title: Chronic dialysis and dialysis doctors in the United States: a nephrologist-historian's perspective.
abstract: In an earlier article in Seminars in Dialysis (9:276-281, 1996), the author described the invention of clinical hemodialysis for acute renal failure and its initially equivocal reception by the emerging specialty of nephrology in the United States. A similar story of blunted enthusiasm played out following the invention of the Quinton-Scribner shunt (whose idea "came in the night"), which allowed maintenance treatment for chronic renal failure. Few centers at first could match Belding Scribner's early successes, and some physiology-oriented university nephrologists envisioned how routine dialysis might swamp other activities. Nonetheless, increasingly complex and successful inventions appeared and prevailed: the chronic dialysis unit, the national dialysis chain. A unique federal entitlement program fostered the spread of maintenance dialysis, but so did the emergence of disposable off-the-shelf supplies and many new nephrologists trained in academia but seeking positions in practice. Indeed, the spread of end-stage renal disease (ESRD) care transformed American nephrology. The essay concludes by considering what nephrologists of the ESRD era share with their patients.
authors: Division of Nephrology, Department of Medicine, Medical College of Pennsylvania Hospital and MCP Hahnemann University, Philadelphia, Pennsylvania 19129, USA. sjp27@drexel.edu
authors: S J
authors: SJ
authors: Peitzman
mesh_terms: D049673:History, 20th Century; D009398:Nephrology / Q000266:history*; D006435:Renal Dialysis / Q000266:history* / Q000379:methods; D014481:United States; D000078329:Workforce