Complications of Dialysis PDF

Preface

The worldwide incidence of end-stage renal disease (ESRD) is increasing, with the current total number of cases estimated at 3 million cases. Over the last three decades, advances in the management of this chronic disease have focused primarily on renal replacement therapy with dialysis on renal transplantation. Of the 600,000 people worldwide who will be treated with renal replacement therapy, fewer than 40,000 patients will receive a renal transplant. The large numbers of patients supported with dialysis has spurred several advances in dialysis technology that have allowed nephrologists to offer patients a choice of therapeutic modalities. However, as new applications of dialysis have emerged, new complications have also been identified that are often not well reported. The availability of several books covering dialytic techniques and their applications raises the question: Whey another book on dialysis? We believe the answer lies in the focus of this book on recognition and management of complications of dialysis.

This book is a comprehensive multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies. We have developed the book on the premise that complications result from the interaction of the patient, the technique, and the environment in which dialysis is provided. As a consequence, the complications have been discussed from three angles: patient-related, technique- related, and those contributed to by the organization of care reflecting the changing relationship between providers and beneficiaries of dialysis. We have integrated the knowledge gained from experience with each technique with clinical outcomes, and have explored the emerging role of the economics of these therapies in contributing to adverse outcomes. New and original material has been added rather than known material duplicated. The result is a book that not only is comprehensive and resourceful but also offers details on management of each major complication and practical advice to the dialysis team on several topics that are only covered as exceptions in other books.

Another unique feature of this book is that it is truly international. It was our ambition to cover the problems globally and not to limit coverage to North America and Western Europe. Both our contributors and the topics reflect this theme. We believe that in the immediate future the strategic context of ESRD therapy will make it necessary to maximize clinical and economic outcomes in a rapidly changing healthcare environment. Therefore, attention has also been given to the economic, public health, and environmental problems involved in dialysis. We hope therefore that this book will be useful beyond the need for continuing postgraduate education of the nephrologists and that it will also be of interest to health care providers ranging from government to hospital administrators, health care economists, and all who are directly and indirectly involved in the care of patients with ESRD.

Some degree of overlap among chapters in a multiauthored book, whose writers hail from several countries cannot be avoided. As it should be in a book at the postgraduate academic level, some differences of opinion among authors have not been discarded. We are extremely grateful to all contributors for their time and their efforts in making this book a reality. We are indebted to several people at Marcel Dekker, Inc., for their patience and support as this book has developed.

We sincerely appreciate the enormous work by our secretaries Mrs. I. Verslycken and Ms. I. Van Dorpe in Gent for Dr. Lameire and Ms. Rachel Manaster in San Diego for Dr. Mehta.