دانلود کتابچه راهنمای دیالیز، ویرایش ششم

We are very honored and pleased to present this sixth edition of the Handbook of Dialysis to professionals providing care for patients undergoing dialysis. While not completely “settled science,” advances in dialysis therapy over the past 10 years have been modest. One meaningful advance has been a focus on the patient and on outcomes that are important to patients and their caregivers. Accordingly, the one new chapter that has been added, by Dr Mark Unruh, targets this new area of knowledge. Several chapters were removed from this edition. A chapter on sorbent-based dialysis is no longer included, as one major dialysis equipment manufacturer that was previously enthusiastic decided to abandon development of sorbent-based machines. We no longer include a chapter on reuse of hemodialyzers, although reuse continues to be practiced in some countries and regions. What was written about reuse in the fifth edition remains useful and valid. There is little new regarding hemodialysis or peritoneal dialysis adequacy. More frequent hemodialysis treatment schedules are perhaps increasing in popularity, but only slightly. There is less enthusiasm for use of kinetic modeling methods for both hemodialysis and peritoneal dialysis. For peritoneal dialysis, the emphasis now is on patient tolerability and convenience. With regard to hemodialysis, a small number of randomized trials have suggested increased survival when hemodiafiltration is added, as reviewed in an updated chapter. The exact mechanism of benefit remains a mystery, as predialysis and time-averaged levels of those middle molecules that are removed more efficiently by hemodiafiltration are only slightly reduced and remain far above levels in nonuremic individuals. Much of the excitement around chronic kidney disease (CKD) has focused on the predialysis stages, and on use of new drugs that have been shown to improve survival in patients with predialysis CKD and may also retard progression. These advances are briefly described in the introductory chapter dealing with predialysis CKD, but of course, this is not the focus of this Handbook. One of the founding editors of the Handbook, Dr Todd S. Ing, passed away while this sixth edition was in preparation. Dr Ing was a valued mentor to one of us (JTD) as well as to numerous other nephrologists. Readers can find a tribute to Dr Ing in the April 2024 issue of Hemodialysis International, 28(2):133-138, journal of the International Society of Hemodialysis, which Dr Ing was instrumental in founding. We miss him greatly. In the final scene of the movie “Apocalypto” (released in 2006 by director Mel Gibson) indigenous inhabitants of Mexico (circa 1517 AD) peer through a coastal forest and see the approach of Spanish sailing ships. The message is that very soon for these cultures, everything will change. There have now been a handful of shortterm successes with xenotransplantation, and it is quite possible that, at the time that a seventh edition of the Handbook is being contemplated, dialysis treatment will be reserved for those for whom xenotransplantation is not practicable. Once again, we would like to thank the many chapter authors who agreed to write for the Handbook. The time demands on clinical nephrologists continue to increase, and we greatly appreciate their willingness to allocate some of their precious time to share their insights and expertise.