I am delighted to introduce a guest post from Dr Kelvin Lynn. Dr Lynn worked as a Nephrologist at Christchurch Hospital for 35 years and retired in 2015. He is the lead author for a book just published:
Available at no charge at www.kidneys.co.nz/Kidney-History from 16 October 2018.
Dr Kelvin Lynn and his fellow editors tell the history of the treatment of people with kidney failure in New Zealand; beginning in the early 1950s this story encompasses remarkable experiences of patients and their families, and of the contributions made by dedicated health professionals. It also reveals the challenges and ethics of meeting an ever-increasing demand for treatment.
New Zealand doctors were early adopters of new dialysis technology. The first peritoneal dialysis (PD treatment in New Zealand occurred at Wellington Hospital in 1954. Two young doctors tried a recently reported treatment using homemade equipment – classic Number 8 wire technology. Dr Neil Turnbull was a medical registrar in 1954 when he admitted a pale, vomiting, dehydrated 24-year-old woman who had not passed urine for the past nine days. Fifteen days before admission she had tried to terminate an unwanted pregnancy by infusing a Dettol solution into her cervical canal. In spite of rehydration with blood and five per cent glucose she became comatose. It was then that pathology registrar, Dr Dave Reid, suggested trying PD, which he had recently read about in the New England Journal of Medicine. After mixing 20 litres of a glucose solution in sterilised glass bottles they had to stop as the solution had caramelised. They supposed the autoclave (steriliser) had been too hot and were proved right when after the autoclave temperature was reduced the new glucose solution remained clear. This was not the end of their technical problems, however, for after running two litres of the solution through the polythene tube that they had inserted into the right iliac fossa with a trocar and cannula, there was no drainage. Undeterred, they pulled the tube out and established good drainage by pricking holes in the tubing with a hot 22-gauge needle. After three days of peritoneal dialysis the patient began passing increasing volumes of urine and then regained consciousness. When last seen by Turnbull in 1992, she had normal renal function.
This book recounts the contribution of doctors, nurses, technicians, and patients and their families to the story of kidney treatment in New Zealand. Social and political changes in our country since the 1950s have critically influenced the development of treatment services for New Zealanders with kidney failure. The improvements in technology and community expectations regarding access to treatment over the past 50 years are discussed as well as the issues for patients and families coming to terms with kidney failure and its treatment.
This story is illustrated with many anecdotes and historical photographs.
- The experience of living a life with kidney failure is recounted from patient interviews. These stories are a testament to the bravery and determination of these individuals. Rob Brydon’s story demonstrated what ordinary people were able to do in the face of kidney failure.
Rob began home haemodialysis on 31 August 1976 just after getting married. After two failed transplants, the second from his brother Nev, he remains on HHD over 40 years later. Most of this time, he worked full-time. Following redundancy in 1993, he started his own painting business which he ran for ten years until he had both legs amputated below the knee, bringing this to an end. Rob had a profound anaemia as the result of having both his kidneys removed to control his high blood pressure. He built his own house while his haemoglobin concentration was only 40 to 50 g/L, and subsequently Rob was one of the first patients in New Zealand to benefit from erythropoietin treatment for renal anaemia. Rob remembers the burden of having to reuse dialysers and blood lines and the unpleasantness of using formalin for sterilisation. His advice to other dialysis patients is to “try to keep your life as normal as possible.”
- There are chapters devoted to the professional development of renal nurses and dialysis technicians who have played a key role in the progress made in kidney treatment. Nurses were important members of the early clinical teams who pioneered dialysis treatment. Now renal nursing is an established nursing specialty. Hospital technicians who maintained the early dialysis equipment quickly took up clinical roles, particularly in training patients for dialysis at home.
- There is an account of the trends and statistics of dialysis treatment in the past and a chapter discussing where dialysis treatment may go in the future.
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