Composition and Management of Hemodialysis Fluids
A. Grassman, I. Uhlenbusch-Körwer, E. Bonnie-Schorn, J. Vienken, Pabst Science Publishers, Lengerich, Germany, ISBN 3–934252–64–8

C. Jacobs

Over the past twenty-five years much of the large body of literature devoted to extra-corporeal dialysis technology has focused on the depurative performances, biocompatibility characteristics and economics of dialysis/filtration membranes. In more recent years, together with the diversification of dialysis/filtration procedures, the other major component of extra-corporeal blood purification systems, namely the dialysis fluid, has also gained its place on the front-stage as the key importance of its physical, chemical and bacteriological characteristics for alleviating, preventing, or, on the other hand, generating dialysis-related complications became more evident and thus entailed the compelling requirement imposed both on industry and the medical community for optimizing the quality and safety of this indispensable component of dialysis therapy.

The authors of ‘Composition and Management of Hemodialysis Fluids’ have worked out a very comprehensive review of the subject in a clearly presented and well documented 320 page handbook organized into four main chapters followed by a constructive outlook into the future developments in this area.

The first chapter recalls the basic physical principles involved in the interactions of the dialysis fluid with the bloodstream across a semi-permeable membrane. The second chapter analyses in great detail the buffer and electrolyte composition of dialysis fluids, the numerous clinical and biological detrimental effects which may result from insufficient correction of uraemia-related metabolic acidosis and/or from inappropriate dialysis fluid concentrations of sodium, potassium, calcium and magnesium. The ‘optimal’ concentration of each of these components is presented, based on physiological data and on the modification of their respective balances due to the uraemic state and the ‘unphysiology’ of the dialysis procedures.

The chapter on the management of the chemical and microbial quality of dialysis fluids details the rationale for setting rigid standards for the fabrication and delivery of dialysis fluids, justified by potentially very severe clinical adverse effects resulting from chemical or bacteriological contaminations. The key-role of a precise monitoring of dialysis fluid delivery during the dialysis/filtration sessions is well demonstrated for obtaining an as accurate as possible dry weight at the end of each treatment, through fine-tuned setting of pressure or volumetric controls of ultra-filtration rates and volumes.

Finally, a comprehensive review of the currently used dialysis fluid supply systems and of the advances recently introduced in this area such as ultra-filtration or electrolyte profiling, use of biofeedback systems or dialysis-fluid as substitution fluid for on-line haemofiltration or haemodiafiltration place this volume at a true cutting-edge level of the literature on dialysis technology.

The book authored by Grassmann, Uhlenbusch-Körwer, Bonnie-Schorn, and Vienken is easy and pleasant to read. It is abundantly illustrated with numerous and very informative tables, graphs and charts. The scientific content of each of the chapters is substantiated by a comprehensive and well updated reference list. Guidelines for dialysis fluid prescription and a well composed glossary efficiently conclude the volume which, without doubt, will be very useful to the practising dialysis community, physicians, nurses, technicians, as well as for all of us involved in teaching the techniques of renal replacement therapy.





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