ASN President’s Column

 

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Physicians, scientists, and other health professionals are problem solvers. This reality is especially true in nephrology, in which complex diseases and co-existing conditions are often challenging and sometimes daunting. However, this very complexity provides so many of us lifelong career interest and opportunities, and profound satisfaction when we can provide and improve care for our patients with kidney diseases.

As ASN marks its 50th year, it is worth looking back at the landscape for kidney patients and professionals in 1966. Although we nephrologists sometimes bemoan the lack of innovation in our field, the advances made in our field in the past 50 years are astonishing. No doubt most of these changes seemed to have come slowly, but taking a snapshot of 1966 really highlights the curiosity, achievements, and dogged determination emblematic of nephrology professionals.

What did nephrology look like in 1966?

Hospitals that performed transplants managed all aspects of organ procurement themselves; if an organ couldn’t be used at that institution, it was discarded.

The number of “artificial kidney centers” in the US increased to 43, providing dialysis to approximately 400 patients.

Dialysis care in the United States was rationed because of the scarcity of available machines. The committees charged with deciding who received dialysis considered such diverse criteria as marital status, net worth, educational level, intelligence, and church attendance.

Dialysis carried out at home had been introduced 2 years earlier, in 3 cities: Boston, Seattle, and London.

James E. Cimino, MD, developed a direct artery to vein fistula that permitted a direct flow from an artery to a vein.

The US government noted that most nephrologists had to be trained “out of service.”

The National Library of Medicine subject headings for renal topics took up less than one page.

It is a tribute to the commitment and the genius of so many kidney-related investigators that in the past 50 years they were able to provide molecular insight into the transport and cellular functions of all segments of the nephron; unlock the genetic, pathophysiologic, and biochemical underpinnings of a host of kidney diseases; make advances in dialytic therapy; and develop significant improvements in immunosuppression for both kidney transplantation and immunologically mediated diseases of the kidney.

In my next column, I will take a look at the nephrologist of the future. Pondering the amazing trajectory of our field since 1966, I am confident that we can look forward to the kind of new treatments and cures that will continue to improve the lives of our patients and give all of us professional satisfaction.

October/November 2016  (Vol 8, Issue 10/11)