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1.
Adv Chronic Kidney Dis ; 25(6): 474-479, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30527544

RESUMEN

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.


Asunto(s)
Fallo Renal Crónico/historia , Liderazgo , Nefrología/historia , Diálisis Renal/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Fallo Renal Crónico/terapia , Estados Unidos
4.
Int J Artif Organs ; 40(7): 313-322, 2017 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-28685808

RESUMEN

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.


Asunto(s)
Fallo Renal Crónico/historia , Trasplante de Riñón/historia , Diálisis Renal/historia , Aniversarios y Eventos Especiales , Predicción , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Fallo Renal Crónico/terapia , Trasplante de Riñón/tendencias , Diálisis Renal/tendencias
5.
Tech Vasc Interv Radiol ; 20(1): 2-8, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28279405

RESUMEN

Dialysis vascular access management in the United States changed significantly after National Kidney Foundation-Kidney Disease Outcome Quality Initiative (NKF-KDOQI) clinical practice guidelines were first published in 1997. The Centers for Medicare and Medicaid Service adopted these guidelines and in collaboration with the End-Stage Renal Disease Networks established the Fistula First Breakthrough Initiative (FFBI) in 2003 to improve the rate of arteriovenous fistula use over arteriovenous graft and central venous catheter in the dialysis population. The implementation of guidelines and FFBI has led to a significant increase in the arteriovenous fistula use in the prevalent dialysis population. The guidelines are criticized for being opinion based and often impractical. Over the past 2 decades, the patient population undergoing dialysis has become older with complex comorbidities and challenges for creating an ideal vascular access. Advancing knowledge about access pathophysiology, improved treatment options, and improved process of care with team approach model point toward diminishing relevance of few of the existing guidelines. Moreover, several guidelines remain controversial and may be leading to clinical decisions that may be unfavorable to the patients. The review discusses the historical aspect of vascular access care in the United States and evolution of current practice standards and controversies surrounding few of these guidelines in the current time.


Asunto(s)
Derivación Arteriovenosa Quirúrgica/normas , Implantación de Prótesis Vascular/normas , Cateterismo Venoso Central/normas , Fallo Renal Crónico/terapia , Guías de Práctica Clínica como Asunto/normas , Diálisis Renal/normas , Anciano , Derivación Arteriovenosa Quirúrgica/efectos adversos , Derivación Arteriovenosa Quirúrgica/historia , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/historia , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/historia , Femenino , Adhesión a Directriz/normas , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/historia , Masculino , Persona de Mediana Edad , Selección de Paciente , Pautas de la Práctica en Medicina/normas , Diálisis Renal/historia , Factores de Riesgo , Resultado del Tratamiento , Estados Unidos/epidemiología
6.
Pediatr Res ; 81(1-2): 259-264, 2017 01.
Artículo en Inglés | MEDLINE | ID: mdl-27732587

RESUMEN

Successful renal transplantation is the optimal treatment for chronic kidney failure, but this was not always so for children. Beginning with the first kidney transplants in the 1950s, children experienced poorer patient and graft survival rates than adult patients. But over the last 6 decades, an improved understanding of the immune system which has steered pediatric multi-center clinical/pharmacokinetic and mechanistic studies that have sculpted our immunosuppression with markedly better patient and graft survivals. In addition, uniquely pediatric issues related to growth, development, neurocognitive maturation, increased complications from primary viral infections, and comorbid congenital/inherited disorders, are now diagnosed and effectively managed in these children. Refined pretransplant preparation (vaccinations for preventable diseases, attention to cognitive delays, effective dialysis and nutrition) improved donor selection, and more potent immunosuppression have all contributed to enhanced outcomes. Similarly, improvements in pediatric surgical techniques, postoperative care and better antiviral prophylaxis have all shortened hospitalizations and reduced morbidity. Today pediatric kidney transplant outcomes are markedly improved and younger children today experience better long-term graft survival than adults! While difficult problems remain, we have made tremendous progress and anticipate even more advances in the future of pediatric kidney transplantation.


Asunto(s)
Fallo Renal Crónico/cirugía , Trasplante de Riñón/historia , Trasplante de Riñón/métodos , Nefrología/historia , Niño , Preescolar , Supervivencia de Injerto , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Inmunosupresión , Inmunosupresores/uso terapéutico , Lactante , Fallo Renal Crónico/historia , Trasplante de Riñón/efectos adversos , Tasa de Supervivencia , Resultado del Tratamiento
7.
Urologe A ; 55(10): 1353-1359, 2016 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-27518791

RESUMEN

The history of kidney transplantation is a history of many unsuccessful efforts and setbacks, but also the history of perseverance, pioneering spirit, and steadfast courage. The first successful transplantation of a dog kidney was done by the Austrian Emerich Ullmann (1861-1937) in 1902. The kidney was connected to the carotid artery of the dog and the ureter ended freely. The organ produced urine for a couple of days before it died. In 1909, there were efforts to transplant human kidneys from deceased patients to monkeys and in the following year the first xenotransplantation in humans was completed. Different kinds of donors were tried: dogs, monkeys, goats and lambs, all without success. In 1939, the first transplantation from a deceased human donor was done by the Russion Yurii Voronoy, the patient survived for only a couple of days, and the organ never worked. In 1953, the first temporarily successful transplantation of a human kidney was performed by Jean Hamburger in Paris. A 16-year-old boy received the kidney of his mother as living donor transplantation. Then in 1954, a milestone was made with the first long-term successful kidney transplantation by Joseph Murray: the transplantation was done between monozygotic twins; the organ survived for 8 years. For his efforts in kidney transplantation, Murray was honored with the Nobel Prize in medicine in 1990. In 1962, the first kidney transplantation between genetically nonrelated patients was done using immunosuppression and in 1963 the first kidney transplantation in Germany was done by Reinhard Nagel and Wilhelm Brosig in Berlin. The aim of this article is to present the history of kidney transplantation from the beginning until today.


Asunto(s)
Fallo Renal Crónico/historia , Fallo Renal Crónico/terapia , Trasplante de Riñón/historia , Nefrología/historia , Europa (Continente) , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos
9.
Blood Purif ; 41(4): I-V, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26756788

RESUMEN

The University of Alberta (UofA) in Edmonton, Canada has a rich and productive history supporting the development of critical care medicine, nephrology and the evolving subspecialty of critical care nephrology. The first hemodialysis program for patients with chronic renal failure in Canada was developed at the University of Alberta Hospital. The UofA is also recognized for its early pioneering work on the diagnosis, etiology and outcomes associated with acute kidney injury (AKI), the development of a diagnostic scheme renal allograft rejection (Banff classification), and contributions to the Renal Disaster Relief Task Force. Edmonton was one of the first centers in Canada to provide continuous renal replacement therapy. This has grown into a comprehensive clinical, educational and research center for critical care nephrology. Critical care medicine in Edmonton now leads and participates in numerous critical care nephrology initiatives dedicated to AKI, renal replacement therapy, renal support in solid organ transplantation, and extracorporeal blood purification. Critical care medicine in Edmonton is recognized across Canada and across the globe as a leading center of excellence in critical care nephrology, as an epicenter for research innovation and for training a new generation of clinicians with critical care nephrology expertise.


Asunto(s)
Lesión Renal Aguda/historia , Cuidados Críticos/historia , Fallo Renal Crónico/historia , Trasplante de Riñón/historia , Nefrología/historia , Diálisis Renal/historia , Lesión Renal Aguda/patología , Lesión Renal Aguda/terapia , Alberta , Cuidados Críticos/métodos , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Fallo Renal Crónico/patología , Fallo Renal Crónico/terapia , Trasplante de Riñón/métodos , Trasplante de Riñón/estadística & datos numéricos , Nefrología/instrumentación , Nefrología/métodos , Diálisis Renal/instrumentación , Diálisis Renal/métodos
10.
Contrib Nephrol ; 186: 1-12, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26283554

RESUMEN

The constant side method of access cannulation in hemodialysis, popularly known as the 'buttonhole' method, has an interesting history. Dr. Zbylut J. Twardowski, a Polish nephrologist, discovered this technique by pure serendipity in 1972. A patient with a complicated vascular access history and limited options for cannulation was repeatedly 'stuck' at the same sites by a nurse. Soon it was noticed that the cannulation at the same spot became easier with time. Since the needles were being reused, the sharpness of the needles decreased with time and the bluntness of the needle seemed to minimize the damage to the cannulation tract (another serendipity!). This method soon became popular among patients, and many patients started using this technique. This chapter traces the invention of this technique and its subsequent development following Dr. Twardowski's emigration to the USA.


Asunto(s)
Derivación Arteriovenosa Quirúrgica , Cateterismo Periférico/historia , Fallo Renal Crónico/historia , Diálisis Renal/historia , Cateterismo Periférico/métodos , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Fallo Renal Crónico/terapia , Polonia , Diálisis Renal/métodos
12.
Clin J Am Soc Nephrol ; 10(2): 326-30, 2015 Feb 06.
Artículo en Inglés | MEDLINE | ID: mdl-25278550

RESUMEN

The medical director has been a part of the fabric of Medicare's ESRD program since entitlement was extended under Section 299I of Public Law 92-603, passed on October 30, 1972, and implemented with the Conditions for Coverage that set out rules for administration and oversight of the care provided in the dialysis facility. The role of the medical director has progressively increased over time to effectively extend to the physicians serving in this role both the responsibility and accountability for the performance and reliability related to the care provided in the dialysis facility. This commentary provides context to the nature and expected competencies and behaviors of these medical director roles that remain central to the delivery of high-quality, safe, and efficient delivery of RRT, which has become much more intensive as the dialysis industry has matured.


Asunto(s)
Prestación Integrada de Atención de Salud/tendencias , Fallo Renal Crónico/terapia , Nefrología/tendencias , Ejecutivos Médicos/tendencias , Rol del Médico , Calidad de la Atención de Salud/tendencias , Competencia Clínica , Prestación Integrada de Atención de Salud/historia , Prestación Integrada de Atención de Salud/normas , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/historia , Liderazgo , Medicare , Nefrología/historia , Nefrología/normas , Ejecutivos Médicos/historia , Ejecutivos Médicos/normas , Rol del Médico/historia , Calidad de la Atención de Salud/historia , Calidad de la Atención de Salud/normas , Estados Unidos , Recursos Humanos
14.
Acta Med Hist Adriat ; 11(1): 149-58, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23883091

RESUMEN

The early and unexpected death of Wolfgang Amadeus Mozart (Salzburg, 1756 - Vienna, 1791) was a mystery from the very first day and the subject of wildest speculations and adventurous assertions. Over the last 100 years, medical science has investigated the physical sufferings and the mysterious death of Mozart with increasing intensity. The aim of this article was to recreate Mozart's pathography relying on the his correspondence with father Leopold and sister Nannerl and on reports from his physicians and contemporaries. The rumour that Mozart was poisoned followed shortly after his death on 5 December 1791, at the age of 35, and has survived to this day. The alleged culprits were his physician van Swieten, Mozart's freemasons lodge, and the Imperial Chapel Master Salieri. Mozart however died of chronic kidney disease and ultimately of uraemia. If kidney damage reaches a critical point, even a minimum additional stress can lead to its failure. This usually occurs in the fourth decade of life. Next time we listen to Mozart, we should remember that this apparently happy person was actually a precocious boy, ripped of his childhood, whose short life was an endless chain of complaints, fatigue, misery, concern, and malady.


Asunto(s)
Personajes , Fallo Renal Crónico/historia , Uremia/historia , Austria , Historia del Siglo XVIII , Música/historia
15.
Wien Med Wochenschr ; 163(11-12): 255-65, 2013 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-23591854

RESUMEN

During the past years new developments in peritoneal dialysis (PD) technique have resulted in continuous improvement of patient outcome. The importance of salt and fluid balance, residual renal function and peritoneal glucose load are of increasing interest, whereas small solute clearances have lost importance. In patients with high peritoneal transport rates automated PD (APD) is indicated. However, APD can also be chosen as initial PD treatment since recent studies show comparable or even better survival as compared to continuous ambulatory PD patients. Alternative PD solutions improve peritoneal ultrafiltration (icodextrin), reduce peritoneal glucose load (amino acid solution, icodextrin) and protect the peritoneal membrane (solutions with low concentration of glucose degradation products). Infection risk can be reduced when using antibiotic creams, but resistances should be considered. Ongoing studies will clarify if non-antibiotic agents, e.g. medihoney, are effective in preventing PD-associated infections. Due to these improvements PD and hemodialysis have become equivalent treatments.


Asunto(s)
Soluciones para Diálisis/historia , Fallo Renal Crónico/historia , Diálisis Peritoneal Ambulatoria Continua/historia , Diálisis Peritoneal Ambulatoria Continua/tendencias , Austria , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Fallo Renal Crónico/terapia , Pronóstico , Equilibrio Hidroelectrolítico/fisiología
19.
Kidney Int ; 82(6): 627-34, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22673884

RESUMEN

Organ shortage for transplantation remains a worldwide serious problem for kidney patients with end-stage renal failure, and several countries have tried different models to address this issue. Iran has 20 years of experience with one such model that involves the active role of the government and charity foundations. Patients with a desperate demand for a kidney have given rise to a black market of brokers and other forms of organ commercialism only accessible to those with sufficient financial resources. The current Iranian model has enabled most of the Iranian kidney transplant candidates, irrespective of socioeconomic class, to have access to kidney transplantation. The Iranian government has committed a large budget through funding hospital and staff at the Ministry of Health and Medical Education by supporting the brain death donation (BDD) program or redirecting part of the budget of living unrelated renal donation (LURD) to the BDD program. It has been shown that it did not prevent the development and progression of a BDD program. However, the LURD program is characterized by several controversial procedures (e.g., confrontation of donor and recipient at the end of the evaluation procedure along with some financial interactions) that should be ethically reviewed. Operational weaknesses such as the lack of a registration system and long-term follow-up of the donors are identified as the 'Achilles heel of the model'.


Asunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Disparidades en Atención de Salud/organización & administración , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Donadores Vivos/provisión & distribución , Modelos Organizacionales , Obtención de Tejidos y Órganos/organización & administración , Financiación Gubernamental , Regulación Gubernamental , Política de Salud , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/ética , Accesibilidad a los Servicios de Salud/historia , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Disparidades en Atención de Salud/ética , Disparidades en Atención de Salud/historia , Disparidades en Atención de Salud/legislación & jurisprudencia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Inmunosupresores/uso terapéutico , Cobertura del Seguro/organización & administración , Seguro de Salud/organización & administración , Irán , Fallo Renal Crónico/historia , Trasplante de Riñón/economía , Trasplante de Riñón/historia , Trasplante de Riñón/legislación & jurisprudencia , Donadores Vivos/historia , Donadores Vivos/legislación & jurisprudencia , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Factores Socioeconómicos , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/historia , Obtención de Tejidos y Órganos/legislación & jurisprudencia
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