The History of Peritoneal Dialysis: How It All Began

Since I am a Peritoneal Dialysis user/patient, I must have a rudimentary understanding of the history behind this life-saving procedure. Thus, the following blog entry: Please note the many links included in this blog entry to explain the terms and concepts introduced.

Introduction:

Peritoneal dialysis (PD) is a life-saving treatment for patients with end-stage renal disease (ESRD). The history of PD dates back to ancient times when physicians used peritoneal lavage as a therapeutic tool to treat patients with abdominal infections. However, the modern use of peritoneal dialysis for the treatment of renal failure started in the 20th century. This blog will discuss the history of peritoneal dialysis, from its inception to the present day.

Ancient Times:

Peritoneal lavage was first described in ancient Greek medical texts as a treatment for abdominal infections. In the 1st century AD, the Roman physician Asclepiades used peritoneal lavage to treat a patient with peritonitis. This involved injecting warm water into the peritoneal cavity and then draining it out. The use of peritoneal lavage continued through the Middle Ages and the Renaissance, but it was not until the 19th century that peritoneal dialysis began to take shape as a medical procedure.

19th Century:

In the 19th century, the Italian physiologist Carlo Matteucci conducted experiments in which he injected saline solution into the peritoneal cavity of dogs and observed the osmotic transfer of fluid across the peritoneal membrane. In 1856, the German physiologist Carl Ludwig described the transfer of fluids and solutes across the peritoneal membrane in his book “Physiology of the Circulation.” However, it was not until the early 20th century that peritoneal dialysis became a practical treatment option.

Early 20th Century:

In the early 1900s, Russian surgeon Dimitri Ivanovich Abrikossoff used peritoneal lavage as a treatment for uremia. He injected saline solution into the peritoneal cavity of patients with renal failure and then drained it out. Although Abrikossoff’s technique was not very effective, it laid the foundation for using peritoneal dialysis to treat renal failure.

In 1923, the American surgeon Leonard Rowntree and his colleagues at the University of Minnesota performed the first successful peritoneal dialysis in a dog. They injected saline solution into the peritoneal cavity of a dog with uremia and then drained it out. The dog’s condition improved, and it lived for several months after the procedure. Rowntree and his colleagues then performed peritoneal dialysis on a patient with renal failure, but the patient did not survive the procedure.

Mid-20th Century:

In the mid-20th century, several advances in peritoneal dialysis technology were made. In 1959, the Dutch physician Willem Kolff and his colleagues developed the first commercial peritoneal dialysis machine, the Kolff-Brigham dialysis machine. See the picture below. This machine used gravity to circulate the dialysis solution through the peritoneal cavity. In 1965, the American nephrologist Henry Tenckhoff developed the Tenckhoff catheter, which is still used today for peritoneal dialysis.

Late 20th Century:

In the late 20th century, peritoneal dialysis became a widely accepted treatment for ESRD. In 1976, the National Cooperative Dialysis Study showed that peritoneal dialysis was as effective as hemodialysis in the treatment of ESRD. In 1980, the International Society for Peritoneal Dialysis was founded to promote the development of peritoneal dialysis as a treatment for renal failure.

Current Era:

In the current era, peritoneal dialysis remains an important treatment option for patients with ESRD. In 2016, there were approximately 240,000 patients worldwide receiving peritoneal dialysis, with the majority of patients living in developing countries.

Advancements in technology have improved the safety and effectiveness of peritoneal dialysis. Newer machines use automated cycling to circulate the dialysis solution through the peritoneal cavity, reducing the risk of infection and improving patient outcomes. Additionally, the development of newer dialysis solutions has improved the removal of waste products from the blood.

Conclusion:

Peritoneal dialysis has a long and storied history, dating back to ancient times. The modern use of peritoneal dialysis for the treatment of renal failure started in the 20th century, with the development of peritoneal lavage techniques and the first successful peritoneal dialysis procedures. Advancements in technology and the widespread acceptance of peritoneal dialysis as a treatment for ESRD have improved patient outcomes and made peritoneal dialysis an important treatment option for patients around the world.

References:

1. Golper, T. A., & Piraino, B. (2015). Peritoneal dialysis: Its history and current status. American Journal of Kidney Diseases, 66(5), 932-936. doi: 10.1053/j.ajkd.2015.07.008
2. Bleyer, A. J., & Diaz-Buxo, J. A. (2002). The history of peritoneal dialysis. Journal of the American Society of Nephrology, 13(Supplement 1), S23-S28. doi: 10.1097/01.asn.0000031473.60357.2b
3. Oreopoulos, D. G. (1996). Peritoneal dialysis: A personal history. Peritoneal Dialysis International, 16(Supplement 1), S12-S18.
4. Krediet, R. T. (2008). Peritoneal dialysis: From its origins to the twenty-first century. Kidney International, 73(Supplement 108), S3-S12. doi: 10.1038/sj.ki.5002713
5. Li, P. K., Szeto, C. C., & Piraino, B. (2016). Peritoneal dialysis in the modern era: How did we get here and where are we going? American Journal of Kidney Diseases, 68(4), 692-699. doi: 10.1053/j.ajkd.2016.05.020