Who was the first patient to benefit from chronic maintenance hemodialysis?
The artificial kidney introduced after World War II remained experimental and was used mainly in exploratory attempts to sustain the lives of selected patients with acute kidney injury through the 1950s. The need for repeated access to the circulation limited the use of hemodialysis to the short term only in patients with acute kidney injury. Even in patients with acute kidney injury with delayed recovery, prolonged dialysis presented insurmountable problems that led to its abandonment before kidney function had recovered. The breakthrough came in March 1960, when Belding Scribner (1921–2003), a nephrologist, and Wayne Quinton (1921–2015), an engineer, working in Seattle, developed the so-called Quinton-Scribner shunt using Teflon, which had become available recently and was being used to coat implantable cardiac pacemakers. Shortly thereafter, the shunt was modified to be made from more flexible silicone tubing with Teflon tips inserted into the radial vasculature. The first patient to benefit from this new device was Clyde Shields (1921–1971), a 39-year-old Boeing machinist. In April 1960 Scribner took Clyde to the annual meeting of the American Society for Artificial Internal Organs in Atlantic City, New Jersey for a private demonstration of the shunt. The news traveled with lightning speed, and suddenly long-term maintenance hemodialysis became possible. For the first time in medicine, technology and creativity allowed the replacement of the functions of a vital body organ. Literally overnight, repeated hemodialysis allowed survival from the otherwise fatal disease described by Richard Bright (1789–1858) some 150 years earlier.
That was when dialysis moved from its rudimentary beginnings in the 1950s to a chronic life-sustaining modality of treatment, for which Kolff and Scribner were to share the Lasker Award in 2002. Unfortunately, the extremely limited resources then available in Seattle necessitated the creation of a committee to select who received maintenance dialysis (later dubbed “Life and Death Committee”). Even when restricted funds were made available, dialysis remained limited and choices of who was dialyzed continued to be made, albeit based on “medical criteria” and “first come, first served” basis imposed by the limited means and available dialysis machines. It was not until 1973, when Public Law 92-603 amendment to the 1972 Social Security Act went into effect, that dialysis care became accessible to almost everyone.
In response to mounting needs for maintenance dialysis, hospital-based dialysis centers moved into for-profit outpatient facilities and proliferated. The rush to save the life of otherwise dying patients outpaced the science of dialysis, resulting in the delivery of a treatment that was primarily empiric. Over the decades that followed, the complications of dialysis and the significant morbidity and mortality associated with it emerged as serious concerns of all stakeholders. Some of the early complications of dialysis (aluminum toxicity, water purity, hepatitis, anemia) were soon resolved; others (mineral bone disease, cardiovascular disease) linger on, while that of adequacy of dialysis still awaits resolution.
All those problems and concerns notwithstanding, Clyde Shields survived 11 years on dialysis, succumbing to a myocardial infarction in 1971.
