January

The beginning of maintenance haemodialysis in the UK

The Royal Free

The first haemodialysis (HD) for end-stage renal disease in the UK was in 1962 at the Royal Free Hospital, directed by Stanley Shaldon.

Shaldon was a lecturer in medicine interested in liver disease and went to the first International Society of Nephrology Congress in Evian in 1960 to give a paper on diuretics in liver disease. There he was much impressed by a presentation on a world-first, chronic dialysis for irreversible renal failure given by Belding Scribner (Seattle, USA).

Many still thought HD would only ever be a realistic treatment for acute reversible renal failure, but Shaldon thought otherwise. The Royal Free Hospital already had a dialysis machine, set up by urologist John Hopewell specifically to support patients with end-stage renal disease in preparation for transplantation, which he was developing there with Roy Calne.

But a major challenge in making chronic dialysis a realistic option was the inability to access the circulation repeatedly. The AV shunt, developed by Scribner, later became the usual means of vascular access until the AV fistula was developed. But in 1961 Shaldon began to test the method he had used to study liver blood flow – insertion of vascular catheters into femoral vessels without a surgical procedure using the Seldinger technique.

He went on to develop maintenance dialysis using this technique, and you can see a remarkable Movietone newsreel from 1963 showing this in action.

The Luck 13 - first UK patients to receive dialysis — *The ‘lucky thirteen’, the first patients treated at the Royal Free (with Stanley Shaldon sitting the middle of the front row).*

Intermittent dialysis begins to catch on

In December 1963, Newcastle became the second unit in the UK to start treating end stage renal failure by dialysis. At the second International Society of Nephrology meeting in Prague in 1963, Hugh de Wardener (Fulham/Charing Cross Hospital) heard that some of Scribner’s patients were still alive. So he sent a team to Seattle to learn the technique. They returned to set up a unit, the first specifically for long-term dialysis, at Fulham Hospital (a branch of Charing Cross Hospital) in August 1964. This became the third unit providing dialysis for end-stage renal failure in the UK. Several other units that treated ARF followed later that year. The pace of change was remarkable – a fatal disease had become treatable.

By mid 1966 a report by David Kerr found there were already 104 patients being treated across the UK.

Or visit www.ukkidneyhistory.org to find out more about these and other early developments in UK nephrology.