SP744E. PANAGIOTOPOULOS AND D. VALTIS: PERITONEAL DIALYSIS PIONEERS IN LATE 1940'S GREECE

Abstract

Introduction and Aims: Technical problems regarding collodion membranes fragility hindered early hemodialysis research at the start of the 20th century. This led to search for alternative membranes and G. Ganter was the first to report the use of peritoneal membrane in situ for dialysis of uremic patients (1923), followed by S. Rosenak (1934). In the years afterWorldWar II, peritoneal dialysis for treatment of potentially reversible acute kidney injury attracted the interest of many researchers. Methods: We searched through medical textbooks, conference proceedings, journal article databases and Internet search engines for references reporting the beginnings of peritoneal dialysis in Greece. Results: Efthymios Panagiotopoulos (1904-73) and Dimitrios Valtis (1917-73) published in 1950 the first attempt of peritoneal dialysis at Hippokrateion Hospital of Thessaloniki, Greece in the paper entitled “Observations from the implementation of intraperitoneal dialysis in a case of acute uremia” (originally in greek). In the introduction, they acknowledged contemporary work by the groups of J. Fine in USA and M. Dérot in France on peritoneal dialysis. The authors described the case of a 25-year-old female who developed acute kidney injury with complete anuria, jaundice, hemolytic anemia and thrombocytopenia following septic abortion induced by apiole, a commonly used abortifacient of the time. Two weeks after disease onset, they performed two peritoneal dialysis sessions 48 hours apart, during which they continuously instilled 10 liters of dialysis solution inside the peritoneal cavity over 12 hours yielding 12 liters of drainage fluid. A third session was stopped due to outflow tube obstruction. Although plasma urea concentration halved after treatment and temporary clinical improvement was noted, flow problems due to lack of heparin made them discontinue treatment and the patient deceased soon afterwards. Conclusions: The two physicians maintained a lifelong interest in renal medicine.D. Valtis was amongst the first to introduce hemodialysis in Greece and a founding member of the Greek Society of Nephrology. In a country devastated by the destructive consequences of Nazi Occupation (1941-44) and a bloody Civil War (1946-49), Greek physicians strived to keep abreast of novel research developments and offer their patients up to date medical care under extremely harsh conditions.