HEMODIALYSIS
Prepared by,
Avinder Kaur Mann
Group 13
WHAT IT DOES?
It removes wastes from the blood.
It removes excess fluid from the blood
and it keeps electrolytes well balanced.
What sort of things are excreted by the kidney?
Urea - 30 g/day
Creatinine - 2 g/day
Salt - 15 g/day
Uric Acid - 0.7 g/day
Water - 1500 mL/day
Unknown
Kidney failure
accumulation of waste
acidosis, edema, hypertension, coma
Actively Secreted Substances
Hydroxybenzoates
Hippurates
Neutrotransmitters (dopamine)
Bile pigments
Uric acid
Antibiotics
Morphine
Saccharin
Reabsorbed Substances
Glucose
Amino acids
Phosphate
Sulfate
Lactate
Succinate
Citrate
Filtration and Reabsorption of
Water by the Kidneys
L/day mL/min
Filtration 170 120
Resorption 168.5 119
Urine 1.5 1
Excretion
What does this mean in terms of
dialysis?
Purpose - removal of wastes from the body
Kidney should be the ideal model for hemodialysis
Water retention / removal
Salt retention / removal
Protein retention
HOW IT WORKS?
Dialysis works on the principles of the diffusion and
osmosis of salutes and fluids across a semi permeable
membrane.
Blood flows by one side of a semi-permeable
membrane and a dialysate or fluid flows by the
opposite side.
Mechanisms of solute clearance
Diffusive transport
Blood from the patient flowing within the dialysis
apparatus interfacing with dialysate fluid via pores
located within each fiber of the dialysis membrane
Convective transport
In this mechanism, solutes are effectively dragged along
with fluid as it moves across the membrane depending
upon their size relative to the size of the membrane
pores.
Diffusion (true dialysis)
movement due to concentration gradient
If concentration is higher in the blood and the species
can pass through the membrane, transport occurs until
the concentrations are equal
Slow
If dialysate concentration is higher, the flow goes
toward the blood
Convection
Massive movement of fluid across membrane
Fluid carries dissolved or suspended species that can
pass through the membrane
Usually as a result of fluid pressure (both positive and
suction pressure)
Principal means of water and electrolyte removal
(ultrafiltration)
Can also remove water by adding glucose to dialysate
(osmotic gradient)
FUNCTIONS OF BUTTONS OF HEMODIALYSIS
MACHINE
Hollow fiber dialyzers
Contain thousands of
hollow fibers similar in
structure to a human
capillary
Types of membranes
Cellulose
Substituted cellulose
Synthetic
Types of vascular access
AV fistula
AV graft
Central venous catheters
Clinical Indications
Pericarditis or pleuritis
to Start Dialysis
Progressive uremic encephalopathy or neuropathy, with signs such
as confusion, asterixis, myoclonus, wrist or foot drop, or, in severe
cases, seizures
A clinically significant bleeding diathesis attributable to uremia
Fluid overload refractory to diuretics
Persistent metabolic disturbances that are refractory to medical
therapy; these include hyperkalemia, metabolic acidosis,
hypercalcemia, and hyperphosphatemia
Persistent nausea and vomiting
Hypertension poorly responsive to antihypertensive
medications
Weight loss or signs of malnutrition
Possible Indications For Early Dialysis
Most nephrologists agree that delaying initiation of
dialysis until one or more of these complications is present
may put the patient at unnecessary jeopardy
An important goal of dialysis is to enhance the quality of
life as well as to prolong survival
It is therefore important to consider less acute indications
for dialysis
Estimation of GFR (<15 ml/min)
Nutritional status
Complications during dialysis
Common Less common but serious
Hypotension (20-50%) Dialysis disequilibrium
Muscle cramps (5-20%) Arrhythmias
Nausea (5-15%) Cardiac tamponade
Headache (5%) Intracranial bleeding
Itching (5%) Hemolysis
Chest pain/back pain (2-5%) Air embolism
Fever and chills (<1%)
Intradialytic hypotension
There are two clinical patterns of dialysis-associated
hypotension
Episodic hypotension, which typically occurs during the
latter stages of dialysis; this is associated with vomiting,
muscle cramps, and other vagal symptoms (such as yawning).
Chronic persistent hypotension, which may occur in long-
term patients in whom predialysis systolic blood pressures of
less than 100 mmHg are frequently observed.
Serious complications of dialysis
Arrhythmias
Especially common in patients on Digoxin
Intracranial bleeding
Underlying cerebrovascular disease combined with the use of
heparin
Hemolysis
Port wine appearance to blood in return lines
Sudden back/chest pain
Associated with obstruction of blood line and problems with the
dialysis solutions
Air embolism
Enters cerebral venous system in seated patients
Enters right ventricle in recumbent patients
