates in Seattle.[5] Its integration into general medical practice in a community as opposed to a university hospital was recorded in JAMA in 1968.[6]

Hemodialysis may now be common place, but it is well to remember that once the notion of hemodialysis in a hospital, let alone in the home, was a terrifying prospect for many. Without the determination of these groups of nurses, technicians, and physicians—who persevered despite opposition on both sides of the At lantic from academics who thought the money could be better spent on research into the cause of chronic kidney failure—which remains elusive—the courage of their patients and families, and the heroic efforts of the BCPRA, the prospects for those now benefiting from these procedures would be far less promising than they are.

—Angus Rae, MB 
Vancouver

References

1. Rae A, Craig P, Miles G. Home dialysis: Its costs and problems. CMAJ 1972;196: 1305-1316. PubMed Citation 
2. New developments with artificial kidney [editorial]. BMJ 1963;1:1685-1686. 
3. Shaldon S. Independence in maintenance haemodialysis. Lancet 1968;1: 520-523. PubMed Citation 
4. Merrill, JP, Schupak E, Cameron E, et al. Hemodialysis in the home. JAMA 1964; 190;468-470. PubMed Citation 
5. Curtis FK, Cole JJ, Tyler LL, et al. Hemodialysis in the home. Trans Amer Soc Artif Intern Organs 1965;11:7-10. PubMed Citation 
6. Rae A, Marr T, Steury R, et al. Hemodialysis in the home: Its integration into general medical practice. JAMA 1968;206: 92-93. PubMed Citation