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Doody's Review ServiceReviewer: Kevin C Harned , MD (Nephrology Associates of Lexington)
Description: This is the fourth edition of an excellent resource on the range of renal replacement therapies. It covers all of the thus far approved modalities and includes well written sections on specific aspects of each one including adequacy, acid-base, electrolyte, how to manage complications, etc. This edition attempts to incorporate the updated National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines/recommendations that were not available at the time of the previous edition five years ago.
Purpose: The authors attempt to fill certain voids in the third edition, specifically placing greater emphasis on chronic kidney disease (CKD) stages 3 and 4, providing more complete and current information on various aspects of water treatment and vascular access, and making it more user-friendly to practitioners worldwide by having direct unit conversions instead of leaving readers to convert the units themselves. Overall, the authors achieve these goals.
Audience: Practitioners from various backgrounds will find this useful. Experienced clinicians will appreciate the ability to quickly "grab-and-go" to review points they may not encounter daily. The less experienced clinicians and those in training will appreciate the ease of searching for specific information throughout the book as well as the relatively easy to read style. Nursing staff of dialysis units will certainly be able to appreciate the material, although most topics do not particularly target their clinical roles and consequently they would have to seek out further reading. This is a well written book from the most honored researchers in the field of nephrology.
Features: It begins with discussions regarding management of CKD, though it is not intended to be a complete resource. The review of hemodialysis, the importance of water purification, access, dosing, anticoagulation, complications, etc., progresses logically. Peritoneal dialysis, sometimes neglected in other books, is discussed well in a similar format, albeit in less detail than hemodialysis. The end of the book covers other aspects of renal replacement therapies, including anemia management (with the updated guidelines), diabetes-hypertension-cardiovascular disease risk modification, genitourinary changes that arise throughout the duration of CKD progression, etc. Most notably, despite the small size of this book (which is quite deceiving given the amount and quality of information provided), the authors take the time to methodologically explain a multitude of points via a discussion of real-life problems and go through them in a step-wise fashion enabling readers to see the reasoning behind the evaluation, diagnosis, and treatment. One criticism is that while some points are expressed in bold print, not all of the KDOQI updates are bolded, which was one of the objectives of this revision. A clear, emphasized statement in each section on the KDOQI recommendation on that topic, followed by the explanation, would have improved the presentation. This would enable clinicians to quickly locate the important points, while still allowing them to read later at their leisure.
Assessment: This is certainly superior to many of the larger nephrology texts such as Comprehensive Clinical Nephrology, 3rd edition, Feehally et al. (Elsevier, 2007), or Brenner & Rector's The Kidney, 7th edition, Brenner (Elsevier, 2004), when considering the ease and speed with which information can be retrieved. However, it should be viewed as a complement to these textbooks as the latter include much more in-depth discussion of the topics to foster a better understanding. Although this edition appears to be slightly superior to its predecessor in the information it imparts, those who already have the previous edition may not necessarily have to make the expenditure for this one. Those who have yet to obtain a copy and fellows in training certainly would benefit from having this newest version with the most up-to-date information.