The Inspiring History of Nephrology and Hemodialysis in India: A Journey of Determination and Innovation
The story of nephrology and hemodialysis in India is one of resilience, groundbreaking innovation, and tireless dedication. It is a tale shaped by the unwavering vision of pioneers like Dr. K.S. Chugh, India’s first nephrologist, whose contributions laid the foundation for modern kidney care in the country.
The Early Days: Dr. Chugh’s Journey into Nephrology
In 1956, while studying at Government Medical College, Patiala, Dr. Chugh developed a keen interest in kidney diseases. At the time, diagnosing kidney conditions was challenging, and the concept of nephrology as a specialized field didn’t even exist in India. However, pioneering work on renal biopsies by Iversen and Brun (1950) intrigued him. The early biopsy technique had a low success rate of 38.5%, but Dr. Chugh saw its potential.
A breakthrough came when Kark and Muehrcke improved the biopsy technique by changing the patient’s position from sitting to prone. Inspired, Dr. Chugh decided to focus his postgraduate thesis on renal biopsies, despite initial resistance from medical faculty who didn’t recognize nephrology as a distinct field. As a compromise, he was allowed to specialize in genitourinary medicine, completing his thesis in 1958. His research, which included 50 successful renal biopsies, became India’s first systematic study of kidney diseases, setting the stage for the emergence of nephrology as a medical specialty.
India’s First Dialysis: A Historic Breakthrough
A major milestone was achieved in 1961 when Christian Medical College (CMC), Vellore, received India’s first Kolff twin-coil artificial kidney dialysis machine, a gift from the Christian Mission of the USA. The historic first-ever dialysis in India was performed on His Excellency Shri Gopeshwar Prasad Sahi, the Maharaja of Hathwa, who suffered from chronic uremia.
Since no Indian doctor was trained to operate the machine, Dr. P. Koshy sought guidance from Dr. Willem Kolff, the inventor of the dialysis machine, who sent Dr. Satoru Nakamoto from the USA to assist. The successful procedure marked a turning point for kidney care in India.
Dr. Chugh’s Role in Advancing Dialysis in India
Eager to expand dialysis access, Dr. Chugh visited CMC Vellore in 1962 to observe dialysis treatments firsthand. During his visit, he proposed a renal biopsy for a patient with bronchiectasis and proteinuria—a suggestion initially met with skepticism. However, the biopsy confirmed his diagnosis of renal amyloidosis, a significant diagnostic breakthrough for kidney disease in India.
The Growth of Dialysis in India
1963: Dr. Chugh joined Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. By July 1963, PGIMER performed its first dialysis on a patient with acute renal failure, officially starting a long-term dialysis program in India.
May 31, 1963: At King Edward Memorial (KEM) Hospital, Mumbai, Professor P. Raghavan and Dr. Vidya Acharya successfully performed dialysis, refining arteriovenous cannulation techniques using experiments on dogs—an approach that later became essential for hemodialysis in India.
In 1964, PGIMER performed India’s first peritoneal dialysis (PD). Due to the lack of PD catheters, Dr. Chugh’s team improvised with polythene tubing and an abdominal trocar. Despite these limitations, their efforts paved the way for Continuous Ambulatory Peritoneal Dialysis (CAPD), which became more widespread in the 1980s.
International Training and Technological Advancements
Determined to bring the best practices to India, Dr. Chugh trained at Hammersmith Hospital in London in 1967-68 under Dr. Oliver Wrong, a leading nephrologist. He returned to Chandigarh and expanded PGIMER’s dialysis program, incorporating volumetric ultrafiltration, microprocessor-based control, and hollow-fiber dialyzers, bringing Indian nephrology closer to international standards.
The Expansion of Dialysis Services Across India
By the early 1970s, more hospitals began offering dialysis:
- 1971: AIIMS, New Delhi established a dialysis unit.
- Late 1970s: Over 40,000 dialysis sessions had been performed nationwide.
- Present Day: India now has over 800 hospitals with dialysis services, providing life-saving treatment to millions.
The Legacy of India’s Dialysis Pioneers
The evolution of nephrology and dialysis in India is a testament to the perseverance of Dr. K.S. Chugh and other pioneers who defied challenges to bring kidney care to the forefront. From makeshift PD catheters to cutting-edge hemodialysis machines, their work continues to shape the future of nephrology in India.
As the demand for dialysis grows, the next challenge is ensuring affordable and accessible kidney care for all. With advancements in portable dialysis machines, telemedicine, and AI-driven diagnostics, the future of nephrology in India looks promising.
Final Thoughts
From humble beginnings to a nationwide network of dialysis centers, India’s nephrology journey is nothing short of remarkable. What innovations will define the next chapter of kidney care? Only time will tell, but one thing is certain—the vision and dedication of pioneers like Dr. K.S. Chugh have left an indelible mark on India’s healthcare system.
References:
Chugh, K. S. (2001). "History of Dialysis in India." Indian Journal of Nephrology, 11(3), 87-90.
Saha, A., & Sharma, S. (2011). "Early History of Hemodialysis in India." Indian Journal of Nephrology, 21(6), 352-355.
Gupta, A., & Sharma, R. (2010). "The Journey of Hemodialysis in India: A Historical Perspective." Nephrology Dialysis Transplantation, 25(6), 2302-2308.
Pande, A., & Pawar, D. (2015). "The Growth of Renal Care in India: Challenges and Solutions." Indian Journal of Nephrology, 25(5), 283-289.
Sharma, S. K., & Bansal, S. K. (1994). "The First Successful Renal Dialysis in India." Indian Journal of Medical Research, 100, 72-75.
National Institute of Health (NIH). (2005). "History of Dialysis: The Pioneering Work of Dr. Willem Kolff." National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Parikh, R. M., & Rathi, V. S. (2017). "Peritoneal Dialysis in India: History, Challenges, and Future Directions." Indian Journal of Nephrology, 27(6), 473-479.
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