From the New England Journal of Medicine, June 21, 2001
Depurative therapy is life-sustaining for more than 300,000 patients with end-stage renal disease in the United States and for many others in whom acute renal failure develops during their hospital course. Yet the annual overall mortality in end-stage renal disease is over 20 percent, and in acute renal failure, survival is less than 50 percent -- numbers that have remained unchanged for many years. These dismal statistics attest to the imperfection of artificial renal-replacement therapy.
Complications of Dialysis catalogues the causes of the problems inherent in the treatment of renal failure. The editors have divided the complications into those related to imperfections in the techniques for replacement themselves, the coexisting conditions in patients with acute or chronic renal failure, and the care delivery infrastructure. The book also includes chapters dealing with problems associated with the delivery of care worldwide.
The major patient-related challenges are directly related to the two main causes of mortality in end-stage renal disease: cardiovascular events and infectious diseases. Chronic inflammatory processes that can cause malnutrition are frequent contributors to the high rates of illness and death. Complications of Dialysis highlights these complications, and the chapters dealing with them are a major strength of the book.
The section covering procedure-related complications includes chapters on hemodialysis, peritoneal dialysis, and continuous renal-replacement therapy. These chapters will primarily interest nephrologists involved in dialysis. Neverthe-less, there is sufficient background information to permit nonspecialists to understand the causes of these complications.
Many of the chapters are comprehensive, but more detail on the reuse of dialyzers would have been welcome, since this practice remains of concern to patients and nephrologists in countries that do not usually reuse dialyzers. The chapter on the adequacy of hemodialysis is concise and comprehensible, and the mathematical principles are clear. Unfortunately, the authors chose not to cover the recent controversy concerning the best method of determining adequacy, the effect of race on the predictive power of some of the indexes of adequacy, and the effect that the volume of distribution of urea may have on the outcome.
The third section deals with socioeconomic issues, differences across nations in the delivery of dialysis and other practices, and special situations such as dialysis in pediatric patients and those with diabetes or human immunodeficiency virus infection. The chapter on outcomes and the transfer of patients from one method of dialysis to another is particularly important because it offers the reader a comparison between the rates of survival among patients on hemodialysis and among those on peritoneal dialysis.
The detail and number of illustrations and tables in Complications of Dialysis will make it a valuable addition to the libraries of those who care for patients with end-stage renal disease and acute renal failure.
Gerald Schulman, M.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Nephron
"…a pleasure to read…should be in the possession of every nephrologist who treats dialysis patients."—
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