Dr. Che-Hung Leong (1979-1984)
Dr. Man-Kam Chan (1984-1989)
Dr. Ignatius Kum-Por Cheng (1990-1992)
Dr. Chun-Sang Li (1992-1994)
Dr. Siu-Fai Lui (1994-1996)
Dr. Matthew Kwok-Lung Tong (1996-1998)
Dr. Ka-Foon Chau (1998-1999)
Dr. Wai Kei Lo (1999-2001)
Dr. Philip Kam-Tao Li (2001-2004)
Dr. Alex Wai-yin Yu (2004-2006)
Dr. Andrew Kui-Man Wong (2006-2008)
Dr. Sing-Leung Lui (2008-2010)
Dr. Chi-Bon Leung (2010-2012)
Dr Samuel Ka-Shun Fung (2012–2014)
Dr Koon-Shing Choi (2014-now)
Scrolling through the history of the Hong Kong Society of Nephrology and the nephrology service in Hong Kong
In the Sixties, renal service was very limited. There was only one nephrologist and one dialysis center in Hong Kong. Renal biopsy was rarely done and the reports were very simple. Acute hemodialysis was first performed in 1962 in the Department of Surgery of the Queen Mary Hospital (QMH). The first hemodialysis machine was donated by the Rotary Club. Kloff twin coils immersed into a big tank were used for dialysis. The dialysate was homemade by surgeons who wore long gloves and used a long stick to mix up the solution. The coils burst easily and negative pressure could not be applied. Later, Drake Willock with Kiil replaced the twin coils with parallel plates. Doctors had to assemble plates with sheets of semipermeable membrane, test the transmembrane pressure and leakage as well as to sterilize the membranous compartment with formalin before use. Both the twin coils and the Kiil plates had very large internal volume and several pints of blood had to be transfused during every dialysis. This very tedious procedure was only performed for post-operative acute renal failure patients until 1969 when Drs. Richard Yu and Che-Hung Leong started the chronic hemodialysis program at QMH. The first chronic hemodialysis patient survived for a year. The second patient, a 3 years old man, luckily had a renal transplant in 1972 and is now the longest transplant survivor in Hong Kong.
Intermittent peritoneal dialysis was also started in 1969 at QMH. Peritoneal dialysate was prepared by hospital pharmacy. There were only 2 strengths, either isotonic or hypertonic. The solution was heated in a special cabinet, which often caramelized the glucose to an amber color. The bed of the patient had to be raised with blocks to facilitate drainage. Infection rate was, of course, very high.
The first cadaveric renal tranplantat was performed by Drs. George Koo and Chi-Hung Leong in QMH in 1969. The donor was a 22 years old girl who had cardiac death due to suicide. The recipient survived for 18 months.
Caritas Medical Center (CMC) and Princess Margaret Hospital (PMH) started to provide renal service in 1973 and 1977 respectively, following by Tung Wah Hospital (TWH), United Christian Hospital (UCH) and Kwong Wah Hospital (KWH) in 1980. Cobe hemodialysis machines and parallel plate dialyzers were used by all centers in these 10 years.
In 1980, continuous ambulatory peritoneal dialysis (CAPD) was started in United Christian Hospital. Dr. Andrew Hua nd Russel Clark developed a sandwich bag technique by which the exchange was done within a 10¡¦10 cm plastic bag with a piece of chlorhexidine-in-alcohol iodine gauze inside. This innovation reduced dramatically the infection rate and the technique was so well known worldwide that it was called the "Hong Kong Connection".
In 1979, Princess Margaret Hospital became the second center in Hong Kong to do cadaveric transplantation and was the first to perform living related transplantation in 1980.
In 1979, seven enthusiastic doctors founded the Hong Kong Society of Nephrology. They were Dr. Che-Hung Leong, a surgeon, the late Dr. Woon-Cheung Chan, a pathologist, Dr. Yen-Chow Tsao, a pediatrician and 4 nephrologists, Drs. Richard Yu, Andrew Hua, Charn-Sing Chan and Jeffrey Tsang. Dr. Chi-Hung Leong was elected the Founding Chairman. Despite this small group, the Society was a success and hosted the 4th Colloquium in Nephrology in 1981 in Hong Kong. Professor David Kerr from United Kingdom, Renee Habib from France and Robert Schneider from United States participated and gave their state of art lectures. Professor OT Khoo delivered the first OT Khoo Foundation Lecture. Delegates from Indonesia, Singapore, Thailand, Japan, Malaysia and the Philippines joined the event. The Society also initiated the earliest organ donation campaign on the television and radio programs in 1979. Exhibitions were held, booklets printed and organ donation cards distributed. A survey, co-organized with Baptist College, was conducted and was probably the first survey on public opinion on organ donation in Hong Kong.
More dialysis centers were established during these 10 years. Three hospitals namely Queen Elizabeth (QEH) in 1982, Prince of Wales Hospital (PWH) and Yan Chai Hospitals (YCH) in 1984, started the renal dialysis service. Three satellite centers were established: Aberdeen Renal Dialysis Center in 1983, Tuen Mun Polyclinic Dialysis Center in 1985 and Pamela Youde Renal Dialysis (PYPC) in 1988. The trend of chronic hemodialysis as an outpatient treatment for stable cases. This was made possible by the availability of safer hemodialysis machines and dialyzers. Cobe Centry II was the most commonly used machine in most centers. The hollow fiber dialyzers replaced the parallel plates. Centralized water treatment system was installed in new centers. Home hemodialysis was fading for social reasons. Despite an increase in the number of hemodialysis machines in the public sector, the demand was never met. Very stringent criteria were set for admitting patients into hemodialysis program. In 1981, the first charitable dialysis center (Kowloon Center) was set up by the Hong Kong Kidney Foundation (HKKF). It offered low cost hemodialysis to those who were otherwise rejected by dialysis schemes in public hospitals. The Eighties saw the beginning of Continuous Ambulatory Peritoneal Dialysis (CAPD). Because this dialysis modality was not limited by the availability of machines, the number of patients on dialysis thus increased rapidly. By the end of the Eighties, CAPD was performed in most dialysis centers and nearly 70% of patients were on CAPD. The first system used was the conventional spike system with or without disinfectant device. Disconnect system, the Medital, was first tried in Caritas Medical Center in 1986 but stopped soon for the cost. The "O" set was successfully launched in 1987 but its use was limited to a small number of patients because of the relatively high cost and the necessity of good eye-hand coordination of the patients. The successful implementation of CAPD was attributed to 2 main factors: the establishment of the Central Renal Committee by the government and the founding of Hong Kong Kidney Patients Trust Fund.
In June 1985, the Medical Development Advisory Committee of the former Medical and Health Department discussed the treatment facilities of endstage renal failure in Hong Kong. The Central Renal Committee was then formed in July 85 to monitor this issue and be responsible for the planning and policy making of the renal service, standardization of practice, training of personnel, central registration of patients and transplant promotion in Hong Kong. From the very beginning of the formation of the CRC, CAPD was identified as the most cost-effective treatment modality for treating endstage renal failure in Hong Kong. 150 CAPD spaces were funded by the Government every year but patient age limit was set at <55.
Under the government admission criteria, there were still a sizable number of patients being rejected. Founded in 1985 by Miss Jennifer Parr, the HKKPTF provided subsidy to CAPD patient not eligible for government funding. At one time, HKKPTF provided subsidy for up to 24% of all the CAPD patients.
During these ten years, three more hospitals started performing renal transplantation: PWH in 1985, KWH in 1988 and CMC in 1989. The first living "unrelated" renal transplantation was done in PMH in 1987. It was a wife to husband donation and both the donor and the recipient are still surviving and leading an active life. Under the CRC, all the dialysis and transplant activities of the government run hospitals were coordinated and standardized. The Tissue Typing Laboratory, first established in 1982 by Dr. Brian Hawkins in Queen Mary Hospital, who was invited to join the CRC and provided tissue-typing service to all hospitals. The Transplant Coordinating Unit was formed in 1988. The age limit for waiting a kidney transplant was set at 50.
During this period, the Society played a very active role in many areas in the development of nephrology in Hong Kong. Working closely with the CRC and other charitable organizations such as HKKF and HKKPTF, the Society had enormous influence in the planning and policy making in renal service.
Since 1984 Dr. Man-Kam Chan has established regular inter-hospital renal meetings. This attracted a large number of young doctors into the field of nephrology. The annual scientific meeting was first held in 1985 and thereafter it became a regular yearly activity of the Society. Internationally renowned nephrologists and speakers were regularly invited. Renal courses were organized for the training of renal nurses. As a result, there was an enormous expansion of the membership, especially associate membership from the renal nurses. This has proved to be very important as renal nurses are always good partners of the nephrologists in both renal service and organization of the patient activities.
Close international relationships were established with the International Society of Nephrology, Asian Colloquium of Nephrology, Asian Society of Transplantation and Asian Pacific Society of Nephrology. An early relationship was established with nephrologists in China when Prof. L T Liao joined our scientific meeting in 1985.
The Society has been actively involved in the establishment of postgraduate nephrology training since mid-80's. The Society was involved when the Subspecialty Advisory Committee (SAC) was formed under the Joint Committee on Internal Medicine Training (JCIMT) established jointly between the HKCP and the Coordinating Committee in Internal Medicine of the Hospital Authority in 1993. The SAC was to formulate training guidelines for the training of nephrologist. The Society was represented by Dr. Chun-sang Li when the Education and Accreditation Committee was formally established in July 1993 to implement higher physician training, accreditation of training units in Hospital Authority and Fellows of the College. The SAC became formally the Specialty Board in Nephrology. The Society continued its role in nominating 2 members to sit in the Board up to the present day. Dr. Chun-sang Li is the present chairman of the Board.
The Society started to shift its attention to the rehabilitation of renal patients in the mid Eighties. The Renal Companion Association was established at QMH and TWH and was the first registered renal patients' organization in Hong Kong. Dr. Man-Kam Chan led a team of 4 transplant patients to Singapore for the World Transplant Games in 1989. This was the first time for our transplant patients to join this international sports event.
Among the eight new dialysis centers in the Nineties, 2 were satellites and 3 were run by the charitable organizations, namely the Precious Blood Hospital Dialysis Unit run by Lions Kidney Educational Center and Research Foundation (LKEC) in 1991, Hong Kong Renal Center (HKRC) originally run by Hong Kong Kidney Patients Trust Fund in 1993 and Shatin Center run by Hong Kong Kidney Foundation in 1994. The contribution of these charitable organizations to overall haemodialysis service increased to nearly 30%.
With the new LKEC Chan Wong Sau Wah Memorial Renal Dialysis Center came into service by October 1999, the proportion increased further. Other modalities of irregular haemodialysis such as haemofiltration and haemodiafiltration were practiced in some hospitals for selected patients.
CAPD remains the main dialysis modality in Hong Kong. In 1995, HKKPTF sponsored 100 UV Flash machines for CAPD patients who had poor eye-sight or poor eye-hand coordination. In 1994, the CRC lifted the age limit for dialysis, the quota and mean test for CAPD. The number of patients on peritoneal dialysis thus increased rapidly and is now accounting nearly 80% of the dialysis population.
The disconnect systems and the twin bag systems became the predominant systems used. Automated peritoneal dialysis (APD) was first introduced in 1985 in PWH but was not popular in the subsequent 10 years because of cost. With introduction of the APD subsidy schemes by HKKF and HKKPTF in 1997, an increased number of APD was being performed and 73 patients had benefited so far. As APD will help in better rehabilitation, it is expected to play a more significant role in the future.
Before the Nineties, expensive drugs such as Erythropoietin and Cyclosporin A were not freely available to the patients. In the early Nineties, HKKPTF sponsored a proportion of patients in need. Both drugs were then provided by the Hospital Authority hospitals starting in the mid-Nineties after endorsement by the CRC.
Two more centers performed renal transplant since 1991, OEH in 1991 and Tuen Mun Hospital (TMH) in 1995. The smooth running of organ procurement was made possible by CRC, now headed by Dr. Wing-man Ko, the Deputy Director of the Hospital Authority which endorsed the brain stem death criteria and the point scoring system for organ sharing in 1991. It has been increasingly recognized that the main obstacle of organ procurement was within the medical profession. In 1994, 10 delegates from Hong Kong including Drs. Siu-fai Lui, Ka-foon Chau and Yiu-wing Ho from the Society attended the 'Train the trainer' Course organized by the European Donor Hospital Education Programme. The effect of the course was perpetuated by a series of workshops organized by the 'trained trainers' under the CRC, extended to target at the staff in Intensive Care Units Neurosurgical Units and Medical Departments. Transplanted patients were organized to visit the hospital wards to keep up the staff awareness regularly. An obvious improvement in the organ procurement rate was seen thereafter. The Human Organ Transplant Board was set up and Human Organ Transplant Ordinance passed into law on April 1998. The age limit to wait for a kidney was raised to 60 years old. However the number of renal transplants still fell short of the number of new dialysis population, with the back lock of patients waiting for transplant. There was, therefore, an increasing number of patients who sought renal transplant in Mainland China.
Throughout these years, dialysis service has extended to include extremes of age. The youngest patients admitted into the haemodialysis and CAPD program were 12 and 7 years old respectively. The oldest patients admitted into hemodialysis were 94 years in charitable center and 82 years in the public sector. The oldest CAPD patient on admission was age 86 years. The longest survivors on haemodialysis and CAPD were 22 and 18 years respectively. The youngest renal transplant patient was 9 years old and the longest renal transplant survivor has been alive for 26 years. The longest waiting time for getting a kidney was 20 years while some patients has been waiting after 22 years of dialysis.
Not only the quantity of renal service has improved, the quality of life of the patients was also improved. Programs for psychosocial, physical or vocational rehabilitation were established in most dialysis centers. Patient support groups were formed with the help of the nephrologists and renal nurses. The Community Rehabilitation Network, on its own or in collaboration with the Society, had organized many activities to assist full rehabilitation of the renal patients.
In 1992, at the suggestion of the nephrologists, the CRC decided to set up the central electronic renal registry in all dialysis centers for data collection and analysis on dialysis and transplant, organ procurement, distribution and sharing. The initial implementation team included Drs. Siu-Fai Lui, Yiu-Wing Ho, Ka-Foon Chau and Chi-Bon Leung. The system was implemented in 1994 and reliable data was generated for quality assurance, service planning and policy-making.
Dr. Ignatius Cheng, after succeeded the chairmanship in the early Nineties, initiated the strategy of a 2-year term for the chairmanship in order to attract more new blood into the Society Council. He also passed the responsibility for organizing the inter-hospital renal meeting from QMH to 4 different hospitals located throughout Hong Kong in rotation. These strategies had succeeded in uniting nephrologists from different institutions and from different levels of seniority in their quest to promote nephrology training and education and to improve renal service in Hong Kong. Nephrologists were very much united and showed great power in any negotiation for the benefit of both the patients and the profession. The activities of the Society gradually become more diversified involving many young nephrologists.
The number of members was increasing continuously together with the number of nephrologists accredited by the Hong Kong College of Physician where Drs. Richard Yu and Kar-Neng Lai, our senior nephrologists, are serving as the President and the Vice-President. In 1992, with the support of the Society, the Hong Kong Society of Transplantation was established which included transplantation of organs other than the kidneys such as liver, heart, cornea and bone.
In 1995, the Society hosted the 6th Asian Pacific Congress of Nephrology under the leadership of the President Drs. Ignatius Cheng and members of the organizing committed which included Drs. Kar-Neng Lai, Chun-Sang Li, Siu-Fai Lui, Philip Li and Daniel Chan. The activity was enormously successful. More than 40 overseas speakers and 900 delegates attended. The annual scientific meeting of the Society was also well attended with not only increasing number but also very high quality papers. In 1998, there were 40 submissions and was the highest number in 15 years. Important figures were invited for the plenary lectures and hospital visits. The cases presented in the inter-hospital meetings were published in the Renal Bulletin of the Society since 1996. World-renowned nephrologists were invited to give lectures every year. Special symposia on renal rehabilitation, psychosocial care for renal patients and research were organized and well attended. The overall academic standard was rising as reflected by the increasing production of researches and publications by the members to more than 350. In 1997, the Society set up the Young Nephrologist Investigators Scholarship to sponsor the young nephrologists and nurses to attend overseas conferences and present their work. 9 nephrologists had benefited so far. A research grant was set up in 1999 and the selection panel consisted of Drs. Todd lng, David Lee and David Churchill.
In 2000, We also saw the publication of the first issue of our own Journal, the Hong Kong Journal of Nephrology under the of Nephrology under the leadership of the chief editor, Dr. Philip Li, and deputy editor, Dr. AlexYu.
In order to alleviate the short supply of kidneys for transplantation, organ donation campaign was one of Society's main tasks. Organ donation campaigns were frequently held in conjunction with many community and health organizations or media such as Radio Television Hong Kong during the past 20 years. In 1992, a regional transplant coordinating workshop was organized with the assistance from the transplant coordinating team in Singapore. The conclusions and suggestions were submitted to CRC. This initiated the re-organization of the transplant coordinating unit in 1994 when transplant coordinators were de-centralized to the transplant hospitals. In 1998, 500 patients gathered at Chater Garden, Central to appeal for organ donation. This attracted much media concern. The Society also played an active role giving inputs to the Hong Kong Government, in the formulation of the legislation of organ donation, such as the Organ Transplant Bill and Human Organ Transplant Ordinance.
One of the main focuses in the Nineties was the rehabilitation of the renal patients. In 1993, Dr. Siu-Fai Lui led a team of 17 patients to the IX World Transplant Games in Vancouver. Three silver medals were awarded. Since then, this became a regular activity for the transplant patients. Since 1993, the Society has held regular Sports Days for dialysis and transplant patients, including an Asian Renal Transplant Games in 1994 with delegates from 6 other Asian countries joining the event. The Sports Days were well attended by all dialysis centers and the attendance was usually up to 2000. Table tennis and gate ball competitions were also held regularly since 1996 and 1998 respectively in smaller scales. These activities suited different groups of patients and were very popular. A karaoke competition was organized in 1994 and a cooking competition aiming at encouraging 'healthy' and 'delicious' renal food was organized in 1997. These activities not only provide a boost to the physical fitness and morale of the patients, but also hastened the growth of patient self-help groups and helped to improve the relationship between the health care professionals and patients.
2 sets of videotapes, one on dialysis and one on transplant, were produced by the Society in 1996 and 1997 respectively. They were distributed to hospitals, schools and libraries for patient and public education. Public education programs were carried out regularly together with the other community or professional bodies such as LKEC and Federation of the Medical Societies.
With the change of sovereignty of Hong Kong in 1997, the Society has re-established the link with the Chinese Professional Organizations. Led by Dr. Siu-Fai Lui and Kwok-Lung Tong, the Council visited Beijing and participated in the Continuous Medical Education Conference organized by the Chinese Society of Nephrology in 1996. The Society was much received. In return, the Council of the Chinese Society of Nephrology, led by the present president, Professor Shan-Yan Lin, joined our Annual Scientific Meeting in 1997. Thereafter, there had been frequent academic exchanges and visits between the two Societies.
Representatives from the Society had sat at the Councils and hold offices in all major regional Societies in Nephrology. Drs. Che-Hung Leong, Ignatius Cheng and Siu-Fai Lui took turn to represent the Society in the Asian Colloquium of Nephrology since its inception. Dr Philip Li is a council member and Dr. Ignatius Cheng is the current Treasurer of the Asian Pacific Society of Nephrology. The international involvement of the Society in these regional societies had continued after the change of sovereignty to China in 1997, thanks to the acceptance by membership countries of these societies of the one country two systems principle. This has positioned the Society in a pivotal role in the liaison between China and countries in the rest of Asia or the Asian Pacific region.
Good and beneficial working relationship was maintained with our service partners: the Central Renal Committee, Hong Kong Kidney Foundation, Hong Kong Kidney Patients Trust Fund, Lions Kidney Educational Center and Research Foundation and Community Rehabilitation Network. Many activities were the collaborative work of this partnership. Complementation and co-operation has provided the best outcome for the renal service in Hong Kong.
The renal service in Hong Kong continues to expand. The supply of haemodialysis service is still not meeting the need. Satellite centers or self-help centers are probably the solution for better patient rehabilitation with lower cost. Automated peritoneal dialysis will improve the working capacity and will have an increasing demand. The aim should be for the patients to choose his/her own mode of dialysis. Improving the renal transplant rate is the main goal still for the next century.
With the effort and guidance of the past chairmen, the Society has grown steadily. The core group of the Society is enlarging. We enjoy a warm relationship with the international professionals, Chinese Society of Nephrology and local partners. The direction in the coming years should be a more in depth and coordinated training for young nephrologists to conduct academic research and publication.
Given adequate irrigation and nourishment, the Society will be witnessing a golden harvest in the 21st century.