NDT Advance Access originally published online on July 28, 2006
Nephrology Dialysis Transplantation 2006 21(12):3610-3611; doi:10.1093/ndt/gfl450
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Origin of home haemodialysis
Email: stanley.shaldon{at}libello.comSir,
Mark MacGregor and his colleagues [1] are to be congratulated on their excellent article on home haemodialysis (HD). It is refreshing to see that this almost discarded form of end-stage renal disease therapy is being so successfully resurrected today. However, I would like to make some comments on the origin of home HD. First, I think it is time that the claim by Nosé referred to by MacGregor [1], with the subtlety that requires a profound knowledge of English grammar, be put into perspective. The use of the adverb ‘apparently’ in the text referring to Nosé's claim could be interpreted as an expression of doubt about the validity of his claim. This nuance may be lost on many of your readers and so I believe it is reasonable to report the evidence or rather the lack of it supporting the claim by Nosé, so that readers can make up their own minds on this contentious issue. First, there is no written evidence that Nosé performed home HD in Japan in 1961, other than his article published in 2000 and cited by MacGregor [2]. Indeed, in a series of letters subsequently published in 2002 in the same Journal of ASAIO [3], I challenged Nosé's claims following some personal research of his referenced thesis on dialysis which was published in Japanese with an English translation and was available for viewing at the Medical School Library in the University of Hokaido. In this thesis, he describes the use of a ‘domestic washing machine, available in every hospital’ to circulate dialysate through the coil dialyser. He reports on nine patients suffering from either acute renal failure (three cases), barbiturate intoxication (five cases) and acute on chronic renal failure (one case). Photographs in the thesis show an apparent intensive care setting of a hospital with a white coated figure attending a patient in a hospital bed with the home made coil in a washing machine. I asked him for a copy of his thesis and he refused to give me one. He admits in our correspondence [3] that no mention of the home is made in his thesis. Suggestions to the editor of the Journal of ASAIO that the memorandum of Nosé [2] be withdrawn were not accepted.
Furthermore, in an abstract published in 1961 entitled ‘A compact artificial kidney device which is a dialysis unit set (Frame coil Dialyzer-Blood washer type 507) washable by an electric washing machine’ of a paper presented at the 8th Japanese Internal Artificial Organ Research Conference in February 1961, he stated that the dialysis unit set was used in five clinical cases. Two cases were in the University Hospital and in three cases, the device was transported to local hospitals. The device ‘could be carried by one person’.
No mention of home dialysis was made in the published abstract. In addition, the original English translation of the title of the reference in the Journal of Japanese Medical Instruments (J Jpn Med Instr 1961; 31: 40–41) was ‘on a portable type artificial kidney set’ and was published as such in the 2000 memoir referenced by MacGregor [2].
However, the same reference cited by Cameron in his book on the history of the treatment of renal failure by dialysis [4] has been translated into English as ‘a portable set of small artificial kidneys; on the clinical application on patients at home in emergency’. According to Cameron the translation was supplied by Nosé.
On asking Prof. K. Ota, the author of a chapter on the history of dialysis in Japan in his book on blood access [5], why he did not cite Nosé as pioneering home dialysis, he replied ‘I received your letter at amid the Goldenweek. I have checked what you want to know. He has made a portable set of dialyser and conducted dialysis at a small hospital. They used washing machine as a batch of dialysate and small motor for extracorporeal circulation. He could dialyse patients at home at that time. However, I can't find a scientific paper regarding the matter.’ (Figure 1).
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There is no doubt that the first mention of home HD in the literature was in 1961 during the presidential address at ASAIO as a theoretical concept for the future [6]. Independently, in 1963, we described a patient performing self dialysis overnight which was being developed for the goal of independent overnight unattended home HD which was first performed in 1964. I believe that my group were the first to demonstrate the feasibility of overnight unattended HD in 1963 [7] and were the first to perform unattended overnight home HD in October 1964 [8–10]. These claims were confirmed by Belding Scribner in discussion remarks during the EDTA conference at Lyons in 1966 [11]. I believe it is time to discard the Nosé claim when writing introductions about home HD as a long-term treatment for patients with chronic kidney disease.
Conflict of interest statement. None declared.
References
- MacGregor MS, Agar JMW, Blagg CR. (2006) Home Haemodialysis – International Trends and Variation. Nephrol Dial Transplant 21:1934–1945.
[Abstract/Free Full Text] - Nosé Y. (2000) Home hemodialysis. A crazy idea in 1963. A memoir. J ASAIO 46:13–17.[CrossRef][Web of Science][Medline]
- Shaldon S and Nosé Y. (2002) Letters to the Editor. J ASAIO 48:577–578.[Web of Science][Medline]
- Cameron JS. (2002) History of the treatment of renal failure by dialysis(Oxford University Press, Oxford) pp. 195.
- Ota K. (1982) Blood Access 1st (Nankoudou, Tokyo).
- Kirby C. (1961) Presidential Address of ASAIO 1961. Trans ASAIO 7:153–155.[Medline]
- Rae AI, Rosen SM, Silva H, Oakley J, Shaldon S. (1963) Refrigerated femoral venous-venous haemodialysis with coil preservation for the rehabilitation of terminal uraemic patients. Br Med J 1:1716–1719.
[Free Full Text] - Shaldon S, Comty C, Sevitt L. (1964) 18 months experience with a nurse-operated chronic dialysis unit. Proc Eur Dial Transpl Assoc 1:233–240.
- Shaldon S. (1964) Panel contribution on experience with over-night haemodialysis in the home. Proc Working Conference on Chronic Dialysis at University of WashingtonSeattleUniversity of Washington Press pp. 40.
- Baillod R, Comty C, Shaldon S. (1965) Over-night haemodialysis in the home. Proc Eur Dial Transpl Assoc 2:99–104.
- Scribner BH. (1966) Planning for the future in US. Proc Eur Dial Transpl Assoc 3:156–157.
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