M a n u a l d e

D i á l i s i s

ADVERTENCIA

La medicina es un área en constante evolución. Aunque deben seguirse unas precauciones de seguridad estándar, a medida que aumenten nuestros conocimientos gracias a la investigación básica y clínica habrá que introducir cambios en los tratamientos y en los fármacos. En consecuencia, se recomienda a los lec-tores que analicen los últimos datos aportados por los fabricantes sobre cada fármaco para comprobar la dosis recomendada, la vía y duración de la administración y las contraindicaciones. Es responsabilidad ineludible del médico determinar la dosis y el tratamiento más indicado para cada paciente en función de su experiencia y del conocimiento de cada caso concreto. Ni los editores ni los directores asumen responsabilidad alguna por los daños que pudieran generarse a personas o propiedades como consecuencia del contenido de esta obra.

El Editor

M a n u a l d e

D i á l i s i s

Cuarta edición

Allen R. Nissenson, MDProfessor of Medicine, Associate Dean,

Director, Dialysis ProgramDavid Geffen School of Medicine, at UCLA

Los Angeles, CA

Richard N. Fine, MDDean, School of Medicine

SUNY at Stoney BrookStony Brook, NY

ELSEVIERMASSON

Este libro está dedicado a la memoria de Hinda Rosenthal, cuya compasión, inteligencia, ingenio y sabios consejos han supuesto una inspiración de

incalculable valor para mí, tanto desde el punto de vista profesional como personal.

Allen R. Nissenson, M.D.

Quiero dedicar esta edición de Manual de diálisis a mi querido amigo y colega, John E. Lewy, MD, cuyo lamentable fallecimiento antes de llegar a

cumplir los 72 años ha supuesto una trágica pérdida para toda la comunidad de la nefrología pediátrica. John fue un pionero en este campo y

nunca olvidaré su amistad y sabiduría.Richard N. Fine, M.D.

ix

Í N D I C E D E C o N t E N I D o S

Sección 1: Demografía

C A P Í t U L o 1Demografía de la población con insuficiencia renal crónica terminal 3Allan J. Collins

Sección 2: Acceso vascular para hemodiálisis

C A P Í t U L o 2Acceso vascular temporal para hemodiálisis 23John J. White, Matthew J. oliver y Steve J. Schwab

C A P Í t U L o 3Evaluación de la disfunción del acceso vascular 37David W. Windus

C A P Í t U L o 4Acceso vascular para hemodiálisis en adultos 49Peter F. Lawrence

C A P Í t U L o 5Principales complicaciones del acceso vascular para hemodiálisis crónica 79Jeffrey L. Kaufman

C A P Í t U L o 6Recirculación del acceso de diálisis 102Richard A. Sherman y toros Kapoian

Sección 3: Dispositivos de acceso peritoneal

C A P Í t U L o 7Dispositivos de acceso peritoneal y técnicas de colocación 111Stephen R. Ash

C A P Í t U L o 8Complicaciones de la inserción del catéter peritoneal agudo 136Anthony R. Zappacosta

Índice de contenidosx

Sección 4: Aspectos mecánicos de la diálisis

C A P Í t U L o 9Equipo de tratamiento del agua para la hemodiálisis hospitalaria: verificación de la calidad del agua y su desinfección 143 Richard A. Ward

C A P Í t U L o 1 0Máquinas de hemodiálisis individuales 157Richard A. Ward

C A P Í t U L o 1 1Diálisis con unipunción 168Matthias Kraemer

C A P Í t U L o 1 2Controles de seguridad en hemodiálisis 188Joanne D. Pittard

C A P Í t U L o 1 3Métodos de anticoagulación en hemodiálisis 224Patrick H. Pun y Eugene C. Kovalik

C A P Í t U L o 1 4Preparación del domicilio e instalación para hemodiálisis domiciliaria 239Christopher R. Blagg y Connie Anderson

C A P Í t U L o 1 5Cicladoras de diálisis peritoneal y otros dispositivos mecánicos 248José A. Diaz-Buxo

Sección 5: Dializadores

C A P Í t U L o 1 6Selección del dializador: consideraciones técnicas y clínicas 263Nicholas Andrew Hoenich y Claudio Ronco

Índice de contenidos xi

C A P Í t U L o 1 7Biocompatibilidad de las membranas de diálisis 279Nicholas Andrew Hoenich y Claudio Ronco

Sección 6: Modelos cinéticos en la hemodiálisis

C A P Í t U L o 1 8Modelo cinético de la urea como guía terapéutica de hemodiálisis en adultos 297Frank A. Gotch

C A P Í t U L o 1 9Fórmulas y nomogramas simplificados para controlar la adecuación de la hemodiálisis 310Richard A. Sherman y Robert Hootkins

Sección 7: Métodos para mejorar los resultados en pacientes de diálisis

C A P Í t U L o 2 0Calidad, seguridad y responsabilidad 321Jay B. Wish

C A P Í t U L o 2 1Inicio del tratamiento de diálisis 341Scott G. Satko y John M. Burkart

C A P Í t U L o 2 2Hemodiálisis diaria 352Andreas Pierratos, Christopher t. Chan y Philip A. McFarlane

C A P Í t U L o 2 3Recomendaciones fundamentales de la NKF-K/DoQI: 364Adeera Levin y Michael V. Rocco

Sección 8: Procedimiento de hemodiálisis

C A P Í t U L o 2 4Venopunción del acceso vascular para hemodiálisis: ciencia y arte 383Lesley C. Dinwiddie

Índice de contenidosxii

C A P Í t U L o 2 5Ultrafiltración aislada 393John J. White, Laura L. Mulloy, Ralph J. Caruana y todd S. Ing

Sección 9: Complicaciones durante la hemodiálisis

C A P Í t U L o 2 6Problemas clínicos frecuentes durante la hemodiálisis 407Peter Kotanko y Nathan W. Levin

C A P Í t U L o 2 7Actividad comicial asociada a la hemodiálisis 418Neenoo Khosla

C A P Í t U L o 2 8Arritmias en los pacientes de hemodiálisis 426Claudio Rigatto y Patrick S. Parfrey

C A P Í t U L o 2 9Prevención y tratamiento de las hemorragias en los pacientes en diálisis 445Paola Boccardo, Miriam Galbusera y Giuseppe Remuzzi

C A P Í t U L o 3 0Hemólisis durante la hemodiálisis 457Ramin Sam, Leila Haghighat, Carl M. Kjellstrand y todd S. Ing

Sección 10: Reutilización de hemodializadores

C A P Í t U L o 3 1Métodos y complicaciones de la reutilización del dializador 469John Kenneth Leypoldt

Sección 11: Técnicas hemodialíticas alternativas

C A P Í t U L o 3 2Aplicación clínica de la hemodiálisis de alta eficacia 481Gerald Schulman

C A P Í t U L o 3 3tratamientos de sustitución renal continua 498André A. Kaplan

Índice de contenidos xiii

C A P Í t U L o 3 4Sistema de hemodiálisis con adsorbente Allient 512Warren B. Shapiro

C A P Í t U L o 3 5tratamientos convectivos de sustitución renal para la insuficiencia renal aguda y la insuficiencia renal crónica terminal 521Jeffrey J. Letteri, Claudio Ronco, Zhongping Huang, Dayong Gao y William R. Clark

Sección 12: Diálisis peritoneal: práctica clínica

C A P Í t U L o 3 6Decisión de las prescripciones de diálisis peritoneal ambulatoria continua y de diálisis peritoneal automatizada 539Scott G. Satko y John M. Burkart

C A P Í t U L o 3 7Diálisis peritoneal tidal 549Zbylut J. twardowski

C A P Í t U L o 3 8Soluciones de diálisis peritoneal 558Declan de Freitas y Alastair J. Hutchison

C A P Í t U L o 3 9Vasos linfáticos, pérdidas de líquido peritoneal y diálisis peritoneal 569Ramesh Khanna

Sección 13: Complicaciones infecciosas de la diálisis peritoneal

C A P Í t U L o 4 0Anomalías de los mecanismos de defensa del huésped durante la diálisis peritoneal 575Clifford J. Holmes

C A P Í t U L o 4 1Infecciones del orificio de salida del catéter peritoneal y del túnel subcutáneo 584Zbylut J. twardowski

Índice de contenidosxiv

C A P Í t U L o 4 2Peritonitis en los pacientes de diálisis peritoneal 596Philip Kam-tao Li, Chi-Bon Leung y Cheuk-Chun Szeto

Sección 14: Complicaciones no infecciosas de la diálisis peritoneal

C A P Í t U L o 4 3Función aparentemente inadecuada de la membrana peritoneal para la eliminación de solutos 617Zbylut J. twardowski

C A P Í t U L o 4 4Fallo de la ultrafiltración y esclerosis peritoneal encapsulante 628Dana Negoi y Ramesh Khanna

C A P Í t U L o 4 5Hipotensión en los pacientes de diálisis peritoneal 640Ramesh Khanna

C A P Í t U L o 4 6Catástrofes abdominales, eosinofilia peritoneal y otras complicaciones infrecuentes en la diálisis peritoneal 645Rajnish Mehrotra y Pranay Kathuria

Sección 15: Complicaciones de la diálisis peritoneal relacionadas con la presión intraabdominal

C A P Í t U L o 4 7Hernias abdominales en la diálisis peritoneal continua ambulatoria 657Michael H. Schwenk, Bruce S. Spinowitz y Chaim Charytan

C A P Í t U L o 4 8Fugas del dializado 662Michael H. Schwenk, Chaim Charytan y Bruce S. Spinowitz

C A P Í t U L o 4 9Hidrotórax y diálisis peritoneal 665Michael H. Schwenk, Bruce S. Spinowitz y Chaim Charytan

Índice de contenidos xv

Sección 16: Homeostasis acidobásica

C A P Í t U L o 5 0Homeostasis acidobásica en diálisis 673F. John Gennari

Sección 17: Tratamiento nutricional de los pacientes en diálisis

C A P Í t U L o 5 1tratamiento nutricional en la hemodiálisis crónica 687Kamyar Kalantar-Zadeh

C A P Í t U L o 5 2tratamiento nutricional en la diálisis peritoneal 703Robert McGregor Lindsay y Evelyn Spanner

C A P Í t U L o 5 3Nutrición parenteral en los pacientes sometidos a diálisis de mantenimiento 715Denis Fouque y Raymond Vanholder

Sección 18: Enfermedades digestivas

C A P Í t U L o 5 4Hepatopatía en los pacientes de diálisis 723Fabrizio Fabrizi, Suphamai Bunnapradist y Paul Martin

C A P Í t U L o 5 5Ascitis en los pacientes de diálisis 734Alf M. tannenberg

Sección 19: Pacientes con infección por VIH

C A P Í t U L o 5 6Cuidados de los pacientes de diálisis infectados por VIH 743Rudolph A. Rodriguez

Sección 20: Anemia y uso de eritropoyetina

C A P Í t U L o 5 7Anemia en los pacientes con insuficiencia renal crónica terminal 761Rebecca J. Schmidt y Anatole Besarab

Índice de contenidosxvi

C A P Í t U L o 5 8Utilización de fármacos estimulantes de la eritropoyesis en pacientes en hemodiálisis 771Arthur tsai y Jeffrey S. Berns

C A P Í t U L o 5 9tratamiento de la anemia en pacientes en diálisis peritoneal 787Curtis A. Johnson, Maureen Wakeen y Stephen W. Zimmerman

C A P Í t U L o 6 0Hipertensión y empleo de eritropoyetina en pacientes en diálisis 796Nosratola D. Vaziri y Madeleine V. Pahl

C A P Í t U L o 6 1Eritropoyetina y ferropenia 804Rajiv Agarwal

C A P Í t U L o 6 2Resistencia al tratamiento con eritropoyetina humana recombinante (r-HuEPo) 812John C. Stivelman

C A P Í t U L o 6 3Eritropoyetina y calidad de vida en la enfermedad renal crónica 832Steven D. Weisbord y Paul L. Kimmel

C A P Í t U L o 6 4Concentración diana de hemoglobina 845Mitchell H. Rosner y W. Kline Bolton

Sección 21: Enfermedad cardiovascular

C A P Í t U L o 6 5Hipertensión en pacientes en diálisis crónica 857Lionel U. Mailloux y Vito M. Campese

C A P Í t U L o 6 6tratamiento de la cardiopatía isquémica, la insuficiencia cardíaca y la pericarditis en los pacientes en hemodiálisis 887Sean W. Murphy y Patrick S. Parfrey

Índice de contenidos xvii

Sección 22: Anomalías metabólicas

C A P Í t U L o 6 7tratamiento de la hiperlipidemia en los pacientes sometidos a diálisis crónica 905Ziad A. Massy y William F. Keane

C A P Í t U L o 6 8Alteraciones de la función tiroidea en pacientes sometidos a diálisis crónica 912Elaine M. Kaptein

C A P Í t U L o 6 9Alteraciones metabólicas: evaluación de la disfunción sexual 930Biff F. Palmer

Sección 23: Aspectos neurológicos de la uremia

C A P Í t U L o 7 0tratamiento de la neuropatía periférica urémica 943Morrell Michael Avram y Neal Mittman

C A P Í t U L o 7 1Electroencefalografía en la evaluación de la función neurológica 951Warren S. Brown

C A P Í t U L o 7 2Impacto de la anemia y su corrección en la función cerebral 958Allen R. Nissenson

Sección 24: Osteodistrofia urémica

C A P Í t U L o 7 3Diagnóstico diferencial de la osteodistrofia renal 965Pouneh Nouri, Bijan Nikakhtar y Francisco Llach

C A P Í t U L o 7 4Quelantes del fósforo 987Laura Kooienga, Antonio Bellasi y Geoffrey A. Block

Índice de contenidosxviii

C A P Í t U L o 7 5Empleo de los esteroles de la vitamina D en pacientes con insuficiencia renal crónica terminal 999Kevin J. Martin y Esther A. Gonzalez

C A P Í t U L o 7 6osteodistrofia relacionada con el aluminioen los pacientes en diálisis 1005William G. Goodman

C A P Í t U L o 7 7tratamiento de la toxicidad por aluminio 1017Antonios H. tzamaloukas y Dominic S.C. Raj

C A P Í t U L o 7 8Paratiroidectomía 1024Phuong-Chi t. Pham y Phuong-thu t. Pham

Sección 25: Amiloidosis por diálisis

C A P Í t U L o 7 9Amiloidosis por diálisis 1041Sergio R. Acchiardo

Sección 26: Enfermedad renal quística adquirida

C A P Í t U L o 8 0Enfermedad renal quística adquirida 1051Margaret MacDougall

Sección 27: Diabetes

C A P Í t U L o 8 1Insuficiencia renal crónica terminal en pacientes diabéticos 1061Jeffrey Giullian y Anthony Langone

C A P Í t U L o 8 2Elección de la vía de administración de la insulina en los pacientes diabéticos con diálisis peritoneal 1076José A. Díaz-Buxo y terri L. Crawford-Bonadio

Índice de contenidos xix

Sección 28: Utilización de fármacos en la uremia

C A P Í t U L o 8 3Principios del uso de fármacos en los pacientes de diálisis 1089Ali J. olyaei y William M. Bennett

Sección 29: Rehabilitación y aspectos psicosociales

C A P Í t U L o 8 4Actividad física y funcional de los pacientes en diálisis 1199Patricia Painter

C A P Í t U L o 8 5Rehabilitación física, psicosocial y profesional de los pacientes adultos de diálisis 1221John H. Sadler

C A P Í t U L o 8 6Consideraciones éticas del cuidado de los pacientes de diálisis 1234Charles Jerome Foulks

Sección 30: Diálisis pediátrica

C A P Í t U L o 8 7Acceso vascular en los niños 1247Darrell L. Cass y Jed G. Nuchtern

C A P Í t U L o 8 8Hemodiálisis infantil 1262Eileen N. Ellis

C A P Í t U L o 8 9Modelo de cinética de la urea para la prescripción de hemodiálisis en niños 1271Avram Z. traum y Michael J. G. Somers

C A P Í t U L o 9 0Anticoagulación en niños sometidos a hemodiálisis 1280Daljit K. Hothi y Elizabeth Harvey

Índice de contenidosxx

C A P Í t U L o 9 1Colocación del catéter peritoneal en niños 1295Mary L. Brandt y Eileen D. Brewer

C A P Í t U L o 9 2Protocolos de seguimiento de diálisis peritoneal pediátrica 1302Karen B. tipton, Suzanne H. White y Mark R. Benfield

C A P Í t U L o 9 3tratamiento nutricional de los niños sometidos a diálisis peritoneal 1320Ashley A. Perilloux e Isidro B. Salusky

C A P Í t U L o 9 4Diálisis peritoneal en lactantes y neonatos 1336Alicia M. Neu

C A P Í t U L o 9 5Diálisis en niños con errores innatos del metabolismo 1345Franz Schaefer

C A P Í t U L o 9 6Ajuste psicosocial y tratamiento de los niños y adolescentes con insuficiencia renal crónica terminal 1352Erik Qvist, Kai Rönnholm y Christer Holmberg

C A P Í t U L o 9 7Crecimiento en niños con insuficiencia renal crónica terminal 1360Steven J. Wassner

C A P Í t U L o 9 8Adecuación de la diálisis peritoneal en pacientes pediátricos 1372Vimal Chadha y Bradley A. Warady

C A P Í t U L o 9 9test de equilibrio peritoneal en pacientes pediátricos 1390Cornelis H. Schröder

C A P Í t U L o 1 0 0terapias de sustitución renal continua en pacientes pediátricos 1404Carl H. Cramer II y Patrick D. Brophy

Índice de contenidos xxi

C A P Í t U L o 1 0 1Prevención y tratamiento de la osteodistrofia en pacientes pediátricos sometidos a diálisis 1417Cheryl P. Sanchez

C A P Í t U L o 1 0 2tratamiento de la anemia en niños sometidos a diálisis 1435Amira Al-Uzri

C A P Í t U L o 1 0 3Valoración de la calidad de vida en pacientes pediátricos sometidos a diálisis 1447Stuart L. Goldstein

C A P Í t U L o 1 0 4Inmunización en niños sometidos a diálisis 1454Jodi M. Smith y Janet A. Englund

C A P Í t U L o 1 0 5Prevención y tratamiento de las complicaciones cardiovasculares 1465Mark M. Mitsnefes

Sección 31: Cirugía

C A P Í t U L o 1 0 6Cirugía en los pacientes con insuficiencia renal crónica terminal 1479Michael J. Moritz y Vincent t. Armenti

Sección 32: Pacientes embarazadas

C A P Í t U L o 1 0 7Embarazo en las pacientes en diálisis 1493Susan Hou

Sección 33: Intoxicación farmacológica

C A P Í t U L o 1 0 8tratamiento de las intoxicaciones con técnicas extracorpóreas 1507James F. Winchester, Nikolas B. Harbord y Donald A. Feinfeld

xxiii

C o L A B o R A D o R E S

Sergio R. Acchiardo, M.D.Professor and Chief, Division of Nephrology, the University of tennessee Health Science Center, Memphis, tennessee

Rajiv Agarwal, MBBS, MD, DNB, FAHA, FASNProfessor of Medicine, Division of Nephrology, Indiana University; Staff Physician, Department of Medicine, VA Medical Center, Indianapolis, Indiana

Amira Al-Uzri, MD, MCRAssociate Professor of Pediatrics, oregon Health & Science University, Portland, oregon

Connie Anderson, BSN, MBADirector of Clinical Services, Northwest Kidney Centers, Seattle, Washington

Vincent T. Armenti, MD, PhDProfessor of Surgery, temple University School of Medicine;Interim Surgical Director, Kidney transplantation,temple University Hospital, Philadelphia, Pennsylvania

Stephen R. Ash, MD, FACPClinical Associate Professor, Indiana University Medical Center, Indianapolis; Director of Dialysis, Department of Nephrology, Arnett-Clarian Health System, Lafayette; Chairman and Director of Research and Development, HemoCleanse, Inc. and Ash Access technologies, Inc., Lafayette, Indiana

Morrell Michael Avram, MDDivision of Nephrology, Long Island College Hospital, Brooklyn, New York

Antonio Bellasi, MDDivision of Nephrology, University of Milan and San Paolo Hospital, Milan, Italy

xxiv Colaboradores

Mark R. Benfield, MDProfessor of Pediatrics, University of Alabama at Birmingham; Professor and Division Director of Pediatric Nephrology, Children’s Hospital, Birmingham, Alabama

William M. Bennett, MDDivision of Nephrology, Legacy Good Samaritan Hospital, Portland, oregon

Jeffrey S. Berns, MDAssociate Professor of Medicine, Renal, Electrolyte, and Hypertension Division, University of Pennsylvania School of Medicine; Penn Presbyterian Medical Center, Philadelphia, Pennsylvania

Anatole Besarab, MDClinical Professor of Medicine, Wayne State University School of Medicine; Director of Clinical Research, Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan

Christopher R. Blagg, MD, FRCPProfessor Emeritus of Medicine, University of Washington; Executive Director Emeritus, Northwest Kidney Centers, Seattle, Washington

Geoffrey A. Block, MDDirector of Clinical Research, Denver Nephrologists, PC, Denver, Colorado

Paola Boccardo, BiolSciDNegri Bergamo Laboratories, Mario Negri Institute for Pharmacological Research, Bergamo, Italy

W. Kline Bolton, MDProfessor of Medicine and Chief of Nephrology, University of Virginia School of Medicine, Charlottesville, Virginia

Mary L. Brandt, MDProfessor and Vice Chair, Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Department of Pediatric Surgery, texas Children’s Hospital, Houston, texas

xxv

Eileen D. Brewer, MDProfessor and Head, Renal Section, Department of Pediatrics, Baylor College of Medicine; Chief, Renal Service, texas Children’s Hospital, Houston, texas

Patrick D. Brophy, MDAssistant Professor of Pediatrics (Pediatric Nephrology), University of Michigan; Department of Pediatrics and Communicable Diseases, CS Mott Children’s Hospital, Ann Arbor, Michigan

Warren S. Brown, PhDProfessor of Psychology and Director of the travis Research Institute, Graduate School of Psychology, Fuller theological Seminary, Pasadena, California

Suphamai Bunnapradist, MDDivision of Nephrology, Maggiore Hospital, IRCCS, Milan, Italy

John M. Burkart, MDProfessor of Internal Medicine, Division of Nephrology and Director, Dialysis Units, Wake Forest University Medical Center, Winston-Salem, North Carolina

Vito M. Campese, MDDepartment of Medicine, the New York University School of Medicine; North Shore University Hospital, Manhasset, New York

Ralph J. Caruana, MDProfessor of Medicine, Division of Nephrology, Hypertension and transplantation,Medical College of Georgia, Augusta, Georgia

Darrell L. Cass, MD Assistant Professor, Michael E. DeBakey Department of Surgery and Department of Pediatrics, Baylor College of Medicine; Co-Director, texas Children’s Fetal Center, texas Children’s Hospital, Houston, texas

Colaboradores

xxvi

Vimal Chadha, MDAssistant Professor of Pediatrics and Chief, Pediatric Nephrology, Virginia Commonwealth University Medical Center, Richmond, Virgina

Christopher T. Chan, MD, FRCPCAssistant Professor of Medicine, University of toronto; Medical Director, Home Hemodialysis, toronto General Hospital, toronto, ontario, Canada

Chaim Charytan, MDClinical Professor of Medicine, Cornell University College of Medicine, New York; Chief, Renal Division, New York Hospital Medical Center of Queens, Flushing, New York

William R. Clark, M.D.Clinical Assistant Professor of Medicine, Nephrology Division, Indiana University School of Medicine, Indianapolis, Indiana; Vice President, Medical Strategy and therapy Development, Gambro, Inc., Lakewood, Colorado

Allan J. Collins, MD, FACPChronic Disease Research Group, Minneapolis, Minnesota

Carl H. Cramer II, MDLecturer, Department of Pediatric and Adolescent Medicine, Division of Pediatric Nephrology, Mayo Clinic, Rochester

Terri L. Crawford-Bonadio, RN, CNNDirector of Professional Education, Fresenius Medical Care North America, Lexington, Massachusetts

Declan de Freitas, MB, BAO, BCh, LRCP&SI, MRCPIRegistrar in Renal Medicine, Manchester Institute of Nephrology and transplantation, the Royal Infirmary, Manchester, United Kingdom

José A. Diaz-Buxo, MD, FACPClinical Professor of Medicine, University of North Carolina, Chapel Hill, North Carolina; Senior Vice President, Home therapies Development, Fresenius Medical Care North America, Lexington, Massachusetts

Colaboradores

xxvii

Lesley C. Dinwiddie, MSN, RN FNP, CNNSenior Vice President, Institute for Clinical Excellence, Education, and Research, Wheaton, Illinois

Eileen N. Ellis, MDProfessor of Pediatrics, University of Arkansas for Medical Sciences; Director, Pediatric Nephrology, Arkansas Children’s Hospital, Little Rock, Arkansas

Janet A. Englund, MD Associate Professor of Pediatrics, University of Washington; Associate Professor of Pediatrics, Section of Infectious Diseases, Children’s Hospital and Regional Medical Center; Clinical Associate, Department of Infection Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington

Fabrizio Fabrizi, MDStaff Nephrologist, Maggiore Hospital, IRCCS, Milan, Italy

Donald A. Feinfeld, MD, FASNProfessor of Clinical Medicine, Albert Einstein College of Medicine, Bronx; Nephrology Fellowship Program Director, Beth Israel Medical Center, New York, New York

Charles Jerome Foulks, MDProfessor of Medicine and Director, Division of Nephrology-Hypertension, texas A&M University Health Science Center and College of Medicine, Scott & White Clinic and Hospital, temple, texas

Denis Fouque, MD, PhDProfessor of Nephrology, JE 2411-University Claude Bernard, Hôpital E. Herriot, Lyon, France

Miriam Galbusera, BiolSciDNegri Bergamo Laboratories, Mario Negri Institute for Pharmacological Research, Bergamo, Italy

Dayong Gao, PhDProfessor of Mechanical Engineering, University of Washington, Seattle, Washington; Professor of Mechanical Engineering, University of Kentucky, Lexington, Kentucky

Colaboradores

xxviii

F. John Gennari, MDRobert F. and Genevieve B. Patrick Professor of Medicine, University of Vermont College of Medicine; Attending Physician, Department of Medicine, Fletcher Allen Health Care, Burlington, Vermont

Jeffrey Giullian, MDClinical Fellow, Division of Nephrology, Vanderbilt University, Nashville, tennessee

Stuart L. Goldstein, MDAssociate Professor of Pediatrics, Baylor College of Medicine; Medical Director, Renal Dialysis Unit and Pheresis Service, texas Children’s Hospital, Houston, texas

Esther A. Gonzalez, MDAssociate Professor of Internal Medicine, Division of Nephrology, Saint Louis University, St. Louis, Missouri

William G. Goodman, MDProfessor of Nephrology, University of California, Los Angeles, California

Frank A. Gotch, MDAssociate Clinical Professor of Medicine, Division of Nephrology, University of San Francisco, San Francisco, California

Leila HaghighatResearch Assistant, Division of Nephrology, Stroger Hospital of Cook County, Chicago, Illinois

Nikolas B. Harbord, MDNephrology Fellow, Beth Israel Medical Center, New York, New York

Elizabeth Harvey, MD, FRCPCAssociate Professor of Pediatrics, University of toronto; Division of Nephrology, Hospital for Sick Children, toronto, ontario, Canada

Colaboradores

xxix

Nicholas Andrew Hoenich, PhDLecturer in Clinical Science, School of Clinical Medical Sciences, Newcastle University; Clinical Scientist, Renal Unit, the Newcastle upon tyne Hospitals NHS trust, Newcastle upon tyne, United Kingdom

Christer Holmberg, MDProfessor of Pediatrics, University of Helsinki; Head of Pediatric Nephrology and transplantation, Hospital for Children and Adolescents, Helsinki, Finland

Clifford J. Holmes, PhDVice President, Scientific Affairs, Renal Division, Baxter Healthcare, McGaw Park, Illinois

Robert Hootkins, MD, PhD, FASNSection Chief, Department of Nephrology and Hypertension, Austin Diagnostic Clinic, Austin, texas

Daljit K. Hothi, MBBS, MRCPCHDepartment of Pediatric Nephrology, Hospital for Sick Children, toronto, ontario, Canada

Susan Hou, MDProfessor of Medicine, Division of Nephrology. Loyola University Stritch School of Medicine, Chicago, Illinois

Alastair J. Hutchison, MBChB, FRCP, MDHonorary Lecturer in Medicine, Manchester University Medical School; Clinical Director and Consultant in Renal Medicine, Renal Unit, Manchester Institute of Nephrology and transplantation, Manchester, United Kingdom

Zhongping Huang, PhDAssistant Professor of Mechanical Engineering, Widener University, Chester, Pennsylvania

Todd S. Ing, MDProfessor Emeritus of Medicine, Loyola University Chicago, Stritch School of Medicine, Maywood; Staff Physician, Department of Medicine, Veterans Affairs Hospital, Hines, Illinois

Colaboradores

xxx

Curtis A. Johnson, PharmDProfessor Emeritus of Pharmacy and Medicine, University of Wisconsin-Madison, Madison, Wisconsin

Kamyar Kalantar-Zadeh, MD, MPH, PhDAssociate Professor of Medicine and Pediatrics, Division of Nephrology and Hypertension, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles; Director of Dialysis Expansion Program and Epidemiology, Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, torrance, California

André A. Kaplan, MD, FACP, FASN Professor of Medicine, Division of Nephrology, University of Connecticut Health Center; Medical Director, University of Connecticut Dialysis Center; Chief, Blood Purification, John Dempsey Hospital, Farmington, Connecticut

Toros Kapoian, MD, FACPAssociate Professor of Medicine, Division of Nephrology and Hypertension, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School; Medical Director, Kidney Center of New Jersey; Robert Wood Johnson University Hospital; Medical Director, Dialysis Clinic, Inc., North Brunswick, New Jersey

Elaine M. Kaptein, MD, FACPProfessor of Medicine, Division of Nephrology, University of Southern California; Division of Nephrology, LAC+USC Medical Center, Los Angeles, California

Pranay Kathuria, MDAssociate Professor of Medicine and Chief, Section of Nephrology, University of oklahoma College of Medicine, tulsa, oklahoma

Jeffrey L. Kaufman, MD, FACSAssociate Professor of Surgery, tufts University School of Medicine, Boston; Vascular Surgeon, Baystate Medical Center, Springfield, Massachusetts

Colaboradores

xxxi

William F. Keane, MDVice-President, External Medical and Scientific Affairs, Merck & Company, Inc., North Wales, Pennsylvania

Ramesh Khanna, MDProfessor of Medicine and Director, Division of Nephrology, University of Missouri- Columbia, Columbia, Missouri

Neenoo Khosla, MDAssistant Professor of Nephrology, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Paul L. Kimmel, MD, FACP, FASNProfessor of Medicine and Director, Division of Renal Diseases and Hypertension, George Washington University School of Medicine, Washington, DC

Carl M. Kjellstrand, MD, PhD, FACP, FRCP(C)Clinical Professor of Medicine, Loyola University, Chicago; Vice President, Medical Affairs, Aksys Ltd., Lincolnshire, Illinois

Laura Kooienga, MDAssistant Professor, Division of Renal Diseases and Hypertension, University of Colorado Health Science Center, Denver, Colorado

Peter Kotanko, MD Krankenhuas der Barmherzigen Brueder, Abteilung Innere Medizin, Graz, Austria

Eugene C. Kovalik, MD, CM, FRCPCCS, FACPAssociate Professor of Medicine, Division of Nephrology, Duke University Medical Center, Durham, North Carolina

Matthias Kraemer, MDScientific and Medical Affairs, Fresenius Biotech GmbH, Bad Homburg, Germany

Anthony Langone, MDAssistant Professor of Medicine, Division of Nephrology, Vanderbilt University; Medical Director, Kidney transplantation, Veterans Affairs Hospital, Nashville, tennessee

Colaboradores

xxxii

Peter F. Lawrence, MDProfessor of Surgery, Chief of Vascular Surgery, and Director of the Gonda Vascular Center, David Geffen School of Medicine, University of California, Los Angeles;University of California, Los Angeles, Center for Health Sciences, Los Angeles, California

Jeffrey J. Letteri, BSGambro, Inc., Lakewood, Colorado

Chi-Bon Leung, MB, FRCPSenior Medical officer, Department of Medicine and therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong

Adeera Levin, MD, FRCPCProfessor of Medicine, Division of Nephrology, University of British Columbia; Division of Nephrology, St. Paul’s Hospital; Director, BC Provincial Renal Agency,Vancouver, British Columbia, Canada Nathan W. Levin, MDProfessor of Clinical Medicine, Albert Einstein College of Medicine; Attending Physician, Beth Israel Medical Center; Medical and Research Director, Renal Research Institute, New York, New York

John Kenneth Leypoldt, PhDResearch Professor of Medicine and Adjunct Professor of Bioengineering, Department of Medicine, University of Utah; Research Service, VA Salt Lake City Health Care System, Salt Lake City, Utah

Philip Kam-Tao Li, MD, FRCP, FACPProfessor and Chief of Nephrology, Department of Medicine and therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong

Robert McGregor Lindsay, MD, FRCPC, FRCP(Edin), FACP, FRCP(Glasg)Professor of Medicine, Division of Nephrology, the University of Western ontario and London Health Sciences Centre, London, ontario, Canada

Colaboradores

xxxiii

Francisco Llach, MDProfessor and Director of Clinical Nephrology, Georgetown University Medical Center, Washington, D.C.

Margaret MacDougall, MD, PhDClinical Associate Professor of Medicine, SUNY Upstate Medical University, Syracuse, New York

Lionel U. Mailloux, MD, FACPAssociate Professor of Medicine, New York University School of Medicine; Senior Attending Physician, Department of Medicine, North Shore University Hospital, Manhasset; Attending Physician, Division of Nephrology, St. Francis Hospital and Heart Center, Roslyn, New York

Kevin J. Martin, MB, BCh, FACPProfessor of Internal Medicine and Director, Division of Nephrology, Saint Louis University, St. Louis, Missouri

Paul Martin, MDProfessor of Medicine and Associate Director, Division of Liver Diseases, Mount Sinai School of Medicine, New York, New York

Ziad A. Massy, MD, PhDProfessor of Pharmacology and Director, INSERM ERt 12, University of Picardie; Professor of Clinical Pharmacology and Nephrology, Amiens University Hospital, Amiens, France

Philip A. McFarlane, MD, PhD, FRCP(C)Professor, Division of Nephrology, University of toronto; Medical Director, Home Dialysis, St. Michael’s Hospital, toronto, ontario, Canada

Rajnish Mehrotra, MD, FACP, FASNAssociate Professor of Medicine, David Geffen School of Medicine, University of California, Los Angeles; Director, Peritoneal Dialysis, Department of Medicine, Harbor-UCLA Medical Center; Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, torrance, California

Colaboradores

xxxiv

Mark M. Mitsnefes, MD, MSAssociate Professor of Pediatrics, University of Cincinnati; Pediatric Nephrology, Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, ohio

Neal Mittman, MDDivision of Nephrology, Long Island College Hospital, Brooklyn, New York

Michael J. Moritz, MDChief, Section of transplantation, Lehigh Valley Hospital, Allentown, Pennsylvania

Laura L. Mulloy, DOProfessor of Medicine and Section Chief of Nephrology, Hypertension and transplantation Medicine, Medical College of Georgia, Augusta, Georgia

Sean W. Murphy, MDAssociate Professor of Medicine, Divisions of Nephrology and Clinical Epidemiology, the Health Sciences Centre, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada

Dana Negoi, MDAssistant Professor of Clinical Medicine and Medical Director, Medicine Specialty Clinic, University of Missouri, Columbia, Missouri

Alicia M. Neu, MDAssociate Professor of Pediatrics, the Johns Hopkins University School of Medicine; Medical Director, Pediatric Dialysis and Kidney transplantation, Department of Pediatric Nephrology, the Johns Hopkins Hospital, Baltimore, Maryland

Bijan Nikakhtar, MDDivision of Nephrology, Georgetown University Medical Center, Washington, D.C.

Colaboradores

xxxv

Allen R. Nissenson, MD, FACPProfessor of Medicine, Associate Dean, Director, Dialysis Program, and Attending Physician, Department of Medicine, University of California, Los Angeles, Medical Center, Los Angeles, California

Pouneh Nouri, MDDivision of Nephrology, Georgetown University Medical Center, Washington, D.C.

Jed G. Nuchtern, MDAssociate Professor, Michael E. DeBakey Department of Surgery and Department of Pediatrics, Baylor College of Medicine, Houston, texas

Matthew J. Oliver, MDDivision of Nephrology, Medical College of Georgia, Augusta, Georgia

Ali J. Olyaei, PharmD, BCPSAssociate Professor of Medicine, Division of Nephrology and Director, Clinical trials, oregon Health and Science University, Portland, oregon

Madeleine V. Pahl, MD, FACPAssociate Professor of Medicine, Division of Nephrology, University of California, Irvine; Director of Renal Clinic, Division of Nephrology, University of California, Irvine, Medical Center, orange, California

Patricia Painter, PhDAssociate Professor of Medicine, Division of Renal Medicine, University of Minnesota, Minneapolis, Minnesota

Biff F. Palmer, MDProfessor of Internal Medicine and Director, Renal Fellowship training Program, Division of Nephrology, University of texas Southwestern Medical Center, Dallas, texas

Patrick S. Parfrey, MD, FRCPCUniversity Research Professor, Department of Medicine, Memorial University; Staff Nephrologist, Eastern Health, St. John’s, Newfoundland, Canada

Colaboradores

xxxvi

Ashley A. Perilloux, MS, RDPediatric Renal Dietitian, University of California, Los Angeles/DaVita Pediatric Dialysis, Los Angeles, California

Phuong-Chi T. Pham, MDAssociate Clinical Professor of Medicine, Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles; Division of Nephrology, olive View-UCLA Medical Center, Sylmar, California

Phuong-Thu T. Pham, MDAssistant Clinical Professor of Medicine, Kidney and Pancreas transplantation, David Geffen School of Medicine, University of California, Los Angeles, California

Andreas Pierratos, MD, FRCPCAssociate Professor of Medicine, University of toronto; Head, Home Hemodialysis, Department of Medicine, Humber River Regional Hospital, toronto, ontario, Canada

Joanne D. Pittard, MS, RNProfessor of Allied Health, Community Services Education, Glendale Community College, Santa Monica, California

Patrick H. Pun, MDFellow in Nephrology, Duke University Medical Center, Durham, North Carolina

Erik Qvist, MD, PhDProfessor, University of Helsinki; Pediatric Nephrology and transplantation, Hospital for Children and Adolescents, Helsinki, Finland

Dominic S.C. Raj, MD, DMAssociate Professor of Medicine, Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico

Giuseppe Remuzzi, MD, FRCPDirector, Division of Nephrology and Dialysis, Azienda ospedaliera ospedali Riuniti di Bergamo; Research Coordinator, Negri Bergamo Laboratories, Mario Negri Institute for Pharmacological Research, Bergamo, Italy

Colaboradores

xxxvii

Claudio Rigatto, MD, FRCPC, MACP, MScAssistant Professor of Medicine, University of Manitoba; Staff Nephrologist, Manitoba Renal Program, Winnipeg, Manitoba, Canada

Michael V. Rocco, MD, MSCE, FACPProfessor of Internal Medicine (Nephrology), Wake Forest University School of Medicine; Division of Nephrology, North Carolina Baptist Hospital, Winston-Salem, North Carolina

Rudolph A. Rodriguez, MDAssociate Professor of Medicine, Division of Nephrology, University of Washington; Section Head, Primary and Specialty Medicine Service Line, VA/Puget Sound Medical Center, Seattle, Washington

Claudio Ronco, MDDirector, Department of Nephrology, Dialysis, and transplantation, St. Bortolo Hospital, Vicenza, Italy

Kai Rönnholm, MD, PhDProfessor, University of Helsinki; Pediatric Nephrology and transplantation, Hospital for Children and Adolescents, Helsinki, Finland

Mitchell H. Rosner, MDAssistant Professor of Medicine and Associate Chief for Faculty Development, Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia

John H. Sadler, MDAssociate Professor Emeritus of Medicine, Division of Nephrology, University of Maryland; President and Chief Medical officer, Independent Dialysis Foundation, Baltimore, Maryland

Isidro B. Salusky, MDProfessor of Pediatrics, Associate Dean of Clinical Research, Director, Pediatric Dialysis Program, Director, General Clinical Research Center, David Geffen School of Medicine, University of California, Los Angeles, California

Colaboradores

xxxviii

Ramin Sam, MDAssistant Professor of Medicine, University of Illinois at Chicago Medical Center; Physician, Stroger Hospital of Cook County, Chicago, Illinois

Cheryl P. Sanchez, MDAssociate Professor of Pediatrics, University of Wisconsin School of Medicine and Public Health; Department of Pediatrics, University of Wisconsin Children’s Hospital, Madison, Wisconsin

Scott G. Satko, MDAssistant Professor of Medicine and Director, Nephrology Fellowship Program, Division of Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Franz Schaefer, MDProfessor of Pediatrics, University of Heidelberg; Chief, Division of Pediatric Nephrology, Hospital for Pediatric and Adolescent Medicine, Heidelberg, Germany

Rebecca J. Schmidt, DO, FACP, FASNProfessor of Medicine and Chief, Section of Nephrology, West Virginia University School of Medicine; West Virginia University Hospitals, Morgantown, West Virginia

Cornelis H. Schröder, MD, PhDProfessor of Pediatric Nephrology, University Medical Center, Wilhelmina Children’s Hospital, Utrecht, the Netherlands

Gerald Schulman, MD, FAANProfessor of Medicine, Director of Hemodialysis, Co-Director of Clinical trials Center in Nephrology, Vanderbilt University Medical Center, Nashville, tennessee

Steve J. Schwab, MDDepartment of Medicine, Division of Nephrology, Medical College of Georgia, Augusta, Georgia

Michael H. Schwenk, PharmDDivision of Nephrology and Hypertension, the New York Hospital of Queens, Flushing, New York

Colaboradores

xxxix

Warren B. Shapiro, MDAssociate Professor of Clinical Medicine, State University of New York Health Sciences Center at Brooklyn; Co-Chief, Division of Nephrology and Hypertension, Brookdale University Hospital and Medical Center, Brooklyn, New York

Richard A. Sherman, MDProfessor of Medicine, Division of Nephrology, University of Medicine and Dentistry of New Jersey— Robert Wood Johnson School of Medicine, New Brunswick, New Jersey

Jodi M. Smith, MD, MPHAssistant Professor of Pediatrics, University of Washington; Division of Nephrology, Children‘s Hospital and Regional Medical Center, Seattle, Washington

Michael J.G. Somers, MDAssistant Professor of Pediatrics, Harvard Medical School; Director of Clinical Services, Division of Nephrology, Children’s Hospital Boston, Boston, Massachusetts

Evelyn Spanner, MSc, RDRenal Program, London Health Sciences Centre, London, ontario, Canada

Bruce S. Spinowitz, MD, FACPAssociate Clinical Professor of Medicine and Associate Chairman, Department of Medicine, New York Hospital of Queens, Flushing, New York

John C. Stivelman, MDAssociate Professor of Medicine, Division of Nephrology, University of Washington School of Medicine; Chief Medical officer, Northwest Kidney Centers, Seattle, Washington

Cheuk-Chun Szeto, MD, FRCPProfessor, Department of Medicine and therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong

Colaboradores

xl

Alf M. Tannenberg, MDProfessor of Clinical Medicine, New York Medical College; Chief, Renal Service, Metropolitan Hospital Center, New York, New York

Karen B. Tipton, RN, BSN, CPNDirector, Renal Care Center, Children’s Hospital of Alabama, Birmingham, Alabama

Avram Z. Traum, MDHarvard Medical School; Division of Nephrology, Children’s Hospital Boston, Boston, Massachusetts

Arthur Tsai, MDPost-doctoral Fellow, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Zbylut J. Twardowski, MD, PhDProfessor Emeritus of Medicine, Division of Nephrology, University of Missouri, Columbia, Missouri

Antonios H. Tzamaloukas, M.D.Professor of Medicine, University of New Mexico School of Medicine; Chief, Renal Section, New Mexico Veterans Affairs Health Care System; Staff Nephrologist, University of New Mexico Hospital; Nephrologist, Dialysis Clinics, Inc., Albuquerque, New Mexico

Raymond Vanholder, MDDepartment of Internal Medicine, Nephrology Section, University Hospital, Ghent, Belgium

Nosratola D. Vaziri, MD, MACPProfessor of Medicine, Physiology and Biophysics, Division of Nephrology, University of California, Irvine; Chief, Division of Nephrology and Hypertension, University of California, Irvine Medical Center, orange, California

Maureen Wakeen, RN, MSDepartment of Medicine, Division of Nephrology, University of Wisconsin and University of Wisconsin Hospital, Madison, Wisconsin

Colaboradores

xli

Bradley A. Warady, MDProfessor of Pediatrics, University of Missouri-Kansas City School of Medicine; Associate Chairman, Department of Pediatrics, Chief, Section of Pediatric Nephrology, and Director, Dialysis and transplantation, Children’s Mercy Hospital, Kansas City, Missouri

Richard A. Ward, PhDProfessor of Medicine, Division of Nephrology, Kidney Disease Program, University of Louisville, Louisville, Kentucky

Steven J. Wassner, MDVice-Chair for Education and Chief, Division of Pediatric Nephrology and Hypertension, Penn State University College of Medicine; Department of Pediatrics, the Penn State Children’s Hospital, the Milton S. Hershey Medical Center, Hershey, Pennsylvania

Steven D. Weisbord, MD, MScAssistant Professor of Medicine, Renal-Electrolyte Division, University of Pittsburgh School of Medicine; Staff Physician, Renal Section and Core Investigator, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania

John J. White, MDAssistant Professor, Division of Nephrology, Medical College of Georgia, Augusta, Georgia

Suzanne H. White, RN, CNPNurse Clinician, Renal Care Center, Children’s Hospital of Alabama, Birmingham, Alabama

James F. Winchester, MDChief, Division of Nephrology, Beth Israel Medical Center, New York, New York

David W. Windus, MDProfessor of Medicine, Renal Division, Washington University School of Medicine; Attending Physician, Barnes-Jewish Hospital, St. Louis, Missouri

Colaboradores

xlii

Jay B. Wish, MDProfessor of Medicine, Case Western Reserve University; Medical Director, Hemodialysis Services, Division of Nephrology, University Hospitals Case Medical Center, Cleveland, ohio

Anthony R. Zappacosta, MDDirector of Dialysis, Campus Chief, Nephrology, Department of Medicine, the Bryn Mawr Hospital, Bryn Mawr, Pennsylvania

Stephen W. Zimmerman, MDProfessor Emeritus, Department of Medicine, University of Wisconsin; Division of Nephrology, Saint Mary’s Hospital; Madison Area Renal Specialists, Madison, Wisconsin

Colaboradores

xliii

P R Ó L o G o

La población de pacientes sometidos a diálisis continúa creciendo en todo el mundo. Las economías emergentes, así como los países en vías de desarrollo han optado por utilizar los recursos para exten-der la vida de las personas que padecen insuficiencia renal crónica terminal. A pesar de los esfuerzos activos para utilizar el trasplante renal como opción viable en los posibles receptores que presentan una insuficiencia renal crónica terminal, el incremento del número de trasplantes realizados cada año ha sido modesto y, sin duda, por desgracia es inadecuado en comparación con el aumento anual de la población de pacientes sometidos a diálisis. Cualquier incremen-to en el número de trasplantes renales realizados cada año se debe, al menos en Estados Unidos, a la mayor disponibilidad de donantes vivos. La limitada disponibilidad de órganos de donantes fallecidos sigue suponiendo un obstáculo para el éxito de los trasplantes rena-les en todo el mundo. Por consiguiente, los pacientes requieren diálisis durante períodos prolongados de tiempo. Esto da lugar al desarrollo y/o la progresión de la uremia, así como de los trastornos comórbidos asociados: hipertensión, enfermedad cardiovascular y alteraciones relacionadas con la diabetes mellitus. El objetivo de la edición inicial de Manual de diálisis fue reca-bar la participación de expertos destacados de varias áreas de la diálisis clínica para abordar, de forma sucinta, los problemas clí-nicos esenciales que se presentan en adultos y niños sometidos a diálisis. La intención fue proporcionar un enfoque práctico con el fin de ayudar a los lectores a resolver los problemas específicos de los pacientes. El libro Manual de diálisis se elaboró para ayu-dar a los nefrólogos (pediátricos y de adultos), personal de enfer-mería, técnicos y otros profesionales sanitarios a solucionar la infinidad de problemas que surgen a la hora de enfrentarse a los pacientes sometidos a diálisis. Ya ha pasado casi una década de la 3.ª edición de Manual de diálisis y la práctica de la diálisis continúa modificándose para adaptarse a la creciente complejidad de la población de pacientes y a los avances técnicos y farmacológicos. Muchos de los colabora-dores de esta edición de Manual de diálisis han contribuido a las ediciones previas. Sin embargo, en la 4.ª edición participan 29 co-laboradores nuevos que han aportado una novedosa perspectiva a los problemas clínicos que se encuentran en diálisis. De forma similar, el formato de esta 4.ª edición se ha actualiza-do respecto a las ediciones previas. Además de añadir capítulos

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nuevos, se ha prestado especial atención a la legibilidad del texto, las tablas y las figuras. La modificación del tamaño del libro para hacerlo más manejable y el uso frecuente del color son mejoras adicionales. Queremos expresar nuestro agradecimiento a todos nuestros co-laboradores por su extraordinario trabajo y esperamos que este libro se convierta en una referencia útil para médicos, personal de enfer-mería, técnicos, dietistas, trabajadores sociales y gestores sanitarios, todos los cuales intentan optimizar la asistencia clínica de los pa-cientes sometidos a diálisis. Los editores deseamos expresar nuestro agradecimiento a Susan Pioli, de Elsevier, cuya ayuda ha sido de inestimable valor para hacer posible la publicación de esta obra.

Allen R. Nissenson, MDRichard N. Fine, MD

Editores

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