Pierratos searched for new ways to reduce the burden of home dialysis

Issue: February 2023

ByChristopher T. Chan, MD

ByGihad Nesrallah, MD

ByGavril Hercz, MD

ByDavid Mendelssohn, MD, FRCPC

The nephrology community lost an expert in home dialysis on Nov. 15, 2022.

Andreas Pierratos, MD, FRCPC, died surrounded by his closest family. He was 73 years old.

**Andreas Pierratos, MD, FRCPC,** pictured here with his wife Catherine and the Lifetime Achievement Award in Hemodialysis he received at the Annual Dialysis Conference in 2011.

*Source: Source: Christopher T. Chan, MD*

Pierratos will be missed by everyone who had the privilege to know him and he will be remembered for his knowledge and kindness to all his patients.

Born in Trichonion, Greece, Pierratos graduated from medical school in Athens and did his early training while completing his national military service. He moved to Toronto in 1978 and obtained his internal medicine and nephrology training at the University of Toronto, where he later became a professor of medicine. His mentor during his early days in Toronto was Dimitrios Oreopoulos, MD, who was world renown for his expertise in peritoneal dialysis.

Nocturnal dialysis

Pierratos started his full-time career in Toronto at the Wellesley Hospital in the mid-1980s. By the early 1990s, he was part of a team, led by Robert Uldall, MB, BS, MD, FRCP, FRCP (C), that initiated a demonstration project in “slow nocturnal home hemodialysis.”

The project was expanded and improved by Pierratos after the death of Uldall in 1995. In 1998, the nocturnal home hemodialysis (NHD) program moved to Humber River Hospital, where he remained a full-time clinician and scientist for the duration of his career.

Pierratos was the pioneer who established NHD as a dialysis modality. He was also credited with finetuning the technique, establishing the safety requirements for NHD, technological advancements (including remote clinical monitoring), and the determination of solute balance of NHD (eg, calcium, phosphate, beta 2-microglobulin, amino acids and other nutritional elements). He contributed countless peer-reviewed articles and book chapters and was an omnipresent lecturer at local, national and international nephrology meetings.

The first Toronto NHD-detailed methodology paper sparked great interest globally and generated a renaissance in hemodialysis research. Medical leaders from various geographies visited the Toronto NHD program, including Robert Lockridge, MD; Chris Hoy, MD; Carolyn Cacho, MD; Amy Williams, MD; Brent Miller, MD; John Agar, MD, and others, carrying the knowledge back to their home centers to start their own NHD programs. As a result, an international NHD network was born.

Impact on cardiovascular health

It was during this time that Christopher T. Chan, MD, was fortunate enough to meet “Dr. P” (as Andreas was affectionately known locally) and this serendipitous encounter during dinner changed his academic career to become a clinician investigator in home dialysis.

Chan and Pierratos decided to embark on an examination of the effects of NHD on cardiovascular health. Their early observation that NHD was able to regress left ventricular hypertrophy set the stage for the subsequent NIH-sponsored Frequent Hemodialysis Network Trials.

More recently, with the establishment of the Ontario Renal Network, Andreas was the original provincial clinical lead for home and independent dialysis. He developed and implemented a pilot project to establish a publicly funded personal support worker (PSW)-assisted home hemodialysis program in Toronto. Responding to the COVID-19 pandemic, he extended this effort to provide PSW and/or hospital supported dialysis for patients within their long-term care homes, eliminating the need to transport them for dialysis. At the time of this writing, both pilot programs have been approved for full-scale implementation across Ontario.

Given his contributions to dialysis care, Pierratos received the International Society of Hemodialysis Lifetime Achievement Award and the George deVeber Distinguished Service Award from the Kidney Foundation of Ontario. More recently, the Kidney Foundation of Canada hosted a tribute in Pierratos’ honor just prior to the pandemic in late 2019.

Throughout the years, he always personified the essence of a philosopher, scholar and a gentleman; one who led the specialty with modesty and humility. He has changed the lives of countless patients and families. His legacy will be remembered.

References:
Agar JW, et al. Hemodial Int. 2003;doi:10.1046/j.1492-7535.2003.00051.x.
Cacho CP. ASAIO J. 2001;doi:10.1097/00002480-200109000-00008.
Chan CT, et al. Kidney Int. 2002;doi:10.1046/j.1523-1755.2002.00362.x
Hoy C. Hemodial Int. 2004;doi:10.1111/j.1492-7535.2004.01088.x
Lockridge RS, Jr. Nephrol News Issues. 1999;13 (16) 23-6.
Pierratos A. Ann Rev Med. 2004;doi:10.1146/annurev.med.55.091902.103801.
Pierratos A. Am Jrnl of Kid Dis. 1998;doi:10.1016/S0272-6386(98)70166-0.
Pierratos A, et al. JASN.1998;doi:10.1177/039139880102400.
Pierratos A. Semin Dial. 2001;doi:10.1046/j.1525-139x.2001.00073.x.
Uldall R, et al. Adv Ren Replace Ther. 1996;doi:10.1016/s1073-4449(96)80053-7.
Williams AW, et al. Am J Kidney Dis. 2004; doi.org/10.1053/j.ajkd.2003.09.017.

For more information:
Christopher T. Chan, MD, is director of the division of nephrology at University Health Network in Toronto, Canada, and holds the R. Fraser Elliot Chair in Home Dialysis.
Gavril Hercz, MD, is a member of the division of nephrology at Humber River Hospital, Toronto.
David Mendelssohn, MD, FRCPC, is the director of the division of nephrology at the Humber River Hospital, Toronto.
Gihad Nesrallah, MD, is a member of the division of nephrology at Humber River Hospital, Toronto.

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Sources/Disclosures

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Disclosures: Chan is a consultant with Medtronic, Quanta and Dialco Inc. The other authors report no relevant financial disclosures.

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