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For more than a generation haemodialysis has been the principal method of treating patients with both acute and chronic renal failure. Initially, developments and improvements in the system were highly technical and relevant to only a relatively small number of specialists in nephrology. More recently, as advances in therapy have dem onstrated the value of haemofiltration in the intensive therapy unit and haemoperfusion for certain types of poisoning, the basic principles of haemodialysis have been perceived as important in many areas of clinical practice. In this volume, the potential advantages of bicarbonate haemo dialysis are objectively assessed, the technical and clinical aspects of both haemofiltration and haemoperfusion discussed and the con tinuing problems associated with such extra corporeal circuits analysed. All the chapters have been written by recognized experts in their field. The increasing availability of highly technical facilities for appropriately selected patients should ensure that the information contained in the book is relevant not only to nephrologists but to all practising clinicians. ABOUT THE EDITOR Dr Graeme R. D. Catto is Professor in Medicine and Therapeutics at the University of Aberdeen and Honorary Consultant Phy sician/Nephrologist to the Grampian Health Board. His current inter est in transplant immunology was stimulated as a Harkness Fellow at Harvard Medical School and the Peter Bent Brighton Hospital, Boston, USA. He is a member of many medical societies including the Association of Physicians of Great Britain and Ireland, the Renal Association and the Transplantation Society.
The Fourth International Congress of Peritoneal Dialysis was held in Venice, Italy, June 29 to July 2, 1987. By this time peritoneal dialysis had emerged as a treatment for a substantial fraction of patients with end-stage renal disease and countless numbers of patients with acute renal failure. This treatment is now practiced worldwide and is the life-sustaining treatment for about 40,000 patients with chronic renal failure, representing 15 to 20% of dialysis therapy in about 1000 centers. It is not surprising, therefore, that the number of health professionals engaged in the investigation and the application of the treatment has also grown exponen tially. The First International Symposium on Peritoneal Dialysis, organized by Dr. A. Treviiio-Be cerra in Chapala, Mexico, in 1978, brought together a group of pioneers when continuous ambulatory peritoneal dialysis was in its infancy. In 1981, Dr. G. M. Gahl chaired the Second Symposium, in West Berlin, when the technique and professional interest were growing con siderably. By 1984, when Dr. 1. F. Winchester and I organized the Third Symposium, the pre sented papers exceeded 100 and there were about 1000 attendees. At that time, it was deemed appropriate to form a more organized group and the International Society for Peritoneal Dialy sis was founded. One of the first actions of the Society was to choose from among several applicants Dr.
While continuous ambulatory peritoneal dialysis (CAPD) has been the standard peritoneal procedure since the seventies, different schedules of automated peritoneal dialysis (APD) have emerged during the eighties. Today, APD is considered a valuable tool in the management of ESRD patients, together with CAPD and hemodialysis. However, despite its frequent use, APD has not yet been well assessed, and most pathophysiological and clinical studies on PD refer to CAPD. In this book, major experts in the field therefore discuss and evaluate the insights gained on APD up to now, presenting a comprehensive review of all experimental, technical and clinical aspects related to the various treatments grouped under the definition of APD. The recent developments presented are divided into four sections: membrane permeability, transport mechanisms and kinetic modeling applied to APD; prescription and adequacy of different APD treatment schedules; dialysis machines and solutions for APD, and, lastly, different clinical aspects such as the possibility to maintain APD program and residual renal function. Physicians involved in ESRD care, renal fellows and scientists both in the academic world and in the hospital setting will undoubtedly profit from this timely publication.
Continuous ambulatory peritoneal dialysis (CAPD) was introduced by Popovich et al. in 1976, with 4–6 exchanges per day and long dwell time between the exchanges. Later, a group from Seattle used the combination of cyclic and automated PD in their patients and then it was called as continuous automated ambulatory peritoneal dialysis (CAAPD). Later in 1981, this technique was given the name continuous cycling peritoneal dialysis (CCPD) by Diaz-Buxo. Currently, over 130,000 patients are on CAPD worldwide, and it is the most popular form of peritoneal dialysis. This book on continuous ambulatory peritoneal dialysis is designed to address the various clinical decision questions supported by typical clinical scenarios, with which all readers will be able to identify. Thus, it provides an excellent opportunity to widen one’s perspective in this area.
Peritoneal dialysis represents an internal technique for blood purification. In this dialyzer the blood path, the membrane, and the dialysate compartment are provided by nature. The developments of chronic peritoneal catheters, auto mated cycling equipment, solution preparation by reversed osmosis, manipula tions of transport with drugs, and the experiences with continuous ambulatory peritoneal dialysis and continuous cycling peritoneal dialysis have increased the interest in peritoneal dialysis. Publications related to peritoneal dialysis exceed 400 annually. The Peritoneal Dialysis Bulletin represents a new journal devoted to peritoneal dialysis developments. The Third International Symposium on Peri toneal Dialysis is to be held in Washington, D.C. in 1984. From this meeting it is likely that an International Society for Peritoneal Dialysis will emerge. This book is meant to provide an overview of the state of the art of peritoneal dialysis. Many clinicians are making extensive commitments to peritoneal dialysis for the first time. Nephrologists, physiologists, pharmacologists, biomedical engineers, and even physicists are involved in studies to better understand peritoneal dialysis. The complexities of peritoneal dialysis and the peritoneal membrane are becoming apparent. Studies of peritoneal dialysis increase under standing of the anatomy and physiology of biological membranes and of factors influencing the passive movement of solutes across the microcirculation and related structures. Peritoneal dialysis provides a 'window' to the visceral micro circulation in animals and humans. Peritoneal dialysis may be useful to treat problems other than renal failure.
Nolph and Gokal's Text Book of Peritoneal Dialysis, Third Edition, covers advances made in the field for the past 30 years. During the past two decades, the time during which this therapy has been increasingly utilized, this text has continued to be recognized as the major source of the discipline's base knowledge. The evolution of this text to its newest edition parallels the growth of peritoneal dialysis from Continuous Ambulatory Peritoneal Dialysis in the eighties to the current therapy that encompasses manual and automated therapies with full emphasis on adequacy of dialysis dose. Peritoneal dialysis represents an intracorporeal technique for blood purification. This unique dialysis system represents one of many human attempts to manipulate nature for sustenance of life. The past few years of advances have focused on further improvement of the technique. Areas that have fueled the interest of researchers include: (1) Physiology of high transporters (and the role of genetics and inflammation); (2) Continued debate over the most appropriate adequacy indices (small solute clearances, large solute clearances, clinical assessment etc.); (3) Understanding, preventing and treating the MIA syndrome in PD patients ( including the roles of leptin, and adiponectin); (4) Pathogenesis and newer management strategies of vascular calcification; (5) Continued improvements in infectious complications including peritonitis; (6) Further improvements in catheter technology; (7) Automated techniques; (8) Explaining and correcting PD underutilization; (9) Rationale and applications of newer dialysis solutions; (10) New understanding and approaches to management of osteodystrophy; (11) Refinements in anemia management including new insights in iron metabolism in PD patients; (12) Further definition of indications for PD; (13) The ideal time to initiate dialysis. Newer insight into host defense mechanisms have also made the past decade of advances in the field more meaningful for clinicians. This text also covers the knowledge gained from animal models of peritoneal dialysis. Nolph and Gokal's Textbook of Peritoneal Dialysis, Third Edition is a compilation of the latest knowledge in the field. It cites and describes in great detail, the new discoveries and the evolution of understanding the subject of these discoveries.
In 1994, the expert knowledge of Ram Gokal and Karl D. Nolph, the two foremost figures in the field of peritoneal dialysis, was combined to produce the first edition of the Textbook of Peritoneal Dialysis. The work quickly became recognised as the `gold standard' for those working in the field. Since its conception, however, our understanding of peritoneal dialysis related physiology, kinetics and clinical outcomes, as well as the concepts of intraperitoneal chemotherapy, has increased sufficiently to make an updated and completely revised edition of the work necessary. An expansion of the editorial team by fellow-experts Ramesh Khanna and Raymond Krediet enabled an even more comprehensive approach to be taken. This second edition reasserts the book's uniqueness in its detailed discussion of the topic, making it required reading for all those working within the field of peritoneal dialysis.