Early Clinical Experiences with PD

The first patient ever treated with PD was a female with ureteral obstruction due to uterine carcinoma reported by Ganter in 1923¹.  This experience was followed by scattered reports with variable outcomes using the continuous perfusion technique^2,3.

In 1938, Rhoads used intermittent dialysis (IPD) to treat two nephrotic patients⁴.  In 1951, Grollman et al. reported their classic work on the use of IPD in uremic dogs and its application to humans^5,6.  By this time, more than 100 patients had been treated with PD, of which approximately two thirds had acute renal failure⁷.  The next serious contributions to the clinical use of PD were the recognition of the need for frequent intermittent dialysis, the maintenance of a sterile setting and the concomitant use of a conservative chronic renal failure (CRF) program consisting of dietary restrictions and nutritional supplements.  In 1964, Boen published his textbook of PD for use in clinical medicine, emphasizing its importance in the treatment of acute renal failure (ARF), and further contributing to the basic physiology, indications, and complications of this technique⁸.  The success of hemodialysis (HD) as chronic renal replacement therapy and its fast proliferation kept PD dormant for some time. The introduction of a safe and permanent catheter by Tenckhoff⁹, availability of commercial dialysate, and development of automated systems in the 1960s were responsible for the renewed interest in PD.  The novel concept of equilibration dialysis transformed PD into a popular, effective, and acceptable form of renal substitution therapy¹⁰.  The interest in continuous peritoneal dialysis (CPD), the introduction of new modalities of automated PD, advances in connectology and other technological improvements are responsible for the further growth of PD.  The quest for the optimal prescription and dose of dialysis remain an important subject of investigation. 

References:

1. Ganter G. Ueber die Beseitigung giftiger Stoffe aus dem Blute durch Dialyse. Munch Med Wochschr 70:1478, 1923
2. Heusser H, Werder H. Untersuchungen über Peritonealdialyse. Bruns Beiträge z klin Chir 141:38, 1927
3.  Balázs J, Rosenak S. Zur Behandlung der Sublimatanurie durch peritoneale Dialyse. Wien Med Wchnschr 47:851, 1934
4. Rhoads JE. Peritoneal lavage in the treatment of renal insufficiency. Am J Med Sci 196:642, 1938
5. Grollman A, Turner LB, Levitch M, et al. Hemodynamics of bilaterally nephrectomized dogs subjected to intermittent peritoneal lavage. Am J Physiol 165:167, 1951
6. Grollman A, Turner LB, McLean JA. Intermittent peritoneal lavage in nephrectomized dogs and its application to the human being. Arch Intern Med 87:379, 1951
7. Odel HM, Ferris DO, Power MH. Peritoneal lavage as an effective means of extrarenal excretion.  A clinical appraisal. Am J Med 9:63-77, 1950
8. Boen ST. peritoneal Dialysis in Clinical Medicine. Springfield, Illinois, Charles C. Thomas, 1964
9. Tenckhoff H, Schechter H. A bacteriologically safe peritoneal access device. Trans Am Soc Artif Intern Organs 14:181-186, 1968
10. Popovich RP, Moncrief JW, Decherd JF, et al. The definition of a novel portable/wearable equilibrium peritoneal dialysis technique. Trans Am Soc Artif Intern Organs 5:64, 1976 (Abstract)