Home Hemodialysis - History of Home Hemodialysis

History of Home Hemodialysis

Home hemodialysis started in the early 1960s. Who started it is in dispute. Groups in Boston, London, Seattle and Hokkaidō all have a claim.

The Hokkaidō group was slightly ahead of the others, with Nosé's publication of his PhD thesis (in 1962), which described treating patients outside of the hospital for acute renal failure due to drug overdoses. In 1963, he attempted to publish these cases in the ASAIO Journal but was unsuccessful, which was latter described in the ASAIO Journal when people were invited to write about unconventional/crazy rejected papers. That these treatments took place in people's homes is hotly disputed by Shaldon and he has accused Nosé of a faulty memory and not being completely honest, as allegendly revealed by some shared Polish Vodka, many years earlier.

The Seattle group (originally the Seattle Artificial Kidney Center, later the Northwest Kidney Centers) started their home program in July 1964. It was inspired by the fifteen year old daughter of a collaborator's friend, who went into renal failure due to lupus erythematosus, and had been denied access to dialysis by their patient selection committee. Dialysis treatment at home was the only alternative and managed to extend her life another four years. Dr. Chris Blagg has stated that the first training predated the establishment of the home program: the "first home patient wasn’t part of our program at all, he was president of a big Indian corporation, lived in Madras, and he came to Seattle just before I came in ’63. He came in early ’63, again, with his doctor and his wife and Dr. Scribner trained them to do dialysis at home and they went home to Madras."

In September 1964 the London group (led by Shaldon) started dialysis treatment at home. In the late 1960s, Shaldon introduced HHD in Germany.

Home hemodialysis machines have changed considerably since the inception of the practice. Nosé's machine consisted of a coil (to transport the blood) placed in a household (electric) washing machine filled with dialysate. It did not have a pump and blood transport through the coil was dependent on the patient's heart. The dialysate was circulated by turning on the washing machine (which mixed the dialysate and resulted in some convection) and Nosé's experiments show that this indeed improved the clearance of toxins.

In the USA there has been a large decline in home hemodialysis over the past 30 years. In the early 1970s, approximately 40% of patients used it. Today, it is used by approximately 0.4%. In other countries HNHD use is much higher. In Australia approximately 11% of ESRD patients use HNHD.

The large decline in HHD seen in the 1970s and early 1980s is due to several factors. It coincides with the introduction and arise of continuous ambulatory peritoneal dialysis (CAPD) in the late 1970s, an increase in the age and the number of comorbidities (degree of "sickness") in the ESRD population, and, in some countries such USA, changes in how dialysis care is funded (which lead to more hospital-based hemodialysis).

Home night-time (nocturnal) hemodialysis was first introduced by Baillod et al. in the UK and grew popular in some centers, such as the Northwest Kidney Centers, but then declined in the 1970s (coinciding with the decline in HHD). Since the early 1990s, NHHD has become more popular again. Uldall and Pierratos started a program in Toronto, which advocated long night-time treatments, (and coined the term 'nocturnal home hemodialysis') and Agar in Geelong converted his HHD patients to NHHD.