The last 20 years has seen an enormous increase in our knowledge about the management of patients with terminal renal failure. Despite this, even the most successful dialysis and transplant patients require long term specialist supervision so that renal units will have an incremental work load until the death rate of patients undergoing treatment equals the rate of intake of new patients. Furthermore, innumerable conditions which were once regarded as contraindications to therapy may no longer be seen in this light, so that the number of new patients coming forward for treatment each year is increasing rapidly. Dialysis and transplantation are expensive forms of treatment, in terms of staff, facilities and consumables, and it is therefore inevitable that there will be problems in providing treatment for all who need it. These will be particularly acute in times of economic crisis. This book contains the proceedings of a conference which was set up to explore the difference between the supply and the demand for treatment in the United Kingdom, to compare the situation with that in other countries, to explore possible solutions and possibly assign responsibility for the shortfall and to examine the practical and moral implications of our failure to treat the treatable.

The management of chronic renal failure by dialysis and transplantation has now become an established form of treatment in many parts of the world. However, these forms of treatment have brought with them problems in relation to the selection of patients, economics, clinical problems such as hypertension, encephalopathy, anaemia and renal bone disease, and psychological and social problems. The management of haemodialysis has changed over the years with developments in dialysers, vascular access and the duration of dialysis. Although the overall survival from renal trans plantation has changed little in the past four or five years, there are hopes of improvements in relation to tissue typing and enhancement. Perhaps the most important aspect in the management of chronic renal failure is the multi-disciplinary approach. Nursing and medical staff work closely with dialysis technicians, engineers, dietitians, local authority per sonnel, social workers and with the relatives of the patients. The symposium was planned to draw together representatives from all disciplines involved in the care of patients with chronic renal failure. One of the most relevant sessions was that in which two patients with chronic renal failure described their experience."

More than 50 years after Haas' first human dialysis, and second edition by incorporating chapters on its history 40 years after Kolfrs pioneering work, a book on the and on the practical aspects. present state of the art cannot be written by one person: The size of the book has almost doubled, partly by obviously it had to be a multi-authored volume. There using more illustrations. The inclusion of a number of fore some overlap between chapters and even a few con colour reproductions has been made possible by a sup troversies between authors became unavoidable. porting grant * of the National Kidney Foundation of we deliberately avoided editorial streamlin the Netherlands, which the editors gratefully acknow However ing of manuscripts, leaving the authors' personal style ledge. We considered asking several authors to shorten their and personal opinions unaltered as much as possible. We resisted this as it would have delayed the This may make the book more vivid to read and may chapters. sometimes stimulate readers to study a subject in greater publishing date and would possibly have removed much detail from the literature. Additionally, both British and material besides being a painful task for our collea American spellings have been kept because of the inter gues."

BELDING H. SCRIBNER The year was 1942 and Will em Kolff was hard at 60's, we encountered exactly the same kind of work perfecting the device that would not only resistance to the concept of chronic dialysis. But revolutionize the treatment of renal failure, but as has happened over and over again in all of more importantly point the way to the develop science, the heresy of one decade becomes the ment of the entire field of extracorporeal devices practice of the next - a phenomenon that the in general and cardiac bypass devices in particular. young heretics among the third generation readers The enormity of the impact that Kolffs con of this volume should not forget. tribution was to have on medicine was revealed And so, today Drukker, Parsons and Maher retrospectively to me when I recalled that in that have successfully undertaken the very difficult same year, 1942, I was a second year medical task of bringing together in one volume all the student at Stanford University, taking among diverse elements of dialysis therapy. The size of other things, P. J. Hanzlik's required course in the volume reflects not only the magnitude ofthe pharmacology. I have two memories of that interdisciplinary effort that brought about the course. One was the requirement that we students technical and clinical advances, but also the learn to recognize 64 old time drugs by appear many clinical and other ramifications of dialysis ance, smell and taste. For better or worse, almost therapy."