Qian Jiaqi (1939-2019), Professor of Internal Medicine, former Director of the Department of Internal Medicine, Director of the Internal Medicine Teaching and Research Office, and Director of the Department of Nephrology at Renji Hospital

Introduction:

A pioneering physician who witnessed, participated in, and ultimately led the development of nephrology in China. He introduced peritoneal dialysis to the country, establishing national standards that would later influence international guidelines. A champion of standardized treatment, he led quality control initiatives that significantly elevated the level of dialysis care nationwide. He also created China’s first high-quality dialysis registry, earning recognition from leading international medical authorities.

At work, Dr. Qian was always neatly dressed, exuding a kindness and warmth that inspired confidence. He was known for his meticulous and dedicated approach, never cutting corners, which made colleagues and patients feel reassured. No matter how busy he became, he maintained an optimistic and composed demeanor, providing a source of strength for everyone around him.

He was most affectionately known as “Dr. Qian” and “Professor Qian”—titles he himself preferred. To his students, he was a profound and wise mentor, a conscientious physician, and an exemplary role model.

For decades, he never stopped.

The Path of Medicine:

Qian Jiaqi was born in Shanghai in 1939, during World War II, a time when the city was under Japanese occupation outside the international concessions. Growing up in an era of national turmoil, his deepest wish was for an end to the conflict and for a future where people could live in peace and good health.

From an early age, he was an exceptionally bright student, consistently excelling in his studies and earning the admiration of teachers and peers. After the founding of the People’s Republic of China in 1949, Qian cherished the hard-won peace and dedicated himself to his studies. In the 1950s, his high marks earned him admission to the prestigious Shanghai Second Medical College.

Medical education in the early days of the PRC was challenging, with a scarcity of textbooks and equipment. Despite these difficulties, Qian persevered, building a solid foundation of medical knowledge that would serve his future clinical career.

Upon graduating in 1963, Qian joined Renji Hospital, where his talent was quickly recognized by senior professors like Huang Mingxin and Jiang Shaoji. His rigorous approach to medicine, combined with a calm and optimistic demeanor, earned him the trust and respect of both colleagues and patients. He held a firm belief that a true physician and scholar must be fully devoted to patients, driven by passion and persistence in the healing arts.

In the early 1960s, as medical science advanced, Renji Hospital reorganized its internal medicine departments into specialized units. During this transition, guided by senior professors, Qian began exploring the integration of Traditional Chinese Medicine (TCM) with Western medical diagnostics. He worked in a dedicated TCM-WM integrated ward, focusing primarily on patients with kidney diseases.

Building on the success of this ward’s focus on kidney disease, Renji Hospital established its formal Department of Nephrology in the 1970s. From its inception, the new department became a cornerstone of the hospital’s internal medicine services. Qian Jiaqi was instrumental in establishing its regulations and clinical protocols for common kidney diseases, laying the groundwork for both advanced treatment and research in the field.

Dedication to Hemodialysis, Saving Thousands of Lives

In the early decades following the founding of the People’s Republic of China, healthcare resources and medical standards were limited. For patients with kidney disease, treatment options were scarce. Once their condition progressed to end-stage renal disease (ESRD), medications were often ineffective. Without advanced treatments like dialysis or transplantation, ESRD was considered a terminal illness, leaving patients with little hope of survival.

This landscape began to change in the 1950s and 1960s. The development of dialysis and transplantation technologies, combined with increased national investment in the healthcare sector and its supporting infrastructure, steadily improved the treatment and management of kidney disease.

By the 1970s, China was launching large-scale clinical and basic research into kidney diseases, continuously advancing diagnostic and treatment capabilities. Qian Jiaqi was a key participant, promoter, and leader in this national effort.

He had early recognized the critical importance of hemodialysis for treating ESRD. Hemodialysis is a procedure that artificially performs the kidneys’ function for patients whose organs can no longer remove waste and excess fluid from the blood. During treatment, a patient’s blood is circulated outside the body through a dialysis machine, where it passes through a filter that cleanses it before being returned. These sessions, typically lasting several hours, are required multiple times a week to sustain a patient’s life.

Qian Jiaqi was instrumental in the independent research, development, and clinical validation of China’s first flat-plate hemodialysis machine. This was a major milestone, elevating China’s dialysis technology to an international standard and offering long-term survival hope to ESRD patients. By significantly reducing the machine’s size and simplifying its operation, he lowered the barrier to its use. This technological breakthrough was not just an engineering success; it provided the essential equipment to popularize hemodialysis across China, giving countless patients a new lease on life.

As hemodialysis became more widespread, Qian Jiaqi saw the need for national standards to ensure quality and consistency, as development levels varied across the country. He personally authored numerous standards for the treatment and management of both hemodialysis and peritoneal dialysis. These guidelines laid the foundation for the systematic development of dialysis therapy in China. He also actively promoted related research and training, mentoring a new generation of nephrologists skilled in these life-saving technologies.

Continuous Innovation, Leading the Trend

Beyond his achievements in hemodialysis, Qian Jiaqi made significant contributions to other kidney disease treatments and research, with particularly outstanding accomplishments in database development and peritoneal dialysis.

In the 1990s, as hemodialysis became more widespread in China, vast disparities in treatment quality existed between different regions and centers. There was no unified provincial database, making it impossible to know how many patients were receiving dialysis or the basic conditions of each center. This lack of data severely hindered efforts to understand and improve the overall standard of dialysis care in China. As director of the Shanghai Hemodialysis Quality Control Center, Qian compiled the nation’s first hemodialysis quality control manual, using it to implement standardized management. This rapidly elevated the quality of dialysis across Shanghai’s medical institutions. He also spearheaded the creation of the Shanghai Hemodialysis Registry, the first of its kind in China. Its data was also recognized globally.

In addition, Qian Jiaqi did some effort on Peritoneal dialysis technology which was first explored in the 1950s but faced numerous challenges, leading it to be seen initially as merely a supplement to hemodialysis, suitable only for a limited number of patients. This changed in 1979 when Continuous Ambulatory Peritoneal Dialysis (CAPD) was introduced to China, gradually shifting perceptions. CAPD allowed more patients to thrive on peritoneal dialysis, and its use grew year by year, eventually becoming a primary treatment option for renal failure. By the late 1990s, with further technological advancements, peritonitis was no longer a common complication, and peritoneal dialysis entered a period of rapid growth. Today, it is a vital treatment for chronic kidney failure worldwide.

Through Qian Jiaqi’s efforts, Renji Hospital established the first peritoneal dialysis center in China, and he later founded the Shanghai Peritoneal Dialysis Research Center, which became a national leader in the field. He conducted extensive basic research and technical optimization while standardizing clinical workflows, significantly improving treatment outcomes and patients’ quality of life. He promoted and applied various technologies, including CAPD and Automated Peritoneal Dialysis (APD). In practice, he continuously raised standards for quality control, complication management, and infection control, providing a crucial reference for standardized peritoneal dialysis nationwide.

At the time, international dialysis dosage standards were based primarily on data from European and American populations. Qian revised these standards based on his clinical experience with Chinese patients. Through a series of studies, he established more suitable standards for the Chinese population. For instance, when peritoneal dialysis was first introduced, the international standard required 8-10 liters of dialysate per session to achieve a urea clearance index (Kt/V) of 2.0. However, Qian found that Chinese patients achieved excellent therapeutic results with just 6 liters. This reduction not only lowered treatment costs but also protected peritoneal function, extending the duration patients could remain on the therapy.

Through further clinical research, Qian demonstrated that a Kt/V of 1.7 was sufficient to improve patient survival for Chinese patients on peritoneal dialysis, thus establishing the “Chinese Standard for Peritoneal Dialysis Adequacy.” This research was quickly and widely recognized, leading the International Peritoneal Dialysis Guidelines to revise their original recommendations. This standard remains in use worldwide today—a landmark clinical research achievement from China that advanced global medical practice.

For this series of achievements, Qian Jiaqi received numerous honors, including the Second Prize of the National Science and Technology Progress Award and the First Prize of the Ministry of Education. It is through his efforts and practice that he led China’s peritoneal dialysis technology to the international forefront.

In standardizing clinical workflows, he implemented strict quality management systems and formulated a complete set of peritoneal dialysis procedures and standardized treatment plans, ensuring the safety and effectiveness of patient care. He also emphasized psychological counseling and family support, bolstering the confidence of patients and their families while improving treatment outcomes.

On November 19, 2019, Qian Jiaqi passed away at the age of eighty. The Chinese nephrology community lost an outstanding scholar and a master clinician. His passing was met with deep sadness and a profound sense of loss from the domestic and international nephrology communities and his students.

At his memorial service, Academician Chen Xiangmei, leading experts from across China, and nephrologists from around the country gathered to mourn, collectively recalling Qian Jiaqi’s immense impact on the development of nephrology in China. The official journal of the International Society for Peritoneal Dialysis also published an obituary, honoring his lifelong and outstanding contributions to the global fight against kidney disease.