Frequent prolonged home haemodialysis

Stanley Shaldon

25 Le Michelangelo, 7 Avenue des PapalinsMonaco Email: stanley_shaldon{at}monaco377.com

Sir, I read with interest the editorial on frequent prolonged home dialysis by Kooistra in the January 2003 issue of the Journal [1]. He is incorrect when he cites Uldall and Pierratos as innovators of Nocturnal Home Haemodialysis. We were the first to describe this form of treatment, which we pioneered in 1964 [24]. It became the standard form of home haemodialysis in the UK and many other areas of the world but was largely abandoned when shorter hours of dialysis were introduced as the night was too long. The frequency of dialysis was variable but we described in 1968 a patient who dialysed 5 nights per week and who became the first patient to perform this type of treatment in the Federal Republic of Germany [5], although by that time we had placed patients in many other parts of the world having trained them to perform overnight home haemodialysis at the National Kidney Centre in London [6]. The longest surviving patient is a 65-year-old German male who has dialysed in the home for over 33 years (5369 haemodialyses until 21 April 2003) using the same AV fistula that I constructed in February 1970 [7]. In addition, he is incorrect when he claims that the benefits of the excellent blood pressure control reported from Tassin are due only to the long hours of dialysis, as he omits to state that a strict salt-restricted diet is also employed and that the average interdialytic weight gain for the anuric 70 kg patient at Tassin is 1.5 kg [8].

References

  1. Kooistra MP. Frequent prolonged nocturnal home haemodialysis: three old concepts, one modern solution. Nephrol Dial Transplant 2003; 18:16–19[Free Full Text]
  2. Shaldon S. Panel contribution on experience with over-night haemodialysis in the home. Proc Working Conference on Chronic Dialysis at University of Washington, Seattle. University of Washington Press, p 40, 1964
  3. Baillod R, Comty C, Shaldon S. Over-night haemodialysis in the home. Proc Eur Dial Transplant Assoc 1965; 2:99–104
  4. Shaldon S. Independence in maintenance haemodialysis. Lancet 1968; 1:520–523[ISI][Medline]
  5. Oppermann F, Koch KM, Schoeppe W, Shaldon S. Erfahrungen mit heimdialysen. Technische und clinische Aspekte der extrakorporalen Dialyse. Thieme, Stuttgart, Germany, 1970
  6. Shaldon S, Crockett RE. The past, present and future of home dialysis. Kidney Int 1975; 8 [Suppl 3]: 418–424
  7. Shaldon S. 40 years of encounter with dialysis. http://www.nephron.com/shaldon.html. 12 December 2002
  8. Krautzig S, Janssen U, Koch KM, Granolleras C, Shaldon S. Dietary salt restriction and reduction of dialysate sodium to control hypertension in maintenance haemodialysis patients. Nephrol Dial Transplant 1998; 13:552–553[Free Full Text]




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