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
Hypotension (20-50%)
Muscle cramps (5-20%)
Nausea (5-15%)
Headache (5%)
Itching (5%)
Chest pain/back pain (2-5%)
Fever and chills (<1%)
Less common but serious
Dialysis disequilibrium
Arrhythmias
Cardiac tamponade
Intracranial bleeding
Hemolysis
Air embolism
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