Preface

The first mentions of home hemodialysis were at the 1961 meeting of the American Society for Artificial Internal Organs (ASAIO). Following presentation of a paper describing the survival of the first four Seattle patients using the shunt and dialyzing at the University Hospital Kolff complimented Scribner “for the work that he has started. … Undoubtedly, we will all want our artificial kidneys at home …” At the same meeting during his Presidential Address, Charles Kirby, a cardiac surgeon, said: “Perhaps what we need is a home dialysis unit to be placed by the patient's bedside, so that he can plug himself in for an eight-hour period once or twice a week.”1 This year, 2014, is the 50th anniversary of the development of home hemodialysis. During the course of 1964 two institutions in the United States and one in London, England instituted the world's first home hemodialysis programs. The first, early in the year, was at the Peter Bent Brigham Hospital in Boston and was the idea of Eugene Schupak, a renal fellow, encouraged by John Merrill. The patient, one of the Brigham's first chronic hemodialysis patients, happened to travel to the hospital for dialysis twice a week with Schupak who realized that the patient and his wife would be quite capable of performing hemodialysis at home themselves. Merrill agreed but put the suggestion before his renal team one Saturday morning but they did not agree and voted 11 to one against Schupak's suggestion. Merrill had not voted but then pointed out that as head of the Nephrology Division he had 12 votes and so the home hemodialysis program began. The patient and his wife were trained and then dialyzed once a week in the hospital and once a week at home where initially the procedure was monitored by both a physician and a nurse from the hospital. Soon the physician was no longer necessary and shortly thereafter the patient and his wife were capable of carrying out the dialysis themselves. Dialysis was done twice-a-week for between four and six hours using a twin-coil artificial kidney. The machine was installed in a bedroom and water for the dialysate was piped from the bathroom adjacent to the bedroom into the dialysate tank where it was mixed with the appropriate chemicals. The dialysate bath was changed every two hours and drained into the shower at each bath change. No electrical modifications were required, as the artificial kidney operated on the 110-v house current.2 The second program was developed at the University of Washington, Seattle, where a 15-year-old patient of Dr. Scribner's was ineligible for treatment at the Seattle Artificial Kidney Center because she was only 15 and did not met the age criteria for acceptance and also suffered from lupus erythematosus. In early February when it was obvious she would soon require dialysis Scrib approached Professor Les Babb, professor of nuclear engineering at the University of Washington, to develop a machine specifically for safe home hemodialysis. Les and his team had recently developed a device to prepare dialysate from concentrate and water using proportioning pumps that had been installed in the dialysis room at the University Hospital to provide dialysate to four stations. This had been called the “Monster”. The challenge now was to miniaturize this to make a fail-safe single patient device for use in the home. Four months later this machine, the “Mini-Monster” was delivered to University Hospital on June 1, 1964 and the patient, Caroline Helm, with her mother began to train together under the direction of Kingsbury Curtis, a renal fellow, and two nurses. The first dialysis at home was carried out in July, and by November some 40 dialyses had been done at home without any serious problems. This home dialysis machine using proportioning pumps was the prototype of almost all single patient dialysis machines in use in the world today.3 The third program was developed by Dr. Stanley Shaldon at the Royal Free Hospital in London where he ran the hospital dialysis program. His major contribution was being the first to use overnight home hemodialysis in October 1964. His patient was a 36-year-old trained nurse who was dialyzed for 14 hours twice a week using a Kiil dialyzer, dialysate from a tank and a bedside monitoring panel. He pointed out that dialyzing overnight meant that the patient and family could sleep, saving time and effort, and he believed the future for home hemodialysis was very promising. He spoke at a meeting in Seattle in December 1964 and described overnight home hemodialysis4 and subsequently this was adopted for use by most patients in the Seattle home hemodialysis program starting in early 1965. It soon became obvious that home hemodialysis cost significantly less than dialysis in a hospital or dialysis unit and that almost every patient preferred it to care in the hospital. By April 1964, 46 patients were dialyzing at home in the world: eight in Boston; seven in Seattle itself with nine others dialyzing remotely; four in Spokane, Washington, with four more dialyzing remotely, and 12 in London, England with two others dialyzing remotely. The rest is history. Turning now to this issue of Hemodialysis International you must have observed that it is much thicker than usual. In part this is because it includes the abstracts for the forthcoming Annual Dialysis Conference in Atlanta, Georgia and also includes the abstracts from the joint meeting of the International Society for Hemodialysis and the 18th Argentine Congress of Nephrology held in September, 2013 in Buenos Aires. However another reason is that this issue and the next one will both contain more articles than usual because despite a current rejection rate of about 70% of the articles submitted a backlog of articles waiting to be published had accumulated. In the year 2013 more than 330 articles were submitted, a significant increase over previous years. Consequently an increase in the number of pages was arranged so that in the future articles generally will be published within 3 to 6 months of acceptance. As noted in the previous issue the International Society for Hemodialysis is organizing symposia in concert with some of the other international societies around the world. In 2014 the 7th Congress of the International Society for Hemodialysis will be held between April 25 and 27 at the Okinawa Convention Center—see the notice in this issue and the website http://www.2.convention.co.jp/ishd2014. Later in the year the 8th International Congress of the ISHD will be held in Shanghai International Convention Center in Shanghai, China, between September 12 and 14, 2014. Again see the notice in this issue of the journal and the website www.ishd2014.cn. In addition, because of the great success of the two-day ISHD Hemodialysis University organized by John Daugirdas and Madhukar Misra that was held in Chicago in 2012 the Hemodialysis University now is moving abroad and a very successful and well attended one was held in Shanghai by Zhongshan Hospital Department of Nephrology, Fudan University and the ISHD on March 31 and April 1, 2013. The focus of the University was on clinically important problems such as AKI, blood pressure and infection control, adequacy of hemodialysis, complications, vascular access and water treatment. The University is designed for nephrologists, nephrology fellows, nephrology nurses and nurse practitioners. The next University will be held in Hyderabad India, March 1 and 2, 2014, at the Hyderabad Marriott Hotel and Convention Center—see notice in this issue of the journal and website http://www.hdu2014.com/. The edited recordings of the Universities are made available on the ISHD website. The ISHD website also provides links to historical videos and other materials related to people and events involved in the early history of dialysis treatments and new material has been added recently. This is will be an ongoing process. The ISHD website, http://www.ishd.net/ also contains information for physicians and others who wish to become members of the ISHD. The annual individual membership subscription for physicians is $114 and $83 for nurses, giving access to the journal and online. Online only access membership for physician is $109 and for student members is $83. ISHD membership includes a subscription to Hemodialysis International together with access to all available back files for as long as membership is maintained. These personal rates apply to subscriptions from a private address paid by personal check or credit card. You should consider joining the ISHD.

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