On January 20, 2024, we mourned the passing of Professor Zbylut Twardowski, a distinguished Polish-American nephrologist renowned for his groundbreaking contributions to renal replacement therapy. His achievements, detailed in numerous co-authored studies, continue to shape contemporary approaches in the field. The funeral services were held on January 26, 2024, at Krakow Rakowicki Cemetery. The ceremony, marked by an intimate familial atmosphere, was also attended by representatives of the Polish Society of Nephrology, along with colleagues and friends – the community to which the author of this article proudly belongs. Professor Zbylut Twardowski was a truly exceptional person, a rarity seldom encountered.
Professor Zbylut Twardowski was born on June 02, 1934, in Stanisławice, Poland (Figure 1).
fot. Barbara Kańska-Bielak
FIGURE 1 Professor Zbylut Twardowski (©Barbara Kańska-Bielak). [Color figure can be viewed at wileyonlinelibrary.com]
His mother was an educator, while his father, Józef, served in the Polish Army’s cavalry during the conflict with the Soviet Union, where he suffered injuries. Following this, he embarked on a medical career, beginning his studies at the esteemed Jagiellonian University in Kraków. Having completed his medical education in 1927, he commenced work at a hospital in Chorzów, located in the Upper Silesia Voivodeship of Poland.
During the tumultuous time of World War II, significant chapters unfolded in his life. As a soldier in the Home Army, he experienced the horrors of internment in concentration camps, first in Dachau and later in Mauthausen. Although initially released in 1941, he faced a second arrest in 1943. His name was among those listed as potential hostages for execution in the face of resistance against the Germans or their collaborators. The list
included many brave individuals who risked their lives to shelter Jewish people. In 1944, he was transferred to Gross Rosen concentration camp, and his arduous journey culminated in Flossenbürg, Bavaria, where he was liberated by the American military. Finally, in 1946, he returned to Poland.
Zbylut Twardowski began his education during the Second World War, amidst Nazi Germany’s occupation of Poland. He passed his secondary school leaving examinations with honors in Chorzów Batory in 1952 and commenced medical studies at the Faculty of Medicine of the Medical Academy in Krakow, Poland, now known as Collegium Medicum of the Jagiellonian University in Krakow, which he completed with honors in January 1959. In July 1959, he began his professional career as a volunteer assistant at the Second clinic of internal medicine at the Medical Academy in Krakow, actively participating in the establishment of the dialysis center within the clinic. By 1962, he secured a position as an assistant at the same institution. Within a year of joining the Mining Hospital in Bytom in 1963, he successfully organized the fourth Department of Internal Medicine, which included the establishment of a dialysis center (1). This period also marked his attainment of the first degree of specialization in internal medicine in 1963 and the conferment of the Doctor of Medicine degree in 1964 for his thesis titled “On the Advantages and Possibility of Constructing an Artificial Capillary Kidney.” (2)
Twardowski obtained his second degree of specialization in internal medicine in the autumn of 1966, and, by 1968, he ascended to the position of head of the Department of Internal Medicine at the Mining Hospital in Bytom.
In pursuit of professional growth, in 1969 spent 3 weeks in the UK, visiting several nephrology centers, such as Hammersmith Hospital and Royal Free Hospital in London and the Royal Infirmary and Western General Hospital in Edinburgh, Scotland. He completed a month-long internship at the Medical Renal Unit of the Royal Infirmary at the University of Edinburgh, Scotland, UK in 1972. Two years later, he visited several dialysis centers in northern Italy, including those in Bologna, Padua, and Milan.
In 1975, he achieved a significant milestone by successfully defending his habilitation thesis titled “On the Adequacy of Hemodialysis in the Treatment of Chronic Renal Failure.” Following this accomplishment, from September 1976 to August 1977, he worked as a fellow in the Division of Nephrology within the Department of Medicine at the University of Missouri in Columbia, Missouri, USA.
Subsequently, in September 1977, he relocated to Lublin (Poland), assuming the role of Head of the Department of Nephrology at the Institute of Internal Medicine within the Medical Academy in Lublin the following year. In the same year, he was appointed as a member of the Nephrology Commission of the Polish Academy of Sciences.
In July 1981, he once again ventured to the USA, assuming the role of Research Fellow at the Division of Nephrology within the Department of Medicine at the University of Missouri in Columbia, Missouri. While he was working there, martial law was imposed in Poland.
In 1982, he was appointed as a Visiting Associate Professor at the Department of Medicine at the University
of Missouri. By 1985, his contributions and expertise were recognized as he ascended to the position of Professor, simultaneously taking on the role of the Director of the Peritoneal Dialysis Clinic within the Division of Nephrology at the university.
Concurrently, starting from 1983, he also served as a Staff Physician in Nephrology at Harry S. Truman Memorial Veterans Hospital in Columbia, Missouri.
In 1987, he was promoted to a permanent professorship (Professor with tenure) within the Department of Medicine at the University of Missouri. From 1991 to 1999, he worked as an Investigator at the Dalton Research Center, University of Missouri. Following his retirement in 1999, he was granted the esteemed title of Professor Emeritus of Medicine at the same University (Figure 2). Throughout his career, he collaborated closely with prominent figures in nephrology, such as Karl Nolph, Barbara Prowant, Ramesh Khanna, Madhukar Misra, and others.
FIGURE 2 Copy of the diploma confirming that Professor Zbylut Twardowski received the title of Professor Emeritus in recognition of long and efficient service to the University (from Prof. Z. Twardowski’s private archive). [Color figure can be viewed at wileyonlinelibrary.com]
Professor Twardowski’s principal clinical interests and notable achievements, spanning his career both in Poland and in the USA, revolved around renal replacement therapy, with a specific focus on peritoneal dialysis and hemodialysis. Early in his career, he also delved into the intricacies of kidney transplantation. A pivotal moment came in 1964 when he obtained a patent for a capillary dialyzer in Poland, marking the world’s first patent in this domain. Although manufacturing challenges hindered its production in Poland, American developers later succeeded
in building the machine, which has since become widely used globally. His innovative spirit continued to manifest through subsequent patents, including swan neck and presternal catheters for peritoneal dialysis, novel types of hemodialysis catheters resistant to clot formation, as well as machines for daily home hemodialysis. (3,4)
Beyond his contributions to technological advancements in dialysis, Professor Twardowski also developed a keen interest in the historical evolution of dialysis treatment. This passion was manifested by his participation in the 10th Congress of the International Association for the History of Nephrology held in Wieniec-Zdrój, Poland (Figure 3). (5)
FIGURE 3 Professor Zbylut Twardowski during 10th Congress of the International Association for the History of Nephrology in
Wieniec-Zdrój, Poland w 2017 (photo Grzegorz Główczyński). [Color figure can be viewed at wileyonlinelibrary.com]
In total, Professor Twardowski holds 22 patents for solutions in renal replacement therapy across various countries including Poland and the USA.
In the introduction to Professor Twardowski’s biographical book, dedicated to his wife and family and serving as an invaluable source of insight into his life and accomplishments, Karl Nolph remarked, “[…] Zbylut should be considered probably the first inventor of the capillary dialyzer […].” This recognition from a fellow esteemed figure in nephrology underscores the significance of Professor Twardowski’s pioneering work and lasting
impact on dialysis technology.
Professor Twardowski argued that “[…] when coming to the United States, it is relatively easy to be accepted if one is ready to work and create, there are no obstacles […].”
In addition to his groundbreaking contributions to dialysis technology, Professor Twardowski played a crucial role in developing a novel method of peritoneal dialysis known as continuous ambulatory peritoneal dialysis (CAPD) (6). His work also led to the establishment of the peritoneal equilibration test (PET), a standard procedure utilized in peritoneal dialysis centers worldwide (7,8).
Throughout his career, Professor Twardowski authored an impressive body of work, including 180 abstracts, nearly 400 articles and book chapters, seven instructional videos, and 24 letters to editors (9). He shared his expertise through 500 lectures delivered at scientific conferences and served as chairman for approximately 100 scientific sessions, solidifying his reputation as a prolific scholar and influential leader in the field of nephrology.
Professor Zbylut Twardowski held membership in numerous prestigious scientific societies worldwide. These memberships included: Polish Society of Internal Medicine, European Renal Association-European Dialysis and Transplant Association (ERA), International Society for Peritoneal Dialysis, American Society of Nephrology, International Society for Haemodialysis, and many others.
Furthermore, he played significant editorial roles in various publications, serving as the founding editor and editor-in-chief of Haemodialysis International, Advances in Peritoneal Dialysis, editor of Haemodialysis Today, and associate editor of Peritoneal Dialysis Today from 1985 to 2001.
Professor Twardowski’s organizational prowess was also evident in his role as the organizer of numerous conferences, with the Annual Dialysis Conference standing out as a notable event. At the 44th conference held in San Diego, Dr. Misra delivered a touching tribute in memory of the esteemed Professor.
Professor Zbylut Twardowski was the recipient of numerous prestigious awards and honors, recognizing his outstanding contributions and active engagement in the field of nephrology. These accolades include: the American Kidney Fund Torchbearer Award, Best Doctors in America, International Society for Haemodialysis Belding H. Scribner Trailblazer Award, 2004 Lifetime Achievement Award of the National Kidney Foundation, honorary membership of the Polish Society of Nephrology (2009) (Figure 4), International Society for Haemodialysis Award and others.
FIGURE 4 Professor Zbylut Twardowski receiving the honorary membership of the Polish Society of Nephrology at the National Philharmonic in Warsaw, Poland in 2009 (Photo Janusz Ostrowski). [Color figure can be viewed at wileyonlinelibrary.com]
Throughout his illustrious career, Professor Twardowski actively participated in numerous conferences, both nationally and internationally, including those held in Krakow, Poland (Figure 5).
FIGURE 5 Professor Zbylut Twardowski during the Krakow Dialysis Days in Krakow, Poland in 2010 (first left), Professor Andrzej Więcek in the middle, Professor Janusz Ostrowski on the right (photo Maria Ostrowska). [Color figure can be viewed at wileyonlinelibrary.com]
Professor Zbylut Twardowski’s diverse interests extended beyond the realm of medicine to include a passion for music and sports. During his youth, he enrolled in the Secondary Music School for a 2-year period, where he attempted to master the bassoon and piano, although without considerable success. However, it was in the field of sports that Professor Twardowski truly excelled. Throughout his high school and university years, he actively engaged in various athletic pursuits, specializing in track and field, basketball, volleyball, and swimming. His notable achievements in national competitions, particularly in running events, were remarkable, with a special emphasis on the 800-meter race.
Dr. Karl Nolph also highlighted Professor Twardowski’s remarkable linguistic abilities, as he was proficient in four languages and had a keen interest in etymology and comparative linguistics. He was widely regarded as an authority in the evolution of the English language, often quoting
philosophers, historians, and other scholars to enrich his discussions and writings (10).
In addition to his academic pursuits, Professor Twardowski enjoyed traveling with his family, exploring diverse cultures and regions around the world. His multifaceted interests and experiences underscored his deep curiosity, intellectual depth, and appreciation for the richness
of human knowledge and experience (11).
Professor Zbylut Twardowski was married to a psychiatrist Halina (née Nowosielska) for a respectable period of over 65 years. They had two sons, Radomysł and Przemysław.
Radomysł followed a career path into interventional cardiology, holding a position as a Clinical Associate Professor at the University of North Dakota in Grand Forks in 2000. Currently, he serves as a speaker and teacher for the Osher Lifelong Learning Institutes at the University of South Dakota in Sioux Falls.
Przemysław is a professor of oncology specializing in urinary tract cancers and working at the Department of Urologic Oncology within the John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, USA.
Radomysł reflected on his father: “Sons, grandchildren, and family have always felt the constant presence of my father, encouragement for intellectual, scientific, and professional development, and for righteous living.”(12)
Przemysław said, among other things: “Dad was certainly an outstanding doctor, scientist and, in general, an outstanding person. He was a great clinician who would always repeat that most new ideas were provided to him by his patients, to whom he listened very carefully. But he was also very open to new technologies, he knew chemistry, physics and statistics very well. He raised us probably more by example: diligence, perseverance, and determination.”(13)
Professor Twardowski held in high regard key advancements in dialysis treatment, placing particular emphasis on the significance of constructing the arteriovenous fistula. He deeply valued the groundbreaking contributions of Belding Scribner, whose pioneering efforts ushered in the era of chronic hemodialysis treatment, revolutionizing patient care in nephrology. He also highly valued the arteriovenous anastomosis performed by the Brescia-Cimino team, a technique still used in various forms today. (14)
Professor Zbylut Twardowski achieved his first successes in Poland amid challenging economic and political circumstances, before the fall of the Iron Curtain. His success story continued in the USA, where he embarked on an immensely productive clinical and scientific career. Throughout his journey, he remained driven by a relentless pursuit of discovering new possibilities in renal replacement therapy and enhancing its efficacy.
Professor Twardowski’s tireless efforts were dedicated to improving the quality of life and treatment outcomes for patients with chronic kidney disease. His insights and foresight have stood the test of time and remain relevant globally. As a result, Professor Zbylut Twardowski stands out as one of the leaders in the development of renal replacement therapy, particularly in the form of dialysis.
Needless to say, Zbylut Twardowski’s relentless pursuit of perfection has invariably inspired the authors of this article in their professional development. He always stood as a role model of an inquisitive researcher for us and for many others.
The passing away of Professor Zbylut Twardowski is a profound loss for the entire nephrology community worldwide. His contributions have left an indelible mark, and his legacy will continue to inspire advancements in nephrology for years to come.
Janusz Ostrowski 1,2
Ryszard Gellert 3
Władysław Sułowicz 4
Andrzej Więcek 5
1 Department of the History of Medicine, Centre of Postgraduate Medical Education, Warsaw, Poland
2 Historical Section of the Polish Society of Nephrology, Warsaw, Poland
3 Department of Nephrology, Internal Medicine and Family Medicine Centre of Postgraduate Medical Education, Warsaw, Poland
4 Department of Nephrology, Dialysis, Transplantation and Internal Medicine, Collegium Medicum, Jagiellonian University, Krakow, Poland
5 Department of Nephrology, Transplantation and Internal Medicine, Silesian Medical University, Katowice, Poland
Correspondence
Janusz Ostrowski, Department of the History of Medicine, Centre of Postgraduate Medical Education,
Kleczewska str. 61-63, Warsaw 01-826, Poland.
Email: janusz.ostrowski@cmkp.edu.pl
ORCID
Janusz Ostrowski https://orcid.org/0000-0003-1847-512X
Ryszard Gellert https://orcid.org/0000-0001-9382-0734
Andrzej Więcek https://orcid.org/0000-0002-8625-4188
REFERENCES
1. Ostrowski J, Rutkowski B. The origins of renal replacement therapy. Gdansk: Viamedica; 2011.
2. Twardowski Z. On the advantages and possibility of constructing a capillary artificial kidney. Acta Med Pol. 1964;5:303–29.
3. Misra M, Twardowski Z. Daily home haemodialysis: issues and implications. Nephrol Dial Transplant. 1997;12:2494–6.
4. Twardowski Z, Nolph K, Khanna R, Prowant BF, Ryan LP, Nichols WK. The need for a “Swan Neck” permanently bent, arcuate peritoneal dialysis catheter. Perit Dial Bull. 1985;5:219–23.
5. Twardowski Z. Interview during 10th Congress of the International Association for the History of Nephrology. May 27, 2017. CD, Congress own materials.
6. Popovich RP, Moncrief JW, Nolph KD, Ghods AJ, Twardowski Z, Pyle WK. Continuous ambulatory peritoneal dialysis. Ann Intern Med. 1978;88:449–56.
7. Twardowski Z, Nolph K, Khanna R, Prowant BF, Ryan LP, Moore HL, et al. Peritoneal Equilibration Test. Perit Dial Bull. 1987;7:138–47.
8. Ostrowski J, Rutkowski B. The history of peritoneal dialysis in Poland. Gdansk: Viamedica; 2014.
9. Twardowski Z. Constant site (buttonhole) method of needle insertion for haemodialysis. Dial Transplant. 1995;24:559–60.
10. Twardowski Z. Around the world with nephrology: an autobiography. Singapore: World Scientific Publishing Company; 2012.
11. Twardowski Z. Curriculum vitae. August 30, 2006 (unpublished).
12. Twardowski R. Letter to Janusz Ostrowski. February 5, 2024 (unpublished).
13. Twardowski P. Letter to Janusz Ostrowski. On my Dad. February 5, 2024 (unpublished).
14. Ostrowski J. Interview with Prof. Zbylut Twardowski. Krakow, September 11, 2006 (unpublished).