Shaldon was a pioneer in changing hemodialysis

Stanley Shaldon, one of the English pioneers of hemodialysis for chronic kidney failure, died on Nov. 20, 2013 in Monaco at the age of 82.

Stanley trained at Cambridge University and the Middlesex Hospital, London, and at the Postgraduate Medical School at Hammersmith Hospital in London where he learnt how to catheterize the liver and measure hepatic blood flow. When Sheila Sherlock, an expert in liver disease, moved to the Royal Free Hospital in London as Britain’s first female professor of medicine, Stanley went with her and was appointed lecturer in medicine. In early 1960 Sheila told him she wanted a division of nephrology in her newly established department of medicine and he should go to the first meeting of the International Society of Nephrology in Evian-les-Bains, France, in September. This was the meeting where he was impressed by the work of Nils Alwall and Belding Scribner.

Stanley took over the Royal Free Hospital hemodialysis unit and in 1961 developed a new way of providing intermittent access to the circulation for each dialysis with catheters introduced into the femoral artery and vein using the percutaneous Seldinger technique. This eliminated the need for an external device between dialyses. Also in 1961, he was one of the first to develop a technique for reuse of the extracorporeal circuit, primarily for economic reasons so he could treat more patients.

In 1962 he began treating patients with chronic kidney failure using Teflon-Silastic shunts and in 1963 was the first to teach a patient to connect and disconnect himself from the artificial kidney. The patient came into hospital twice a week in the afternoon and dialyzed overnight assisted by a nurse. Stanley called this “self-service dialysis.” In 1964, home hemodialysis began in Boston, Seattle and London, and in October Stanley was the first to use overnight home hemodialysis.

In 1963, the Royal Free Hospital hosted a meeting on acute renal failure organized by Stanley. It was there that David Kerr, Bill Drucker and Stanley came up with the idea that became the European Dialysis and Transplant Association, which remains the primary organization for nephrologists outside the United States.

Stanley had fallen out with dialysis inventor Wilhelm Kolff when he spent some time in Cleveland, and by 1965 he had fallen out beyond repair with Professor Sherlock. He soon left the Royal Free Hospital and the National Health Service to set up the first freestanding independent dialysis unit in the United Kingdom in a house in a London suburb. This, the National Kidney Center, was a home hemodialysis training and support center without hospital backing and between 1966 and 1968 it placed 28 patients on home hemodialysis in the UK, more than the whole National Health Service had done. It also trained patients from outside the UK, particularly from Germany where he helped with the development of dialysis providers. In 1969 he left Britain finally to work in Europe. He worked with Charles Mion in Montpelier, France, and in 1974 was appointed an honorary professor there. He also ran nephrology research at the University of Nimes, France, and spent time in Stockholm with Jonas Bergstrom and Peter Furst studying ultrafiltration. More recently he changed his interest to inflammation in dialysis patients, the role of incompatible membranes, and plastics and the necessity of ultrapure water for dialysis.

Over his career he wrote more than 300 papers, received a number of prestigious awards and worked with and advised a number of international dialysis and dialysis-related companies.

Robin Eady, a retired professor of dermatology and longest surviving ESRD patient in the world, was a patient of Stanley’s as a medical student and has noted Stanley did much of his acclaimed work while he was young and still relatively junior. His work rate was extraordinary and his expectations of staff were very demanding. Robin’s wife, who was a nurse in Stanley’s unit, said that he was intolerant of mistakes, but decisive and excellent in a crisis in the middle of the night when he would be calm, clear and direct.

Stanley Shaldon was of small stature but one of the early giants working with hemodialysis. His personality was the cause of some of the problems that resulted in his peripatetic life. He himself admitted that he was arrogant, did not suffer fools gladly, and could be quite offensive on occasion, particularly with some of the other early leaders in the dialysis field. Even so, Stanley will have his place in the history of hemodialysis and will be sorely missed by those of us who were fortunate enough to know and interact with him as colleagues and friends over the years. -by Christopher R. Blagg, MD