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© Kelvin L Lynn, Adrian L Buttimore, Peter J Hatfield, Martin R Wallace Published 2018 by Kelvin L Lynn, Adrian L Buttimore, Peter J Hatfield, Martin R Wallace National Library of New Zealand Cataloguing-Publication Data Title: The Treatment of Kidney Failure in New Zealand Authors: Kelvin L Lynn, Adrian L Buttimore, Peter J Hatfield, Martin R Wallace Publisher: Kelvin L Lynn, Adrian L Buttimore, Peter J Hatfield, Martin R Wallace Address: 1 Weston Road, Christchurch 8052, New Zealand ISBN PDF - 978-0-473-45293-3 A catalogue record for this book is available from the National Library of New Zealand Front cover design by Simon Van der Sluijs The Tom Scott cartoon on page 90 is reproduced with the kind permission of the artist and Stuff. The New Zealand Women's Weekly are thanked for permission to use the photo on page 26. All rights reserved 2 Acknowledgements The editors would like to thank Kidney Health New Zealand for hosting this publication on their website and providing support for design and editing. In the Beginning, the history of the Medical Unit at Auckland Hospital, provided valuable information about the early days of nephrology at Auckland Hospital. Ian Dittmer, Laurie Williams and Prue Fieldes provided access to archival material from the Department of Renal Medicine at Auckland Hospital. The Australia and New Zealand Dialysis and Transplant Registry provided invaluable statistics regarding patients treated for kidney failure in New Zealand. Marg Walker of Canterbury Medical Library, University of Otago, Christchurch and Alister Argyle provided advice on online publishing. We are indebted to the following for writing chapters: Max Morris, William Wong and John Collins. John also gave valuable input to the chapter on national and regional planning. Ailsa Jacobson, Nick Polaschek and Miranda Walker helped write the chapter on Renal Nursing. The following colleagues provided valuable information about the history of their local renal units: Steve Dixon, Maree McDonald and Robert Walker (Dunedin); Ian Simpson, Martin Searle, Sharon Kletchko (Middlemore); Jenny Walker, Ellen Atkinson, Tafale Maddren and Maurice Orpin (Whangarei); Krishan Madhan (Taranaki); Sue Steel, Lesley McCarthy, Trish Valentine, Jim Gray, David Mee, Geoff Allen, Bill Wright, Anna Holmes (Waikato), Geraldine McLean (Starship Children’s Hospital), Neil Turnbull, J Verney Cable, Donald Urquhart Hay and Peter Meech (Wellington); Trevor Roberts, Guy Johnson, Carmel Gregan-Ford and Max Reid (National Kidney Foundation of New Zealand and Kidney Health New Zealand). We are grateful to the health professionals, patients and their families who provided reminiscences, archival material (including photographs), or agreed to be interviewed: Nora Van der Schrieck, Elizabeth Bowie, David Richmond, Thomas Miller, Lee Mathias, Fredric Doss, Paul Santamaria, Wendy Clarke (née Couchman), Margaret Woodbridge, Kathy Flynn (was Faircloth), Marilyn Odinot, Kay Andrews, Elna Lindsay, Margaret Thomson, Rosie Whitmore (née Daley), Joanna Delahunty, Shona Barlow, Peter Little, Errol Hannah, John Morton, Alan Chirnside, Suetonia Palmer, Judith Inkster, Jo Houghton, John Irvine, Murray Leikis and Janelle Wallace, Gloria Herrick, Kath Gaines, Marie Giles’ family, Rob Brydon, Barbara O’Connor, Carlene Dalzell, Mary Callander, Paul Brickland, Paul Booth, Sheila Henderson, Martin Urlich and Anita Lloyd. The frontispiece was designed by Simon Van der Sluijs of Metafor Creative Ltd. David Gunby read the manuscript and made several suggestions. Maree Coffey proofread the manuscript. Claire Le Couteur’s editing skills are gratefully acknowledged. 3 Foreword Around 2008, Kelvin Lynn and Adrian Buttimore had the idea of writing a history of the treatment of kidney failure in New Zealand. Little progress ensued until after they retired from clinical practice. Peter Hatfield in the 1990’s had interviewed Neil Turnbull and J Verney Cable to record their place New Zealand nephrology history. Peter Hatfield and Martin Wallace joined the project in 2013. In our various professional roles we have experienced the impact of kidney failure on patients and their families. From the earliest days, we saw the effects of the new treatments of dialysis and of transplantation. We recognised the need to document the work of the pioneers of the specialty of renal medicine or nephrology over the past 50 years in New Zealand. We wished to acknowledge the contribution of our teachers, mentors and colleagues, as well as the patients and their families who contributed so much to the development of comprehensive services for people with kidney failure. The story of the modern treatment of kidney failure in this country encompasses remarkable experiences of patients and their families and the contributions made by dedicated health professionals. It also reveals the challenges and ethics of meeting an ever-increasing demand for treatment. Social and political changes in our country since the 1950s have critically influenced the development of treatment services for New Zealanders with kidney failure. The project has taken much longer than we would have hoped for. Encouraging and cajoling contributors is a delicate task and we are aware of the many competing demands we all have for our time. We are dependent on others for a complete version of history of the treatment of kidney failure in New Zealand. For a variety of reasons, this document is incomplete: there are sections yet to be written. The editors decided that an online publication at this stage would keep faith with those who have already provided their contribution and encourage others to help address the gaps. It will also enable us to rapidly address any corrections of fact and keep costs to a minimum. Fortunately, many of the key players in this history were still alive when we started this project and were able to tell their story. Sadly, Martin Wallace died in October 2017. We are grateful to the many people who have provided archival material, agreed to be interviewed or have written sections themselves. We hope that this publication will be of interest to patients and their families, health professionals, medical historians, sociologists and others, such as students and journalists who may wish to learn more about the history of the treatment of kidney disease and the context of its development in New Zealand. Kelvin Lynn, Peter Hatfield and Adrian Buttimore 4 Table of contents Chapter 1 Introduction …………………………………………….............................................. 7 Chapter 2 Development of renal services (1960 to 2000)…..…............................................11 Beginnings 1950-1960 The first renal units 1961-70 Meeting the demand 1971-80 (including Transplantation) Clinical, ethical and funding challenges 1981-1990 Renal services in the time of the Health Reforms1991-2000 Recent developments 2001 to present Chapter 3 Home haemodialysis……………………………………...........................................47 Chapter 4 Treatment of children and adolescents………………............................................60 Chapter 5 Renal nursing in New Zealand …………………………........................................ 65 Chapter 6 Dialysis technician to clinical physiologist-dialysis ...............................................70 Chapter 7 National & regional planning of renal services in New Zealand ...........................81 Clinician led national service planning The West Report National Technical Committee on Renal Dialysis and Transplant New Zealand Chapter of the Australian and New Zealand Society of Nephrology Attempts to define core renal services Effects of the 1990s Health Reforms The National Renal Advisory Board Chapter 8 Kidney Health New Zealand and Kidney Societies.…......................................... 89 Chapter 9 Statistics and trends for the treatment of kidney failure in New Zealand.…….... 97 Chapter 10 The future of dialysis ………………………………….............................................99 Conclusion …………………………………………………………………..................................108 The editors ……………………………………………………………….....................................109 Chapter authors …………………………………………………… ……….................................111 Appendices…………………………………………………………………...................................113 . Appendix A Report of Committee on Renal Dialysis and Transplantation to the Hospitals Advisory Council June 1977. Committee members. Appendix B The Management of End-stage Renal Failure Consensus Development Conference 1992. Committee members. Appendix C New Zealand nephrologists, physicians and surgeons 1960-2000 Appendix D New Zealand Nephrology Units 2018 Glossary of kidney disease terms ……………………………………….................................. 118 5 The Treatment of Kidney Failure in New Zealand Abbreviations and acronyms Area Health Board AHB Arteriovenous AV Australia and New Zealand Dialysis and Transplant Registry ANZDATA Australian and New Zealand Society of Nephrology ANZSN Automated Peritoneal Dialysis APD Chronic Kidney Disease CKD Continuous Ambulatory Peritoneal Dialysis CAPD Crown Health Enterprise CHE District Health Board DHB Endstage Kidney Disease ESKD Haemodialysis HD Home Haemodialysis HHD Intensive Care Unit ICU Kidney Health Australia KHA Kidney Health New Zealand KHNZ Peritoneal Dialysis PD Multiple Artificial Kidney System MAKS National Kidney Foundation of New Zealand NKF National Renal Advisory Board NRAB New Zealand Board of Dialysis Practice NZBDP Renal Society of Australasia RSA Regional Health Authorities RHA 6 1 Introduction Martin Wallace