The history of peritoneal dialysis in China: past, present and future trends.

Peritoneal dialysis (PD) was introduced in China more than 60 years ago and has grown continuously since then. Now China leads the first of the world in number of patients on PD. In this manuscript a brief review of the history of peritoneal dialysis in China is presented; this includes a description of pioneers and their important contributions, discussion of peritoneal dialysate, the technique of the use of Tenckhoff catheter, the use of continuous ambulatory peritoneal dialysis (CAPD) and dialysis registration. Current ongoing PD research activities among Chinese PD academicians are also discussed. Finally, we present four areas of future focus: 1) the promotion of PD in rural areas where PD use is still very limited due to the lack of PD awareness and education; 2) PD quality management and continuous quality improvement (CQI) program particularly focusing on PD adequacy and patient rehabilitation; 3) development and enforcement of national standards on PD management; 4) multi-center studies to compare the benefits of PD and hemodialysis (HD) that should include survival, rehabilitation and cost-effectiveness.

The Birth and Development of Continuous Ambulatory Peritoneal Dialysis.

Peritoneal dialysis has a long and tortuous history. First done in animals in the late 1800s, it became clinically practical in the early 1960s. Peritoneal access was first achieved by intermittent abdominal puncture, and then through the development of a 'permanent access' when Silastic became available. The early design is appropriately named for Dr. Henry Tenckhoff. Successful peritoneal dialysis was performed intermittently with infusion of 2 liters of balanced fluid followed by a dwell time of 30-45 min, which in turn was followed by drainage and new infusion. The procedure was used almost exclusively in the intensive care setting but failed to achieve success when applied on a long-term basis. The new concept of extending the dwell time of the dialysis fluid to allow equilibration between an acceptable blood level of urea and the level of urea in the dialysis fluid remarkably reduced the fluid volume required to control uremic toxins and symptoms. This change also allowed the patient to be disconnected from all devices and freely move about as dialysis took place. It was concluded that an acceptable blood level of urea nitrogen was 70 mg %. Equilibration with dialysis fluid, five 2-liter exchanges for 10 liters per day, would allow the removal of 7,000 mg of urea, the average quantity generated on a diet of a 70-kg person eating 1 g of protein per kg of body weight per day. The procedure was originally called 'equilibrium peritoneal dialysis', but was later changed to 'continuous ambulatory peritoneal dialysis'.

History of nephrology and renal replacement therapy in Korea.

Korea has a long tradition of Eastern (Korean) medicine. Modern nephrology in Korea began in the 20th century after the Second World War. The first nephrology report was presented in 1949 at the third annual meeting of the Korean Society of Internal Medicine. The first hemodialysis was performed in 1952 during the Korean War, the first acute peritoneal dialysis in 1957, the first kidney biopsy in 1959, the first kidney transplantation in 1969 and the first continuous ambulatory peritoneal dialysis in 1981. National Health Insurance was launched in 1976 with a limited coverage, which was gradually expanded to cover all Korean nationals in 1989. The Korean Society of Nephrology (KSN) was inaugurated in 1980. The KSN End-Stage Renal Disease (ESRD) Registry was started in 1985. Brain death legislation was enacted, and the Korean network for organ sharing launched in 2000. During 2009, a total of 8,906 patients or 175.9 patients per million population (PMP) began renal replacement therapy (RRT), and at the end of the year a total of 56,396 patients or 1,113.6 patients PMP were on RRT in Korea. The prevalence of ESRD continues to grow in Korea while its incidence is stable or declining as compared with the previous year.

Unknown Polish pioneers of peritoneal dialysis.

Peritoneal dialysis is one of the methods of renal replacement therapy. The first research using a patient's peritoneal membrane for this purpose appeared at the turn of the 19th to 20th century. Among the many scientists dealing with this field of medicine during that period were also Polish representatives: Prof. Marceli Landsberg, Prof. Henryk Gnoinski and Dr. Tadeusz Szenkier. In the 1920s, independent of their foreign colleagues, they carried out and published interesting experiments on animals in Polish and foreign magazines. They indicated the possibility of using the peritoneal membrane and also the intestines, in uremia treatment. After a long period in which the development of peritoneal dialysis was restrained by the rapidly expanding development of hemodialysis, one saw its resurgent development. And here again Polish scientists made their contribution: among others, Profs. Zbylut Twardowski and Zofia Wankowicz contributed in a significant way and are still contributing to the development of peritoneal dialysis in the world and in Poland.