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At the end of 1976 there were 34,215 people with end-stage renal disease alive on dialysis and transplantation within the registry centers of the European Dialysis and Transplant Association (14:4, 1977). From July, 1973, when the American Government began to fund dialysis, the estimated number of dialysis patients in the United States has risen from 5,000 plus to over 35,000. Jfwe add other regions, such as Canada, Australasia and Latin America, it is safe to say that as this is written, over 100,000 people are living on dialysis. The u.s. Social Security System, Veterans Administration, Medicaid and State Agencies are now paying out over one billion dollars annually to support patients on dialysis in the U. S.A. Cobe, Redy, Travenol, Dow Cordis, Drake Willock, Gambro, Asahi, Erica and a host of other company names have become household words in many households throughout the world. I cite these factors not out of a pretense at precision or a passion for phenomenology, but simply to indicate that dialysis has become lore than this century's therapeutic miracle. (Perhaps the first treatable fatal chronic, terminal, medical disease I). It has also become big business! As such, it has perhaps become too important to be left solely in the hands of medical specialists, such as nephrologists.
Sommario
Preface.- I - Indications for Regular Dialysis Treatment.- 1.1. Criteria for initiating chronic hemodialysis.- 1.2. Kidney diseases which lead to chronic hemodialysis.- 1.3. Evaluating hemodialysis requirements.- II - The Consequences of Loss of Renal Function: The Mechanisms of "Uremic Toxicity".- 2.1. The results of loss of excretory function.- 2.2. Consequences of the decreased water and electrolyte excretion.- 2.3. The results of the loss of endocrine and metabolic functions.- III - Basic Principles of Hemodialysis.- 3.1. The Dialyzer.- 3.2. Diffusion (or conduction) transfer.- 3.3. Ultrafiltration (or convection) transfer.- 3.4. Flow rates and pressure.- 3.5. Evaluating dialyzer performance.- IV - Hemodialysis Equipement.- 4.1. Dialyzers.- 4.2. Dialysate delivery systems and monitoring devices.- 4.3. The dialysate fluid.- 4.4. The special case of hemofiltration.- 4.5. Dialyzer performance.- V - Vascular Access.- 5.1. The main types of vascular access.- 5.2. Complications involved in vascular access.- VI - Organization of Dialysis Treatment.- 6.1. Modalities of chronic hemodialysis.- 6.2. Preparation for regular dialysis treatment.- 6.3. Individual protocol for treatment.- VII - Performance and Follow-Up of Regular Dialysis Treatment.- 7.1. Performance of the hemodialysis session.- 7.2. Incidents and accidents during the hemodialysis session.- 7.3. Clinical and biochemical control of the hemodialysis patient.- VIII - Clinical Problems in Chronic Hemodialysis Patients.- 8.1. Cardiovascular problems.- 8.2. Hematological problems.- 8.3. Neurologic complications.- 8.4. Disorders of phospho-calcic metabolism.- 8.5. Infectious problems.- 8.6. Metabolic and endocrine problems.- 8.7. Gastrointestinal problems.- 8.8. Surgery in the dialysis patient.- 8.9.Dialysis in high-risk patients.- 8.10. Dialysis in the child.- IX - Living With Hemodialysis.- 9.1. Overall results of chronic hemodialysis.- 9.2. Diet of the hemodialyzed patient.- 9.3. The quality of life of the dialyzed patient.- 9.4. Social and professional rehabilitation.- 9.5. Economic consequences of the treatment.- Table of Plates.- References.
