Drukker, Parsons and Maher: Replacement of Renal Function by Dialysis 4th Edition

This book, first published in 1978 was one of the earliest to take dialysis as its main topic. The authors, all pioneers of their science, intended it to be the bible of second and third generation nephrologists, combining theory.and practice in a single authoritative text. The book was immediately successful, so much so that those second and third generations are now themselves the mentors. This edition is the fourth, with a fresh editorial team and many new contributors. The debt due to Drukker and his colleagues is everywhere apparent however, and it is satisfying to see their names preserved in the title. Outwardly the book closely resembles the third edition, although, probably in view of its expansion to over one thousand five hundred pages, it now contains eight separate sections. There has been a great deal of change in content. This is the expressed purpose of the editors and credit is due to them and their publishers for the result, which many will regard as the leading current reference work on dialysis. The contributors are drawn from the world's leading nephrology centres. Every topic is covered in more detail than ever before, while tens of thousands of references testify to the care taken to ensure that all statements are readily verifiable. The edition is important because it comes at a time when dialysis is entering a new era, in which it is becoming routine, available without restriction to all and able to deliver a sustainable long-term improvement in health. Much has been achieved since the first edition. Membranes have diversified and become more biocompatible. The technology of dialysis delivery has become more sophisticated, while concepts of adequacy have been greatly improved by better understanding of dialysis dosage. However, as Belding Scribner, one of the greatest pioneers observes in his foreword, a doubt arises as to whether modern nephrologists are truly taking advantage of equipment and techniques which to him seem unbelievably good. Unfortunately, the answer appears to be "no" as evidenced by an important article from Robert Barth on "short, high efficiency, and high flux dialysis". Barth concludes that most dialysis in the United States, using conventional and even high flux, high efficiency membranes, is inadequate, with prescription "frequently founded on erroneously high dialyser clearances supplied by manufacturers". This message from the United States applies even more to Northern Ireland. Head counts of dialysis numbers and wishful thinking about patients' …