Major advances in both the technology and the medical knowledge of maintenance hemodialysis have been made since the early stages of such treatment in the 60s. Hemodialysis is now an established therapeutic method. and the time has come to present an up-to-date approach to all its technical and medical aspects. We adopted a simple and concise style with a clear design and a large number of tables and illustrations. so that not only health professionals but patients themselves can easily understand the essentials of hemodialysis. In addition to the most recent technical developments of hemodialysis. particular attention is given to biocompatibility. adequacy of dialysis and patient nutrition. The many clinical problems encountered in the dialysis patient have been especially emphasized. since proper management may prevent most uremia-related complications. Indeed. chronic hemodialysis consists not only of providing the patient with safe and well-tolerated dialysis sessions but also of maintaining good general condition, adequate nutritional status and well-being in the long term. All of us have worked in the field of nephrology and hemodialysis at Necker Hospital for more than 25 years, and several of our very first patients are still enjoying life thanks to hemodialysis. We hope that our experience will be of help to nephrologists. renal nurses and technicians in training so that they can offer their patients, through optimal dialysis, long survival with the best possible quality of life and rehabilitation.

At the end of 1976 there were 34,215 people with end-stage renal disease alive on dialysis and transplantation within the registry centers of the European Dialysis and Transplant Association (14:4, 1977). From July, 1973, when the American Government began to fund dialysis, the estimated number of dialysis patients in the United States has risen from 5,000 plus to over 35,000. Jfwe add other regions, such as Canada, Australasia and Latin America, it is safe to say that as this is written, over 100,000 people are living on dialysis. The u.s. Social Security System, Veterans Administration, Medicaid and State Agencies are now paying out over one billion dollars annually to support patients on dialysis in the U. S.A. Cobe, Redy, Travenol, Dow Cordis, Drake Willock, Gambro, Asahi, Erica and a host of other company names have become household words in many households throughout the world. I cite these factors not out of a pretense at precision or a passion for phenomenology, but simply to indicate that dialysis has become lore than this century's therapeutic miracle. (Perhaps the first treatable fatal chronic, terminal, medical disease I). It has also become big business! As such, it has perhaps become too important to be left solely in the hands of medical specialists, such as nephrologists.