Water immersion model in nephrology: from hydrotherapy to weightlessness

Abstract

The term immersion connotes a wide range of different procedures ranging from whole body immersion to head-out water immersion carried out utilizing diverse body postures and water temperatures. Though hydrotherapy has been used for centuries, it was the space program in the sixties of the twentieth century, which gave a new impetus to this procedure as an nonaggressive investigative tool, which has been used in studding the influence of weightlessness on hemodynamic, metabolic, hormonal and nervous system. It was possible because water immersion mimics the weightless state on earth.

During the next years head-out immersion model was used by scientists to investigate function and pathophysiology of cardiovascular system, liver and kidneys. After recognition that water immersion induces diuresis and natriuresis, the procedure has been used to study and to treat the disorders characterized by impaired volume homeostasis, as decompensated liver disease, nephrotic syndrome, essential hypertension, cardiac transplantation, diabetes, primary aldosteronism and pheochromocytoma.

Between investigative groups, which contributed the most in studies with using head-out water immersion model there are teams of M. Epstein (Miami, USA), J.E. Greenleaf (USA), P. Norsk (Denmark), A. Koomans (Utrecht, The Netherlands) and F. Kokot (Katowice, Poland).

Keywords: water immersion, nephrology, hydrotherapy

Introduction

Hydrotherapy is probably as old as mankind. It is one of the basic methods of treatment widely used in natural medicine, and has also been referred to as water therapy, aquatic therapy, pool therapy and balneotherapy.

Hydrotherapy dates back as far as ancient Egyptian, Greek and Roman times, when Egyptian royalty bathed in oils and Roman bath were frequently visited by its citizens. There is also historical evidence of such therapies having been used in the Far East, e.g. China and Japan – where hot springs were frequently used by people to bathe in. However, in those times people used hydrotherapy exclusively for relaxing and indulging themselves and it was only in the 19th century, that hydrotherapy started to resemble the therapy that it has become in today’s society. Heinrich Friedrich Francke (1766-1838), Vincent Priessnitz (1799-1851) and Sebastian Kneipp are supposed to be the pioneers of hydrotherapy.

 

Water immersion as a type of hydrotherapy

Nowadays hydrotherapy procedures can be divided to:

  1. Surface hydrotherapy with absorbent materials (e.g. washes, friction rubs, wraps packs and compresses);
  2. Hydrotherapy showers with variations in water striking pressure (douches, showers);
  3. Procedures based on the effects of hydrostatic pressures (under massage, whirlpool bath, exercise in water, full and partial immersion bath).

Among partial immersion modalities, head-out water immersion is of particular importance. Its effect on different body organs depends on water temperature. Therefore immersion in water at temperature e.g. 14, 20 and > 360C is commonly referred to as thermotherapy.

In the next part of the paper the head-out water immersion in neutral bath, ie. at temperature approximately 32-360C will be discussed and referred to as WI.

 

Differences between WI and saline administration

The most important effects of WI in humans are (1):

  • prompt redistribution of circulating blood from the periphery to the heart and great vessels of the chest and the neck, especially in the areas with volume-, baro- and chemo- receptors with a relative central hypervolemia,
  • increase in cardiac output by 25-33% and central blood volume by ~ 700 ml,
  • progressive diuresis and natriuresis equally in magnitude to those induced by acute NaCl administration (2 l/2 h).

Despite of many similarities, there are some significant differences between WI and saline administration (1).

  1. WI is associated with decrease in body weight rather than the increase that occurs after saline infusion.
  2. Majority of studies have indicated that systematic blood pressure is unaltered during immersion in normotensive studies and can decrease in patients with hypertension. Saline infusion always causes increase in blood pressure.
  3. WI doesn’t cause any changes in plasma compositions, while saline infusion does.
  4. WI entails a central hypervolemia without concomitant peripheral hypervolemia, whereas saline administration involves both a central and peripheral hypervolemia (in majority of studies).
  5. And, what is also important, action of WI is promptly reversible, while saline infusion doesn’t.

 

Head out WI as an investigative tool

Thought many from mentioned facts were already acknowledged in the second half of the 19th century but, unfortunately, there were no practical implications until about 100 years later. There are two applications of water immersion: as an investigative tool and as a therapeutic maneuver. Both applications and based on the above mentioned redistribution of blood volume.

Research studies of Henry Gauer et al carried out in the 50s and 60s 20th century are considered the true beginning of water immersion as an investigative tool. It is ironic that the recent widespread interest in WI as an investigative tool received its impetus not from centuries of hydrotherapeutic practice but from the modern space program. It turned out that, due to the buoyant property of water, head-out water immersion mimics the weightless state. It has therefore been used in studying the influence of weightlessness on human body (2). Norsk et al emphasized the similarities between these two conditions with respect to renal excretion of sodium and water (3).

The number of research studies significantly increased in the 70s and 80s of 20 century, including studies on the effects of WI on renal function. Table 1 presents the number of papers listed in Pub Med that had been prepared by each of the mentioned research teams. All these papers discussed WI as an investigative tool.

In his excellent review Murray Epstein described the mechanisms by which head-out water immersion causes increase in urinary sodium excretion and therefore increase diuresis and decrease blood pressure. The main mechanisms are: inhibition of RAA system, increase of renal prostaglandins production and increase of natriuretic peptides (3).

He also proved, that the rise in urinary sodium excretion occurred no matter how big was sodium contents in diet. On the 10 mmol sodium excretion were of course smaller, than on the 150 mmol, but in compare to controls, in bath cases increase was significantly higher. This increase in urinary sodium excretion decreased after giving steroid, but was still significantly higher than in controls.

In healthy subjects WI induced enhanced diuresis and natriuresis at last partly by suppression of the RAA system, vasopressin secretion, the pituitary adrenal axis and by enhanced of natriuretic factors (4).

In hypertensive patients WI induced a significant decline in plasma renin activity, aldosteron and AVP which is quantitatively different from that observed in normals. As WI induced reduction of blood pressure was not significantly related to endocrine alterations, it seems, that factors other than PRA, Aldo and AVP are of importance in the maintenance of the particular types of hypertension (5).

In contrast to non-pregnant women, healthy pregnant women and women with EPH gestosis showed a significantly reduced increase in ANP secretion induced by WI (6). In diabetes type 1 and type 2 WI induced ANP secretion was significantly reduced as compared with normals. Despite a reduced response of ANP Secretion, the WI induced enhanced diuresis was a comparable magnitude both in normals and diabetics (7). In heart transplant patients ANP plasma levels were significantly higher than in normals  and heart transplant patients. These results suggest presence of an infect physiological regulatory mechanism of ANP secretion in heart transplant patients (8).

To summarize the outcomes of the Kokot group, it can be concluded, that the importance of ANP secretion in the WI induced increase of diuresis may vary in different pathological states. However, first of all WI may be used as an nonaggressive investigative tool in patients with disturbances of the water electrolyte homeostasis, supplying information of endocrine organs, kidneys or nervous system in their pathogenesis.

Research studies into the WI model have been continued in the 21st century. Schou et al demonstrated, that suppression of generation of angiotensin 2 plays an important role in the natriuresis during WI (10). Valenti et al found that WI is associated with a reversible increase in urinary aquaporin 2 excretion (11). Recently Wang et al investigated the influence of WI on human motions and demonstrated that both the wrist and trunk activities were significantly decreased (12).

 

WI as a therapeutic maneuver

As mentioned before, WI was also used as a therapeutic maneuver in patients with excessive sodium and water retention.

The research has revealed the efficacy of WI as a therapeutic intervention for the variety of disease including essential hypertension (48 items in Pub Med), nephritic syndrome (9 items in Pub Med), decompensated liver cirrhosis (4 items in Pub Med), preeclampsia (7 items in Pub Med) and heart failure (38 items in Pub Med).

 

Conclusion

Presented in the article facts let to conclude, that WI was of great importance in development of nephrology as an investigative tool and therapeutic maneuver.

References

  1. Epstein M: Studies of volume homeostasis in man utilizing the model of head-out water immersion. Nephron, 1978, 22: 9-19.
  2. Epstein M: Renal effects of head-out water immersion in humans: a 15-year update.
    Am J Physiol: Endocrinology and Metabol, 1992, 72: 563-621.
  3. Norsk P, Drummer C, Christensen NJ, Cirillo M, Heer M, Kramer HJ, Regnard J, De Santo NG: Revised hypothesis and future perspectives. Am J Kidney Dis, 2001, 38: 696-8.
  4. Epstein M: Water immersion and kidney. Undersea Biomedical Research, 1984, 11: 113-121.
  5. Kokot F, Wiecek A, Grzeszczak W, Zukowska-Szczechowska E, Dulawa J: The water immersion model in nephrology. Acta Med Pol, 1990, 1-4: 77-84.
  6. Kokot F, Jupowiecki J: Head out WI induced endocrine alterations in hypertensive patients, Przegl Lek, 1985, 42: 316-320.
  7. Doniec-Ulman I, Kokot F, Wambach G, Drab M: Water immersion-induced endocrine alterations in women with EPH gestosisClin Nephrol,1987, 28: 51-55.
  8. Dulawa J, Kokot F, Klin M, Bar A, Grzeszczak W, Darocha Z: Studies on the ANP, diuresiss and natriuresis under conditions of WI in patients with diabetes.
    Pol Arch Med Wewn, 1990, 83: 166-176.
  9. Kokot F, Religa Z, Pasyk S, Wiecek A, Frycz J, Grzeszczak W, Bochenek A, Dulawa J: ANP secretion in heart transplant patients.
    Int J Artif Organs, 1989, 12: 321-326.
  10. Schou M, Gabrielsen A, Bruun NE, Skøtt P, Pump B, Dige-Petersen H, Frandsen E, Bie P, Warberg J, Christensen NJ, Norsk P: Angiotensin II attenuates the natriuresis of water immersion in humans. Am J Physiol Regul Integr Comp Physiol, 2002, 283: R187-96.
  11. Valenti G, Fraszl W, Addabbo F, Tamma G, Procino G, Satta E, Cirillo M, De Santo NG, Drummer C, Bellini L, Kowoll R, Schlemmer M, Vogler S, Kirsch KA, Svelto M, Gunga HC: Water immersion is associated with an increase in aquaporin-2 excretion in healthy volunteers. Biochim Biophys Acta, 2006, 1758:1111-6.
  12. Wang P, Wang Z, Wang D, Tian Y, Li F, Zhang S, Zhang L, Guo Y, Liu W, Wang C, Chen S, Guo J: Altered Gravity Simulated by Parabolic Flight and Water Immersion Leads to Decreased Trunk Motion. PLoS One, 2015 Jul 24; 10 (7): e0133398.
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The contribution of Professor Karel Opatrný Jr., MD, DSc. (1954-2006) to nephrology

Abstract

Karel Opatrný Jr., finished his medical studies at the Charles University in Pilsen in 1979. After graduation he began to work at the 1st Department of Internal Medicine at then part of the District Health Authority, and Charles University School of Medicine in Pilsen until the end of 1989. From 1990 to 1992 he worked as an assistant professor in the Department of Internal Medicine at Strahov in Prague. During 1992-1994 he was the Head of this department. In 1994 he returned to Pilsen and became the Head of the 1st Department of Internal Medicine, Charles University Medical School and Teaching Hospital. He worked in this position until his premature death in 2006. The principal subjects of his scientific contributions were: hemostatic disorders in hemodialysis patients; biocompatibility of dialysis membranes; and the novel field of proteomics. He published more than 300 scientific papers, most of them in international journals, and delivered more than 280 lectures.

Key words: nephrology, Karel Opatrný Jr., uremia, biocompatibility of dialysis membrane, hemostatic disorders, proteomics

Professor Karel Opatrný Jr., MD, DSc., was born on July 4, 1954 in Prague and died on March 9, 2006 in Pilsen at the age of 51 (Figure 1).

Karel Opatrný Jr. graduated from the Medical Faculty of Charles University in Pilsen in 1979. He started his medical career at the 1stDepartment of Internal Medicine at then part of the District Health Authority, and Charles University School of Medicine in Pilsen. In 1985 he defended his doctoral thesis on “Haemostatic disorders in hemodialysis patients” at the Faculty of Medicine in Prague. In 1988 he passed the nephrology attestation, and in 1991 he was habilitated as an associate professor in internal medicine. The topic of his habilitation thesis was “Chronic Kidney Failure and Haemostatic Disorders”. He was appointed full Professor of Internal Medicine by President Václav Havel in 2000. He defended his academic title of “Doctor of Medical Sciences” at the Medical Faculty of Comenius University in Bratislava on the topic of “Biocompatibility of dialysis membranes” in 2002.

Professor Opatrný Jr., began working as an assistant professor at the Department of Internal Medicine at Strahov in Prague at the invitation of Professor Albert Válek, MD, DSc., in January 1990. From 1992 to 1994 he was the Head of this department. He returned to Pilsen in 1994 to take up the position of Head of the 1st Department of Internal Medicine, Charles University Medical School and Teaching Hospital replacing his father, Professor Karel Opatrný Sen, MD, DSc., after his retirement. He worked in this position until his premature death in 2006.

Professor Karel Opatrný Jr. scientific activity was manifested in more than 300 published papers, most of them in international journals, and over 280 lectures delivered various congresses around the world, especially in Europe, the USA, and Japan, often as an invited speaker. He held many positions at the university, faculty, international societies and other institutions; for example he was a Vice Dean for Science, Education and International Relations of Charles University in Prague; a Vice President of the Czech Nephrological Society; a Member of the Editorial Boards of international journals such as Blood Purification, Kidney and Blood Pressure Research and Nieren-und Hochdruckkrankheiten. In 1995 he was a founder and editor in chief of the journal “Aktuality v nefrologii (News in Nephrology) issued at his initiative that continues to be published to this day. For his outstanding research activities and achievements in the field of nephrology he received several awards, notably the “International Distinguished Medal” of the American National Kidney Foundation.

His scientific interests and the most important results of his research studies were as follows: At the beginning of the 1980s, K. Opatrný Jr. started his scientific work in the Laboratory for Hemostasis and Thrombosis Research at the 1st Department of Internal Medicine at then part of the District Health Authority, and Charles University School of Medicine in Pilsen, together with J. Dvorak, MD and later L. Vit MD, under the guidance of Professor Cepelak.

Diligent as he was, K. Opatrný studied the platelet adhesion and aggregation induced by adenosine diphosphate (ADP) and collagen, as well as the anticoagulatory activity of heparin and heparinoids (predecessors of today’s low molecular weight heparins) in vitro and in vivoIn vivo research was conducted in healthy volunteers and in patients with end-stage renal failure, who showed persistent strong inhibition of the collagen-induced platelet aggregation activity after administration of heparin even on days without hemodialysis (1).

In his continued research, he hypothesized improvement of the efficacy of 4 times re-used dialyzers (plate dialyzers Gambro Lundia) through administration of the antiplatelet drug ticlodipin (Ticlid) during hemodialysis alongside the standard heparin anticoagulation. The additional administration of 500 mg ticlodipin 2 times/day showed increased dialyzer urea and creatinine clearance. This was a placebo controlled study, i.e. a high-quality randomized controlled trial – especially considering it having taken place in the 1980s‘ Czechoslovakia during the communist era (2).

In subsequent studies he examined the relation between hemodialysis efficacy and hemostasis from a different point of view. It was a prospective study in ESRD patients on long-term maintenance hemodialysis treatment, as then was usually twice a week for 7 hours on a coil dialyzer with an effective surface area of 1 m2. Surviving patients were checked after three and a half and after five years. The study revealed serious defects of thrombocyte functions which deteriorated further during prolonged hemodialysis treatment. He concluded that the applied dialytic therapy was not adequate enough from the aspect of hemostasis and stressed the necessity to alter the technique and prescription the used in the country (3). Later, collaborating with Professors K. Šebeková and R. Dzúrik, they described the retention of a uremic toxin, 5-hydroxyindole-acetic-acid, in ESRD and its effect on platelet aggregation (4).

Subsequently he extended his studies to fibrinolysis, specifically on derangements of fibrinolytic activity in ESRD patients on maintenance hemodialysis or on conservative treatment as compared to healthy volunteers; after a standard fibrinolytic stimulus of i.v. administration of 1-deamino-8-D-arginine-vasopressin (DDAVP). There was a significant reduction of the fibrinolytic activity in hemodialysis patients, which was considered significant in relation to the frequent incidence and an early onset of atherosclerosis in this patient population (5).

Opatrný Jr. continued to study this issue after joining the team of Professor Albert Válek in the Department of Internal Medicine in Strahov, Prague. With the availability of more sensitive and specific methods, which were far from easy to obtain then in Czechoslovakia, he was able to demonstrate that the decreased fibrinolytic response to DDAVP administration in dialysis patients is caused by inadequate rise in the plasma concentrations of tissue-type plasminogen activator (t-PA) released from vessel wall (6).

In subsequent studies, he tried to identify factors contributing to the changes in tissue-type plasminogen activator during haemodialysis (7). The design of this study was very complex and resulted in the finding that t-PA is released from vessel walls during hemodialysis. Thus the extracorporeal circulation system of hemodialysis apparatus was shown to be a contributory factor.

In the 1990s, erythropoietin (EPO) gradually became available to ESRD patients in the Czech Republic. By then, it was still administered in high doses and the treatment was not free of cardiovascular complications including tendency to arteriovenous fistula thrombosis and to blood clotting in the extracorporeal circuit. Karel Opatrny Jr., and his team sought to assess, by means of the changes in thrombin-antithrombin III complex (TAT III), the effect of EPO on coagulation activation during hemodialysis. Surprisingly enough, there was no increase in predialytic nor intradialytic TAT III concentrations (8, 9). Subsequent studies confirmed that EPO therapy does not enhance coagulation activation during hemodialysis, does not have an effect on thrombocyte activation, and does not influence complement activation, provided the hematocrit does not exceed a value of 31% (10). Even when sensitive and specific fibrinolysis markers were used, he did not find fibrinolysis changes during EPO treatment, again when increasing the hematocrit slowly to values not higher than 34% (10). Later he demonstrated a dependance between the severity of anemia and the effectiveness of blood purification in peritoneal dialysis patients as assessed by the Kt/V index, whereas correlation between the renal component of Kt/V was much closer and at a higher level of significance than peritoneal component of Kt/V (11).

In vitro studies had shown that some dialysis membranes significantly adsorb EPO, a fact that might have an effect on anemia in long-term hemodialysis patients and on anemia treatment with recombinant human EPO. In a study designed to determine whether the ability of adsorption demonstrated in vitro also has an effect on EPO concentrations in vivo, he showed that under clinical conditions, AN69 and Cuprophan membranes do not differ in their effects on plasma EPO concentration (12).

Based on his original results from methodical and elaborate work, Karel Opatrný Jr. was invited to collaborate on testing biocompatibility of dialysis membranes developed by the AKZO company, when it became possible to cooperate with Western Europe again. These were well designed methodically challenging, flawlessly conducted and comprehensive trials whose outcome laid the foundation for composition changes of the dialysis membranes under development. These complex trials included activation testing of complement, platelets and fibrinolysis (13). This cooperation resulted not only in a professional collaboration, but also in a lifelong friendship with J. Vienken, of whom Karel Opatrný Jr. thought very highly. The procedures already established were extended and enriched with others, which were used in further studies testing high-flux membranes (14), where, among others, C5a (complement 5a) transfer into dialysate was described.

Another international team Karel Opatrný Jr. started a cooperation with was based at Grosshadern Clinic in Munich, Germany, under the leadership of Prof. Gurland and S. Mujais from Northwestern University in Chicago. Together, they examined the influence of polyacrylonitrile (PAN) membrane modification on its biocompatibility. Modification of this membrane was necessary, as otherwise, it led to disturbing interaction with bradykinin generation system particularly in the presence of angiotensin converting enzyme inhibitors (15).

In another study, K. Opatrný Jr. proved that heparin used to rinse polysulphone dialyzers before hemodialysis (HD) had no effect on blood coagulation or on the need for heparin during the procedure (16).

Professor Opatrný Jr. considered it an honour to be able, together with prof. H. Klinkmann and D. Falkenhagen, to edit a monograph titled “Blood-material interaction” released in 1998 and to contribute to it a chapter on ‘The fibrinolytic system in blood/material interaction‘  (17).

In science, there is considerable need for the exchange of information. To that end, Professor K. Opatrný Jr. started organizing high quality scientific meetings in Pilsen, focused predominantly on uremic toxicity and subsequent metabolic abnormalities in chronic kidney disease. On this occasions, he collaborated not only with above mentioned colleagues, but also with Professors M. Mydlík and K. Derzsiová from Kosice, Slovakia, Professors N.G. De Santo, G. Bellinghieri, V. Bonomini from Italy, Professors Grabensee, Debussmann, Ostenand from Germany, Professor Kokot from Poland, Professors Shaul G. Massry, JD Kopple, G. Eknoyan from the United States as well as many others.

The scientific work of Professor Opatrný Jr. and his team included also the field of peritoneal dialysis, continuous renal replacement therapies and plasmapheresis (18). Further detailed analysis of his contribution to this field would however exceed this article’s framehold.

As a next step, alongside with new technological developments, Professor K. Opatrný Jr. intended to advance his biocompatibility research to the next level through proteomics. Thanks to his scientific work, his enthusiasm and determination and the prospect of introducing proteomics in Pilsen, he succeeded in obtaining a large grant, for The Main Research Project (No MSM 0021620819), of almost 12 millions Euros (approximately 300 millions Czech crowns) for the School of Medicine in Pilsen. He studied proteomics at the Department of Nephrology (head: Professor John Klein) at the Louisville University, Kentucky. During his stay of several months, he collaborated especially with Prof. Visith Thongboonkerd, whom he enjoyed greatly and with Prof. Thongboonkerd, whom he held in high esteem. Regrettably , the unfortunate premature death of Professor Opatrný Jr. put a sad end to all these plans.

However, Prof. Thongboonkerd proved to be not only a brilliant scientist but also an outstanding friend, who helped the Pilsner School of Medicine to introduce and develop proteomic methods even after Prof. Opatrny’s death. This has moved this department to a different level not only within the Charles University and the Czech Republic, but also at the international level. For a whole next generation of scientists in Pilsen, the hard and tremendously diligent work of Professor Karel Opatrný Jr., MD, DSc., thereby became a spring board to work under entirely new and never-thought-of possible circumstances.

In the death of Professor Opatrný the Medical Society in Pilsen as well as the whole Czech Society of Nephrology as well as the International Society of Nephrology have lost a professionally outstanding personality.

This study was supported by the National Sustainability Program I (NPU I) Nr. LO 1503 (Opatrná Sylvie).

References:

  1. Čepelák V, Roubal Z, Zemanová I, Opatrný K Jr. Effect of heparin and heparinoids on platelet aggregation. Folia Haematol 1984;6:750-760.
  2. Opatrný K Jr, Čepelák V, Opatrný K et al. Influence of effectivness of re-use dialyzers after administration of ticlopidin (Ticlid). Vnitř Lék 1986; 4: 356-361.
  3. Opatrný K Jr, Čepelák V, Opatrný K et al. Influence of long-term hemodialysis therapy on some parameters of hemostasis. Vnitř Lék 1986; 7: 667-672.
  4. Šebeková K, Opatrný K Jr, Dzúrik R. Plasma levels of 5-hydroxyindole-acetic acid in chronic Renal insufficiency and their effect on platelet aggregation. Nephron 1991; 2: 253-254.
  5. Opatrný K Jr, Čepelák V, Opatrný K et al. Impairment of fibrinolytic capacity in patients with chronic renal failure. Čas Lék čes 1988; 15: 461-463.
  6. Opatrný K Jr, Vít L, Opatrný K Sen. et al. Fibrinolysis in patients with chronic Renal failure after 1-deamino-8-D-arginine vasopressin. J Nephrol 1991; 4: 233-238.
  7. Opatrný K Jr, Opatrný K Sen, Vít L et al. What are the factors contributing to the changes in tissue-type plasminogen activator during haemodialysis? Nephrol Dial Transplant 1991; S3: 26-30.
  8. Opatrný K Jr, Opatrná S, Vít L et al. Plasma concentrations of the thrombin-antithrombin complex in dialysis patients during erythropoietin therapy. Nephrol Dial Transplant 1992;10:1072-1073.
  9. Opatrný K Jr, Vít L, Opatrná S et al. Hemocompatibility in hemodialysis and erythropoietin therapy. Artif Organs 1995; 8: 814-820.
  10. Opatrný K Jr, Vít L, Opatrná S et al. Hypofibrinolyse nach stimulation durch venose Stauung bei haemodialysierten Kranken und der Einfluss von Erythropoetin. Niern- und Hoch druckkrenkheiten 1995; 7: 324-328.
  11. Opatrná S, Opatrný K Jr, Čejková P et al. Relationship between anemia and adequacy of continuous ambulatory peritoneal dialysis. Nephron 1977; 3: 359-360.
  12. Opatrný K Jr, Kroužecký A, Wirth J et al. The effects of a polyacrylonitrile membrane and a membrane of regenerated cellulose on the plasma concentrations of erythropoietin during hemodialysis. Artif Organs 1998; 22: 816-820.
  13. Opatrný K Jr, Sulková S, Vít L et al. Clinical study of biocompatibility of dialysis membranes from unsubstituted and substituted cellulose. Čas Lék čes 1992;15:457-461.
  14. Opatrný K Jr, Sulková S, Lopot F et al. A Clinical study on high-flux cuprammonium rayon haemodialysis membranes. Artif Organs 1993;12: 971-976.
  15. Mujais S K, Schmidt B, Hacker H, Opatrný K Jr et al. Synthetic modification of PAN membrane: biocompatiblity and functional characterization. Nephrol Dial Transplant 1995; S 3: 46-51
  16. Opatrný K Jr, Bouda M, Kohoutková L et al. A Clinical study to assess the effect of heparin in dialyzer rinsing solution Int J Artif Organs 1997;20:112-118.
  17. Opatrný K Jr, Vít L, Opatrný K Sen. The fibrinolytic systém in blood/materiál interaction,s.65-68. In: Blood-material interactoin. A basic guide from polymer science to Clinical application. D Falkenhagen, H. Klinkmann, E. Piskin, K. Opatrný Jr. (eds). Krems, Glasgow, INFA, 1998, p 156.
  18. Mydlík M, Derzsiová K, Válek A, Opatrný K Jr et al. Influence of continuous ambulatory peritoneal dialysis on some plasma and erythrocyte vitamins – retrospective study. Prague Med Rep 2009; 3: 231-238.
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History of the Polish Society of Nephrology

Abstract

Polish Society of Nephrology (PSN) was born during the Founding Congress organized in September 1983 in Bydgoszcz. The main propagator of this idea was prof. Franciszek Kokot (Katowice) – widely recognized in whole nephrological community. In Bydgoszcz the PSN by-laws was approved and first Executive Council of the Society was elected. First PSN president was elected Tadeusz Orłowski (Warszawa) and vicepresident Andrzej Manitius (Gdańsk) respectively. Subsequent Congresses were organizes each three years in following cities: Kraków (1986), Gdańsk (1989), Katowice (1992), Lublin (1995), Poznań (1998), Kraków (2001), Białystok (2004), Wisła (2007), Bydgoszcz (2010), Wrocław (2013) and Łódź (2016). During these meetings and annual conferences organized between congresses actual topics dedicated to pathophysiology, clinical nephrology, dialysis therapy and kidney transplantation were presented and discussed. Prof. Tadeusz Orłowski was the PSN president till 1986 and subsequently other known Polish nephrology leaders hold this function: Kazimierz Bączyk (Poznań: 1986-1989), Franciszek Kokot (Katowice: 1989-1998), Bolesław Rutkowski (Gdańsk: 1998-2004), Michał Myśliwiec (Białystok: 2004-2007), Andrzej Więcek (Katowice: 2007-2010), Jacek Manitius (Bydgoszcz: 2010-2013), Magdalena Durlik (Warszawa: 2013-2016) and Michał Nowicki (Łódź: 2016 – present). Number of PSN members has risen from 150 at the beginning to over 1000 nowadays. During this 34 years regional structure of PSN was established and today 9 regional divisions are actively working. In 2014 Young Nephrologists’ Club was organized in PSN which is collaborating with Young Nephrologists’ Platform existing in the ERA-EDTA structure. PSN is collaborating closely with international (ISN, ERA-EDTA, IAHN) and Polish (Polish Transplantation Society) scientific societies. Many well known scientists from whole the world were recognized as Honorary Members of PSN. Coming to the end of this short presentation of the PSN activity it is worth to mention also that two journals are officially recognized by our society: Nefrologia I Dializoterapia Polska (Polish Nephrology and Dialysis Therapy) edited from 1997 in Kraków and Forum Nefrologiczne (Nephrological Forum) edited from 2004 in Gdańsk.

Keywords: Poland, nephrology, society, history

Introduction

Polish Society of Nephrology (PSN) was founded during its First Founding Congress organized in September 1983 in Bydgoszcz. At this time two structures connected with nephrology existed in Poland: Nephrological Committee of the Polish Academy of Science chaired by prof. Tadeusz Orłowski (Warsaw) and Nephrological Section of the Polish Society of Internal Medicine chaired by prof. Kazimierz Trznadel (Łódź). The main initiator and propagator of the PSN was prof. Franciszek Kokot (Katowice) who was then member of the European Dialysis and Transplant Association Board (1, 2). One has to remember that it was time when other National Nephrological Societies were founded in whole Europe. Prof. Kokot was supported strongly by the group of other known Polish nephrologists like prof. Kazimierz Bączyk (Poznań), prof. Zenon Szewczyk (Wrocław) and prof. Zygmunt Hanicki (Kraków) and great part of the younger colleagues. All of them worked hard to persuade this idea to other nephrological leaders. In Bydgoszcz last official Conference of the Nephrological Section of Polish Society of Internal Medicine was transformed to the PSN Founding Congress. It is necessary to mention that local organizer of this event was prof. Edmund Nartowicz, Head of Nephrology Department in Bydgoszcz and all necessary documents were prepared by prof. Kazimierz Trznadel (Head of Nephrology Department in Military Hospital in Łódź). During this Founding Congress rules and regulations of the new Society were established and first Executive Council was elected. First PSN president for three years term prof. Tadeusz Orłowski (Figure 1) prominent nephrologist form Warsaw was elected and Vicepresident prof. Andrzej Manitius – Head of Nephrology Department in Gdańsk Medical University (3, 4). Prof. Tadeusz Orłowski was the PSN president till 1986 and subsequently other known Polish nephrology leaders hold this function. Prof. Kazimierz Bączyk from Poznań (Figure 2) was the second and prof. Franciszek Kokot from Katowice (Figure 3) the third PSN president. Whole list of PSN presidents and period of their activity on this position was presented in Table 1, Figure 4, Figure 5 and Figure 6. Subsequent Congresses were organized every three years in following cities: Kraków (1986), Gdańsk (1989), Katowice (1992), Lublin (1995), Poznań (1998), Kraków (2001), Białystok (2004), Wisła (2007), Bydgoszcz (2010), Wrocław (2013) and Łódź (2016). There were also annual scientific and educational conferences organized under the auspices of PSN like:

  1. “Advances in peritoneal dialysis” organized from 1996 in different nephrological centers – prof. B. Rutkowski and currently prof. M. Lichodziejewska-Niemierko (Gdańsk).
  2. “Advances in Nephrology and Hypertension” Polish-German-Czech conferences organized from 1994 by turns in Poland (mainly in Wisła – prof. F. Kokot and Wrocław – prof. M. Klinger), Germany (mainly Gorlitz) and Czech Republic (mainly Liberec).
  3. Post ASN Meetings – Gdańsk Repetitory in Nephrology organized from 2002 by prof. B. Rutkowski
  4. Katowice Seminar – Advances in Nephrology and Hypertension organized from 2001 by prof. A. Więcek
  5. Top Nephrological Trends organized in Poznań currently by prof. A. Oko, earlier from 2002 as Great Poland Spring Nephrological Actualities by prof. S. Czekalski
  6. Nephrocardiology – conference organized from 2005 in Białowieża by prof. M. Myśliwiec (Białystok) and currently by his successor prof. B. Naumnik (Białystok)
  7. Płock Nephrology Days organized between 1995 and 2005 by dr M. Świtalski in Płock
  8. Cracovian Dialysis Days – very special meeting organized on the biennial mode from 1994 until 2014 this meetings which is uniting all parties involved in dialysis – physicians, nurses, technicians, dietitians and patients was organized by prof. O. Smoleński. After his sudden death in 2015 this important meeting is organized by his successors dr A. Smoleńska, mgr M. Liber and prof. J. Pietrzyk.
  9. Nephrological Conference in Włocławek organized from 1992 by doc. J. Ostrowski.

It is worth to mention that also Regional PSN divisions are organizing educational conferences at least 2–3 times during a year. Lectures during all these events were delivered not only by Polish speakers but also very often by eminent nephrologists from Europe and United States. It is worth to mention that many well-known scientists from whole the world were recognized as Honorary Members of PSN. Whole list of foreign PSN Honorary Members is shown in Table 2. One may recognize that among them are also active IAHN members like: G. Richet, S. Massry, G. Eknoyan, R. Ardaillou, A. Heidland and M. Mydlik. There are also twenty six eminent Polish nephrologists who were recognized as PSN Honorary Members (Table 3). Number of PSN members has risen from 150 at the beginning to over 1000 nowadays (Figure 6). During this 34 years regional structure of PSN was established and today 9 regional divisions are actively working. There are also several sections in the PSN central structure eg. historical, rehabilitation in chronic kidney disease, Polish Renal Registry and Polish Registry of Kidney Biopsy. In 2014 Young Nephrologists’ Club was organized in PSN which is collaborating with Young Nephrologists’ Platform existing in the ERA-EDTA structure. PSN is collaborating closely with international (ISN, ERA-EDTA, IAHN) and Polish (Polish Transplantation Society) scientific societies. It is worth to mention that Polish nephrologists played active role in these organizations. Prof. J. Roguski (Poznań) and prof. Stefan Angielski were members of the ISN Board in sixties and seventies. Later on prof. F. Kokot was a member of Nominating Committee and prof. A. Więcek – Head of the section organizing COMGAN CME courses and prof. B. Rutkowski member of the Historical Committee. Even closer is collaboration with ERA-EDTA where several Polish representatives were elected as members of the Council like: prof. T. Orłowski, prof. F. Kokot (3 times), prof. A. Więcek, prof. M. Klinger, prof. J. Małyszko. One have to remember that prof. A. Więcek after accomplishing his second term as Council member was elected as a Secretary-Treasurer and later hold most important position of ERA-EDTA President during last three years (2014-2017). Additionally prof. B. Rutkowski was a member of the Scientific Board of ERA-EDTA Registry and prof. R. Gellert director of the Registry Office. It is worth to mention that three Polish nephrologists were among founders of the International Society of Peritoneal Dialysis: prof. K. Bączyk (Poznań), prof. Z. Twardowski (Lublin), prof. P. Hirszel (Kraków) (4). Currently prof. M. Lichodziejewska-Niemierko is member of the Council in this Society. Very successful EuroPD Meeting was organised in 2015 in Kraków coordinated by prof. W. Sułowicz (Kraków) and prof. Lichodziejewska-Niemierko (Gdańsk). Another scientific collaboration was maintained between PSN and International Society of Uremic Research and Toxicity (ISURT). B. Rutkowski was member of the Council, president elect, president and past president in this Society. He organized also very successful ISURT Congress in Sopot in 2007. Special attention has to be paid to collaboration with the International Association for the History of Nephrology (IAHN). Prof. B. Rutkowski spent in the IAHN Council four terms as member, president elect, president and past president of the Association. Doc. Janusz Ostrowski from Włocławek was Council member, president elect and currently he is holding position of IAHN president. Dr Marek Muszytowski from Toruń was Council member and currently is secretary treasurer. Three IAHN Congresses were organized in Poland: in 2004 in Gdańsk in 2010 in Toruń and in 2016 in Wieniec near Włocławek. All these events were organized in collaboration with PSN.

Coming to the end of this short presentation of the PSN activity it is worth to mention also that two journals are officially recognized by our society: Nefrologia i Dializoterapia Polska (Polish Nephrology and Dialysis Therapy) edited from 1997 in Kraków (Chief editor – prof. W. Sułowicz) and Forum Nefrologiczne (Nephrological Forum) edited from 2004 in Gdańsk (Chief editor – prof. B. Rutkowski).

In summary we like to underline that during almost 35 years of PSN activity our Society help to establish high position of Polish nephrology among European countries both from scientific and practical point of view (5). This fact is the result of hard work of many people mentioned in this article and many other anonymous PSN members. We do hope that young generations of Polish nephrologists will keep this high level and also will remember about their mentors who established and developed PSN.

 

References:

  1. Rutkowski B.: Professor Franciszek Kokot – his contribution in the development of Polish nephrology: Pol Arch Med Wewn 1994, 9: 1 11-13.
  2. Rutkowski B.: Leader and promotor of the of the polish nephrology. In: Franciszek Kokot, Ed. Medical University of Silesia, Main Library, Katowice 1999.
  3. Heidland A., Pączek L. Professor Tadeusz Orłowski – in memory of a pioneer in European Nephrology and Transplantation. Kidney Blood Press. Res. 2009; 32: 304-306.
  4. Ostrowski J., Rutkowski B.: Honorary member of the Polish Society of Nephrology. Part One: Tadeusz Orłowski. Forum Nefrol. 2013; 1: 71-75.
  5. Czekalski S. Kazimierz Bączyk, Poznań, Poland. Nephrol. Dial. Transplant. 1996; 11:1656.
  6. Czekalski S., Rutkowski B. The History of nephrology in Poland. J. Nephrol. 2006; 19 (supl. 10): S150-S158.
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