The Manchester Contribution to Peritoneal Dialysis

Abstract

Two names emerge when considering the contribution of Manchester in the development of peritoneal dialysis (PD). The first is Ram Gokal; the second is icodextrin. As there will be a separate article on icodextrin, this one will focus more on other aspects of the activities performed by the Renal Unit of the Manchester Royal Infirmary. Ram Gokal, Senior Registrar at the time, started the first continuous ambulatory PD (CAPD) program in the United Kingdom in Newcastle under the supervision ofDavid Kerr. In 1980 he published the results of 1 year's experience with 32 CAPD patients in the British Medical Journal (1). Shortly thereafter he moved to the Royal Infirmary in Manchester to become Consultant Nephrologist and Lecturer in Renal Medicine, University of Manchester. At that time, it was already recognized that glucose-based formulations for PD solutions were not ideal because the rapid peritoneal absorption of glucose caused impaired ultrafiltration and metabolic complications. A glucose polymer consisting of dextrins, named Caloreen (Nestle Nutrition, Croydon, Surry, UK) had been in use as an oral nutritional supplement in Manchester by Netar Mallick, one of the more senior consultants in renal medicine at that time. It was especially used in patients with renal and hepatic failure (2). Therefore, the idea arose to try to use it as a high molecular weight osmotic agent in PD solutions. The initial clinical investigations were started in Manchester in 1983 by Chandra Mistry and Ram Gokal (3) and were first published in The Lancet in 1987 (4). After the departure of Mistry, Ram Gokal remained very active in promoting and investigating icodextrin worldwide until his retirement in 2005