Dialysis access: A multidisciplinary approach

BOOK REVIEW

Dialysis Access: A Multidisciplinary Approach

Editors: Richard J. Gray and Jeffrey J. SandsPublisher: Lippincott, Williams, & Wilkins

ACCESS PROBLEMS currently dominate thefield of dialysis. Thus, a textbook that

treats this subject in-depth is welcome. As statedin the preface, this book is intended to provide“an in-depth review of the issues and data sup-porting current access management practices writ-ten by the specialists who pioneered them.” Theeditors and authors have certainly taken on achallenging task. How did they go about this, andwas their effort successful?The book is large and the paper is of high

quality. There are 9 parts with 44 chapters for atotal of 380 pages; there is also a 10-pageindex. On perusing the book, one is struck bythe large numbers of tables, figures, and refer-ences. With some exceptions, the quality of thefigures is good. The 9 parts provide broadcoverage of the field, as indicated by the follow-ing brief review:Part 1 introduces the rationale of the National

Kidney Foundation’s Dialysis Outcomes QualityInitiative guidelines and relates the practical ex-perience (and difficulties) the authors have en-countered in implementing the guidelines. Thesection is valuable reading for anyone planningto implement a vascular access program.Part 2 deals with principles of hemodialysis,

pathophysiology of synthetic graft failure, andmanagement of bleeding and clotting disorders.The material on principles of hemodialysis seemsout of place. It would have been better to elimi-nate such material and provide more completeand up-to-date coverage of neointimal hyperpla-sia and pathophysiology of graft failure (themost recent reference provided on this subject isfrom 1995). Some poor quality illustrations alsomar this section.Part 3 deals with hemodialysis access cre-

ation. There are useful chapters on preoperativeevaluation, surgical techniques, and manage-

ment of surgical complications and infections.This section would be enhanced by summaryfigures on basic vascular access anatomy.Part 4 deals with the controversial subject of

hemodialysis access monitoring. The chapter onphysical examination is particularly useful. Thechapters on access flow, venous pressure, andduplex ultrasound provide valuable descriptionsof these methods. The authors favor employmentof these methods in regular surveillance pro-grams. In contrast, we believe this recommenda-tion lacks support from properly designed clini-cal trials.Part 5 deals with treatment of access dysfunc-

tion, especially angioplasty and stenting. Twointeresting chapters debate the value of prophy-lactic angioplasty, which relates to the contro-versy on surveillance.Part 6 deals with treatment of access thrombo-

sis, including pharmacologic, mechanical, andsurgical treatments. There is an interesting discus-sion of relative benefits of radiologic versussurgical treatment and the need for further re-search.Part 7 deals with central venous dialysis cath-

eters. The authors’ rich experience with catheterplacement and complications is clearly evident.They have reviewed research in this field andhave provided practical recommendations ontreatment of catheter malfunction and infection.Part 8 deals with placement and complications

of peritoneal dialysis catheters. The section iswell written but too short and is not consistentwith the thorough hemodialysis access coveragein the rest of the book. This section should beexpanded to adequate length in future editions.Part 9 provides a nice summary of current

innovative concepts, including free-standing ac-cess centers, pharmacologic prevention of accessfailure, and new catheter technologies.As promised, this book closely examines the

data that support current access managementpractices. As in any multiauthor text, there isoccasionally duplication. There are also some

© 2003 by the National Kidney Foundation, Inc.0272-6386/03/4102-0032$35.00/0doi:10.1053/ajkd.2003.50107

American Journal of Kidney Diseases, Vol 41, No 2 (February), 2003: pp 518-519518

significant omissions. For example, we think thata comprehensive book of this type should in-clude material on the history of the dialysisaccess (ie, how did we get where we are now?).To summarize, this book is a notable achieve-

ment that largely provides the in-depth coveragethat the editors and authors set out to provide. Itshould be a useful tool for all those involved inthe maintenance and care of the dialysis access.

We have currently included this book on thereading list of our nephrology fellows.

Fahim Zaman, MDWilliam D. Paulson, MD

Section of Nephrology, Department of MedicineLouisiana State University

Health Sciences CenterShreveport, Louisiana

BOOK REVIEW 519