Dialysis disseminated

Basic clinical dialysis.

David C Harris, Grahame Elder, Lukas K Kairaitis, Gopala K Rangan (eds). Sydney: McGraw Hill, 2005 (xxiv + 264 pp). ISBN 007471501 1.

Many clinicians will have unpleasant memories of their first visit to their hospital’s haemodialysis unit. Unfortunately, this situation hasn’t improved much over the years, where the evening RMO is called to check Mr Jones’ “dry weight” pre-haemodialysis. This can be a difficult task for a nephrologist, so it was refreshing to review this handbook which states, after a series of helpful instructions, “In practice, initial determination of the dry weight of the patient is trial and error using the signs above and frequent assessment”.

This is a handbook in every sense of the word, of use to its target population of students, RMOs, advanced trainees, nurses and paramedical staff. Information on haemodialysis and peritoneal dialysis as well as acute dialysis and plasmapheresis is backed up by protocols developed within the dialysis units of the Western Sydney Renal Service. While some protocols may be of little use in established units, they could easily be incorporated into the structure of any new department with benefit.

Because many dialysis units have become the domain of the nursing profession over the past few decades, doctors’ dialysis knowledge and skills are often limited. Nevertheless, it is the RMO and rotating registrar that should benefit most from this book. Each section is well referenced with up to date reviews including Australian (CARI) and United States (K/DOQ1) guidelines.

Basic clinical dialysis covers more than dialysis, with sections detailing normal renal function, chronic kidney disease stages, pre-dialysis management and transplantation. In my view, this additional coverage is the book’s main weakness.

Excluding these ancillary areas may have allowed space to better cover emerging issues such as nocturnal dialysis. A more detailed guide to dosing of commonly prescribed drugs as found in The Oxford handbook of dialysis (Oxford University Press, 2001) would have been helpful.

In handbooks such as this, it can be difficult to get the correct balance and cover all relevant areas without too much detail. This one gets it right most of the time and would complement the library of any dialysis unit.

Shane L Carney Nephrologist John Hunter Hospital, New Lambton, NSW