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To DxzerohighOTHER TOXINS
To Dx1.4-3.0Above 5Potassium
To Dx0.5-1.0Above 1Magnesium
+/-180 (10)+/-140 (8)glucose
Dialysate delivered at a rate of 500ml/min
◦ 120 liters of dialysate / 4-hour session!!
Concentrated solutions mixed with water
Usually 1:34 or 1:40
Conductivity is a measurement of electric conductivity of Na to check
if dilution is correct
With proper dilution conductivity = 13-15
Serious hyponatremia or hypernatremia occurs if dilution is incorrect
H+ neutralized by Na HCO3 in the body
◦ Transformed in LIVER to HCO3 (10-15 min)
◦ BUT is a potent vasodilator
Hypotension especially with liver disease
Acetate intolerance in high flux dialyzers
◦ Immediately neutralizes H+
◦ BUT precipitates Calcium salts (CaCO3)
Should be delivered separately as NaHCO3
Short life span of machine
Needs a strong post dialysis acid rinse (citric acid)
Attempts are made to increase the surface area of
contact between dialysate and dialyzer
◦ The Hollow fiber
◦ The parallel plate dialyzer
◦ Surface area.
◦ Low flux vs high flux.
◦ Technique of manufacture including hemo- adsorption.
Cellulose membrane (Cuprophan)
◦ Is the first membrane to be used
◦ Contains free hydroxyl radicals
◦ They are bio-incompatible (BIC)
They are able to activate complement a inflammatory reaction a
chronic inflammation a protein catabolism + anorexia + malnutrition
a Cardiovascular accidents
Cause dialysis related Amyloidosis
Increased incidence of infection
Rapid loss of residual kidney function
◦ Cuprophan is BIC BUT this effect can be abolished after 2nd
◦ Chemically bonding the free hydroxyl group
Cellulose di acetate
◦ Addition of a synthetic material to cellulose
Hemophane (semi synthetic)
Synthetic modified cellulose (SMC)
◦ Contains no cellulose
There is no definite techniques for biocompatibility
There is no clear evidence for its superiority except in
Ability of the dialyzer to clear urea from blood
The more clearance the better the dialyzer
Clearance can be calculated in vivo=
Qb x [BUN ART – BUN VEN]
Clearance is closely related to the surface area of HF
HF with a high urea clearance
◦ They contain pores bigger in number and size
◦ Must be with bicarbonate dialysis
◦ They perform more adequate dialysis
◦ Clearance of bigger molecules toxins e.g. (B2 microglobulin)
The number of ml/hour of water the dialyzer can remove
for every 1 mm Hg rise in TMP
E.g. a HF with KUF of 1 can remove 100ml/hour with
TMP of 100
For volumetric machines HF with KUF above 4 should be
used to give accurate results
The more the patient’s weight the larger surface area (and clearance)
Patients with increased weight gain (volume overload) need a dialyzer
with high KUF
Much debate is present with use of biocompatible membrane EXCEPT
High Flux dialyzer gives a better adequacy but is expensive
ESRD patients are frequently oliguric
If excess water is ingested a
accumulation of water in body a
edema, hypertension, pulmonary edema
To remove water a Ultrafiltration
Addition of hydrostatic force a squeezing out water from dialysate!!!
may be –ve (machine UF)
Or +ve (partial venous clamping)
The net force is reflected by the transmembrane pressure (TMP)
extracorporeal removal of waste products from the
blood of patient who has poorly functioning kidneys with
replacement of some materials deficient in the patient.
The process by which particles, atoms or molecule move from
area of higher concentration to lower concentration across
Factors affecting :
MW of solutes.
Problems with conventional diffusive hemodialysis
Excessive cardiovascular mortality
Insufficient removal of middle molecules
Insufficient removal of phosphate
High risk of intradialytic hypotension
Suboptimal dialysate quality
Chronic inflammation and protein-energy wasting
Is movement of fluid through a filter as a result of hydraulic
In hemodialysis, ultrafiltration , is movement of water from
blood under pressure gradient effect.
Transfer of heat and solute by
physical circulation or or movement
of parts of gas or liquid.
Hemoperfusion therapy (DHP) is a method of treatment to
eliminate causal substances of disease in the blood by adsorption
that takes place by passing the blood directly through an adsorbent.
DHP is characterized by a simple extracorporeal blood circuit and
easy operation. Activated charcoal, and either polymyxin B or
hexadecyl alkyl compound immobilized adsorbents, are clinically
available at present.
The DHP using activated charcoal is mainly applied in cases of
intoxication with either toxic substances or a drug overdose.
Hemodialysis or plasma exchange is also applied in these situations.
Application of either DHP, hemodialysis or plasma
exchange is done according to the characteristics of the
toxins or drugs.
DHP using PMX is applied in cases of septic shock, and
its efficiency is suggested to be due to the removal of
anandamide in addition to endotoxins in the blood.
DHP using BM-01 is applied to a specific disease, dialysis
related amyloidosis, for the purpose of elimination of β2-
Principle method of
CVVHDF Convection & Diffusion
SCUF Ultrafiltration (fluids)
HDF is a blood purification therapy combining diffusive
and convective solute transport using a high-flux membrane
characterized by an ultrafiltration coefficient greater than 20
mL/h/mm Hg/m2 and a sieving coefficient (S) for β2-
microglobulin of greater than 0.6.
Convective transport is achieved by an effective convection
volume of at least 20% of the total blood volume processed.
Appropriate fluid balance is maintained by external infusion of
a sterile, non-pyrogenic solution into the patient's blood.
Kt/V is a number used to quantify hemodialysis and
peritoneal dialysis treatment adequacy.
K - dialyzer clearance of urea
t - dialysis time
V - volume of distribution of urea, approximately equal to patient's
total body water
◦ Kt/V target is ≥ 1.3, so that one can be sure that the delivered
dose is at least 1.2. In peritoneal dialysis the target is ≥