Hemofiltration is now recognised as the optimal therapeutic solution for supplying renal function in patients with acute renal failure associated with poor hemodynamic conditions This situation is often observed in patients with severe impairment in the function of one or several other organs Since its introduction in the intensive care units in the 1970s, hemofiltration has been subject to some major improvements regarding the required material and devices such as catheters, lines, filters, or pumps This progress has been accompanied by a better knowledge of the management of patients undergoing the technique, especially concerning nutritional support, drug administration, control of body temperature, as well as fluid and electrolytes balance or cost control Moreover, some additional beneficial effects of hemofiltration have been recently pointed out, suggesting that this technique could provide more than an already efficient renal support by removing some substances responsible for an exagger

Continuous Renal Replacement Therapy provides concise, evidence-based, bedside guidance for the management of critically ill patients with acute renal failure, offering quick reference answers to clinicians' questions about treatments and situations encountered in daily practice.

Discovery and Relative Importance of Continuous Arteriovenous HemofIltration Lee W. Henderson Continuous arteriovenous hemofiltration (CAVH) has seen a brisk upswing in popularity in Europe since its introduction by Dr. Kramer and colleagues from Gottingen, West Germany in 1977 [1]. In the United States, the technique re ceived approval as a clinical tool from the Food and Drug Administration in April 1982. This approval flowed, in no small measure, from the extensive expe rience reported from Europe and in particular West Germany [e. g., 2, 3]. Reports of its clinical utility now have begun to appear in the United States [4]. Removal of excess total body water using synthetic membranes in an extracor poreal circuit dates back to the work of Alwall and the artificial kidney that he designed which permitted utilization of a hydrostatic pressure gradient to moti vate water flow across the membrane [5]. Kolffs original rotating drum with its unencased membrane required an osmotic driving force [6]. Hemofiltration, the use of the filtration process to remove uremic solutes with the artificial kidney, in analogy with the glomerulus, was reported in 1967 [7]. This was made possible by the availability of synthetic membranes with far higher hydraulic permeability (approximately 10 times higher) than conventionally used cellulosic hemodialysis membrane. Specific applications of these "high flux" membranes to the removal primarily of excess total body water followed shortly thereafter [8].

On-line HDF represents a major technical development in the delivery of hemodialysis therapy: It combines the properties of increased diffusion available in current high-flux membranes with convective removal of between 6 and 30 liters per treatment and requires the use of ultrapure water and online filtration of replacement fluid. On-line HDF has been successfully introduced in Europe and Asia and is routinely prescribed for dialysis patients in these regions.The book at hand summarizes the history and achievements of on-line HDF in four parts: A report of the technological development in both machine and fiber/dialyzer is followed by a description of the challenges encountered in the evolution of on-line HDF, collecting the accounts of clinical key opinion leaders who had been involved in its early application. The third part presents a comprehensive review of the clinical results achieved with on-line HDF from its inception to the present times, in which it represents the clinical golden standard. The fourth and final part is dedicated to on-line HDF as a ‘vision’ for the future.

We are pleased to present our readers the Proceedings of the International Symposium "New Perspectives in Hemodialysis, Peritoneal Dialysis, Arteriovenous Hemofiltration, and Plasma pheresis" which was held in Freiburg i. Br. (FRG) during Oct tober 6-8, 1988. The meeting was held on the occasion of opening the new dialysis unit of the University Hospital of Freiburg i. Br .. The topics discussed included membrane biocompatibility, catabolic factors associated with dialysis therapy, phar macological therapy in dialyzed patients, erythropoietin and renal anemia, new developments in CAVH, CAPD and plasmapheresis, renal replacement therapy in acute renal failure, and plasmapheresis therapy in systemic diseases. It was unfortunately impossible in this volume, to include the extended, lively and stimulating discussions which were enjoyed by the participants during the conference. The meeting has provided an unique framework for close interaction between scientists from various disciplines, including nephrology, pharmacology, hematology, cardiology, anesthesiology, surgery, intensive care medicine, and patho logy. We would like to express our gratitude and appreciation for all those who have stimulated, encouraged and supported us to hold the symposium in Freiburg. This endeaver could not have been possible without the generous financial support of Asid-Bonz (BOblingen), Bayer AG (Leverkusen), Bayropharm GmbH (Koln), Baxter (Munchen), Ciba-Geigy (Wehr/Baden), Cilag GmbH (Sulzbach), Fresenius AG (Oberursel), Gambro (Martinsried), Gry Pharma GmbH (Kirchzarten), Hoechst AG (Frankfurt), Hospal (Nurnberg), Knoll AG (Ludwigshafen), Lederle-Cyanamid (Wolfratshausen), E. Merck (Darmstadt), MSD Sharp and Dohme GmbH (Munchen), Pfizer GmbH (Karlsruhe), and pfrimmer and Co (Erlangen) ."

Hemodiafiltration (HDF) for the treatment of end-stage renal disease patients is predominantly performed in European countries and in Japan, with some differences in technique such as rate of blood flow and dialysis fluid delivery systems. The main focus of this book is on the clinical importance of online HDF, the techniques of which have been re-evaluated with the introduction of super high-flux membrane dialyzers. After a brief introduction into the history of HDF, recent advances and clinical experiences of HDF are summarized, including water quality control for dialysis fluid, equipped system for safe use, clinical advantages, and theoretical aspects of HDF. Moreover, at the end of each chapter researchers and scientists discuss problems into which further research is needed. Clinicians and scientists involved in the treatment of end-stage renal disease patients will find this publication an essential source of information. Moreover, it may also serve as a textbook for those who are planning to start HDF in their clinics or who are studying blood purification therapies in medical schools, nursing schools and even in engineering schools related to medical technologies.