Historia y desarrollo de las técnicas continuas de reemplazo renal (TCRR): el papel realizado por la enfermería / History and development of continuous renal replacement therapy (CRRT): the role of nursing

Objetivo: Conocer la historia de las técnicas continuas de reemplazo renal (TCRR), y el papel de la enfermería, desde su descubrimiento hasta su evolución técnica, y desde su uso temprano en el tratamiento de la insuficiencia renal aguda hasta las actuales terapias extracorpóreas secuenciales y su aplicación en cuidados intensivos (UCI). Metodología: Se han utilizado diversas fuentes documentales procedentes de libros y literatura científica relacionada con nuestro tema. Resultados principales: La historia de cómo se comenzó a conocer el funcionamiento del sistema renal y sus patologías, está ligada a la propia historia del hombre que abarca desde las primeras civilizaciones hasta nuestros días. Una sucesión gradual de descubrimientos e inventos, llegarán a sentar las bases de lo que será la futura diálisis. Pero no será hasta 1977 cuando la hemodiálisis se introdujo en UCI como terapia continua. La vinculación de la enfermera, desde los inicios de la diálisis y de la TCRR ha sido esencial para la implementación y desarrollo de esta técnica. Conclusión principal: Los progresivos avances científicos y tecnológicos han dado lugar a que las TCRR sean una de las técnicas más utilizadas y seguras realizadas en cuidados intensivos, donde la enfermera, desde sus inicios, juega un papel fundamental en la implementación de esta técnica (AU)

Objective: To know the history of continuous renal replacement techniques (CRRT), and the role of nursing, from its discovery to its technical evolution, and from its early use in the treatment of acute renal failure to current sequential extracorporeal therapies and their application in intensive care (ICU). Methodology: Various documentary sources from books and scientific literature related to our subject have been used. Main results: The history of how the functioning of the renal system and its pathologies began to be known is linked to the history of man itself, from the first civilisations to the present day. A gradual succession of discoveries and inventions laid the foundations for the future of dialysis. But it was not until 1977 that haemodialysis was introduced in the ICU as a continuous therapy. The involvement of the nurse, from the beginning of dialysis and CRRT, has been essential for the implementation and development of this technique. Main conclusion: Progressive scientific and technological advances have led to CRRT being one of the most widely used and safest techniques performed in intensive care, with the nurse playing a fundamental role in the implementation of this technique from its beginnings (AU)

Hemodialysis in the Compact Nations of the US Affiliated Pacific: History and Health Care Implications.

Background: The epidemic of non-communicable disease in the Compact nations of the US Affiliated Pacific Islands and the associated renal complications drive the demand for hemodialysis. Limited healthcare budgets and a lack of trained human health resources in these areas make hemodialysis a challenging undertaking that may require significant sacrifices in competing health care priorities. Methods: Two nephrologists who developed hemodialysis in the US Affiliated Pacific Islands provide its history. Cost estimates of hemodialysis for the Compact nations are collected from a 2014 hemodialysis feasibility report. The experiences and outcomes of current hemodialysis centers in the United States and other island nations provide a framework by which to assess the potential benefit and impact of hemodialysis in the Compact nations. Discussion: A consideration of how and why different stakeholders value hemodialysis will be crucial because they will drive the public's response to the institutionalization of any new intervention or the cessation of any existing intervention like hemodialysis. Conclusion: Updated cost estimates for dialysis clinics and data on renal disease rates in the Compact nations will be necessary to make informed decisions about hemodialysis in the current health systems. In the meantime, it is essential to enhance current medical interventions and public health strategies to prevent kidney disease and decrease the risks for kidney failure. Such preventive interventions must be culturally appropriate, effective, cost-efficient, and sustainable in the unique context of the Pacific.

A historical perspective of how public policy shaped dialysis care delivery in the United States.

Broadly defined public policy has been said to be whatever "governments choose to do or not to do" As applied to healthcare, public policy can be traced back to the 4000-year-old Code of Hammurabi. As it applies to dialysis care its history is barely 50 years old since national coverage for end-stage renal disease (ESRD) was legislated as Public Law 92-603 in 1972. As with most healthcare policy changes, it was a result of medical progress which had changed renal function replacement by dialysis from its rudimentary beginnings during the Second World War into an experimental acute life-saving procedure in the 1950s and to an established life-sustaining treatment for the otherwise fatal disease of uremia in the 1960s that was limited by its costs. Since 1973, the Medicare ESRD Program has saved the lives of thousands of individuals, a compassionate achievement that has come at increasing costs which have exceeded all estimates and evaded containment. Apart from cost containment, policy changes in dialysis care have been directed at improving its safety and adequacy. Some of the results of these changes are evident as one compares the outcomes and complications of dialysis encountered in the 1970s to those in the present; others, particularly those related to vascular access and hospitalization rates have improved modestly. This article recounts the historical background in which national coverage for dialysis care was developed, legislated and has evolved over the past 50 years.

The history of hemodialysis in China.

The technique of hemodialysis was introduced into China more than 50 years ago; and both research and use of clinical hemodialysis began in mid-1960s to late-1960s. A brief review of the history of hemodialysis in China is presented here, including a brief description of pioneers and their contributions, local development and use of dialyzers, hemodialysis machines, and vascular access, and dialysis management and logistics.

Achieving a person-centered approach to dialysis discontinuation: An historical perspective.

In this essay, we describe the evolution of attitudes toward dialysis discontinuation in historical context, beginning with the birth of outpatient dialysis in the 1960s and continuing through the present. From the start, attitudes toward dialysis discontinuation have reflected the clinical context in which dialysis is initiated. In the 1960s and 1970s, dialysis was only available to select patients and concerns about distributive justice weighed heavily. Because there was strong enthusiasm for new technology and dialysis was regarded as a precious resource not to be wasted, stopping treatment had negative moral connotations and was generally viewed as something to be discouraged. More recently, dialysis has become the default treatment for advanced kidney disease in the United States, leading to concerns about overtreatment and whether patients' values, goals, and preferences are sufficiently integrated into treatment decisions. Despite the developments in palliative nephrology over the past 20 years, dialysis discontinuation remains a conundrum for patients, families, and professionals. While contemporary clinical practice guidelines support a person-centered approach toward stopping dialysis treatments, this often occurs in a crisis when all treatment options have been exhausted. Relatively little is known about the impact of dialysis discontinuation on the experiences of patients and families and there is a paucity of high-quality person-centered evidence to guide practice in this area. Clinicians need better insights into decision-making, symptom burden, and other palliative outcomes that patients might expect when they discontinue dialysis treatments to better support decision-making in this area.

Dialysis therapy: Its past, present, and future? My personal recollection of dialysis therapy.

In Dr Ohira's era, hemodialysis was done using an external arteriovenous shunt. External arteriovenous shunts surely made repeated hemodialysis possible, but they also brought about serious complications which necessarily produced the arteriovenous fistula. Arteriovenous fistula is definitely the most important contribution to long-term survival of the hemodialysis patient. Hemodialysis therapy soon became very common, so that various kinds of patients appeared for it. Then came the era of arteriovenous grafts, because many patients lost good vessels in order to create the arteriovenous fistula. More grafts are now becoming available, which are made from different materials and in different forms, thus creating greater expectations for the future. Unfortunately, at this time, the revolutionary vascular access surpassing the arteriovenous fistula has yet to appear and we must continue to make proper application of the arteriovenous fistula. Vascular access is surely one of the important factors to assure a smooth dialysis life for patients. So, we must recognize that we play an important role in the dialysis patients' life. It is interesting to note that in every country, medical care exceeds physical care. This means that the mental factor somewhat compensates for the physical factor. Dr Ohira was a vascular surgeon, but he was also interested in the activities of daily living and quality of life, which must be one of the most delicate fields in medicine.

Ideas and Spirit of the Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs (Bantao) Connect Nephrologists from the Balkan Cities - From the Foundation to the 15th Bantao Congress.

The Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs (BANTAO) was established in Ohrid, Republic of Macedonia on October 9, 1993 during the First Congress of the Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO). The idea of the founders was that such Society would have a clear impact on several aspects of practice and research in nephrology and artificial organs in the Balkans, firstly, by increasing its international visibility and potential collaborative work, and recognition by international organizations. Secondly, such a society would facilitate the exchange of experience and knowledge between experts in our area. In addition, it would be a very positive symbolic act showing that collaborative work for the betterment of life is possible and desirable in our area and that coming together will bear better fruits at the human and cultural levels. It will also send a very clear signal to the outside world that the Balkans can be a place of collaboration and mutual understanding. Several international bodies such as the International Society of Artificial Organs and the International Faculty of Artificial Organs have signaled their interest in and support for the creation of such a society. Despite the turbulent times in the Balkan Peninsula, the First BANTAO Congress was held in Varna from September 22 to 24, 1995, which was an impressive event. F. Valderrabano, Chairman of the EDTA-ERA registry reported on that event with a lot of sympathy in the paper entitled "Nephrologists of the Balkan countries meet across political frontiers and war fronts - an example to politicians. The foundation of and the Second Congress of BANTAO were also well accepted by the colleagues nephrologists from Russia. The Second Congress was held on September 6-10, 1997 in Struga, the Third BANTAO Congress was held on September 18-20, 1998 in Belgrade, the Fourth Congress of BANTAO was held in Izmir on November 14-16, 1999, the Fifth Congress of BANTAO was held in Thessaloniki on September 30 - October 3, 2001, the 6th BANTAO Congress was held in Varna, on October 6-9, 2003, the 7th BANTAO Congress was held in Ohrid, on September 8-11, 2005, the 8th BANTAO Congress was held in Belgrade, on September 16-19, 2007, the 9th BANTAO Congress was held in Antalya, November 18-22, 2009, the 10th BANTAO Congress was held in Chalkidiki, October 13-15, 2011, the 11th BANTAO Congress was held from 26 to 29 September 2013 in Timisoara on the 20th Anniversary of the foundation of BANTAO, the 12th BANTAO Congress was held on October 15-18, 2015 in Opatija, the 13th BANTAO Congress was held on 4-8 October, 2017 in Sarajevo, the 14th BANTAO Congress was held on September 20-23, 2018, in Budva and the 15th BANTAO Congress was held in Skopje, 26-29 September 2019. Another milestone in the life of BANTAO was the appearance of the BANTAO journal in 2003, which has been published biannually since then. In the past 17 years there have been 33 editions of the journal and seven supplements reporting BANTAO congresses. The editors of the journal past and present are: 2003-2005 (Dimitar Nenov); 2005-2009 (Ali Basci); 2009-(Goce Spasovski). Up to date, more than 400 papers have been published. The BANTAO journal is registered on EBSCO, DOAJ, SCOPUS, and has become a strong 'glue' among nephrologists from the Balkan cities. The BANTAO congresses and the BANTAO journal have succeeded in elevating nephrology knowledge and thus increased the standards of nephrology patient care throughout the Balkans. Standing above the divisive forces of politics, language and war, BANTAO gives a living example that collaboration and humility are feasible in times of maddening destruction, and are transformative.

A History of Leadership in Dialysis: Perspectives From Seasoned Leaders.

The history of chronic dialysis in the United States highlights the impact nephrology leaders have on improving kidney disease care. Belding Scribner and his Seattle team transformed end-stage renal disease from a fatal illness to a treatable condition with use of the first successful Scribner shunt in 1960. Advances in dialysis machines emerged from Les Babb and Richard Drake finding ways to treat more patients. Innovative nephrology leaders foster incremental change leading to the technically complex, life-sustaining treatments that are widely available to end-stage renal disease patients today. The Nephrology Oral History Project consists of interviews with patient, nurse, and nephrologist pioneers who have witnessed and contributed to these advancements in kidney disease care. This article includes Nephrology Oral History Project excerpts illustrating leadership contributions to dialysis machines, peritoneal dialysis catheters, and treatment best practices. In addition to individual contributions, improvements in treatment also come from patient and provider organizations leading the way and collectively advocating for change. Nephrology leaders continue to play a crucial role in improving dialysis outcomes and quality of life.

Renal function replacement by hemodialysis: forty-year anniversary and a glimpse into the future at hand.

From its introduction in 1943 and until the late 1970s, hemodialysis (HD) has been a lengthy and cumbersome treatment administered by a few skilled physicians and technicians to a very limited number of terminal kidney patients. The technological innovations introduced over the years made HD a treatment administered and supervised by nursing personnel to a very large numbers of kidney patients, hopefully until recovery of kidney functions or kidney transplantation. In 2013, it is estimated that 2.250.00 kidney patients were treated worldwide, and their number is steadily increasing. Shortage of transplant kidneys and quality of current treatments has contributed to increasing the survival of HD patients. Today, it is not unusual to find patients who have been on HD for longer than twenty years. All this generated the feeling that performance of membranes and dialysis technology has reached its limit. Recently, the increasing economic burden of healthcare caused by people ageing and the increasing incidence of degenerative diseases (e.g. diabetes and cardiovascular diseases), and the economic crisis has pushed many governments and health insurances to cut resources for healthcare. The main consequence is that investments in research and development in HD have been significantly reduced. The question is whether there is indeed no need for innovation in HD.In this paper, it is discussed how the paradigm of HD has changed and what possibly are now the drivers for innovation in HD. A few ideas are proposed that could be developed by adapting existing technologies to the future needs of HD.