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HEMODIALYSIS: BASICS
By Ahmed Mohammed Abd El Wahab
Lecturer of internal medicine (Nephrology)
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Dialysis
Process by which the solute composition of a solution
“A” is altered by exposing it to a second solution “B”
through a semi-permeable membrane
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Necessary pre-requisites for
Hemodialysis
1) Semi-permeable
membrane
2) Anticoagulation
3) Knowing what to
remove and how much
of it
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1773: Nurepuel isolates Urea by boiling urine in a
pan
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1828: Wohler
synthesizes Urea and
describes its molecular
structure
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Thomas Graham (1805-1869)
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1850 Glasgow,
Scotland:
Thomas Graham „s
experiment to
demonstrate diffusion
across a semi-
permeable membrane
(Pergamon paper)
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Dialysis Membranes
1750:Advances in the dovelopment of smokeless
gunpowder led to the synthesis of a strong
Nitrocellulose called “collodion”. It was a combination
of Nitric acid and cotton
Addition of Camphor to this substance led to the
synthesis of stable and strong “plastics”
1957:Helmut Staldiger polymerized “Cellulose”
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1913:The First Hemodialysis Experiment
0
10
20
30
40
50
60
70
80
90
1st
Qtr
2nd
Qtr
3rd
Qtr
4th
Qtr
East
West
North
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1937: William Thalhimer
successfully lowers BUN by
performing Hemodialysis
in anephric dogs
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1926:The First Human Experiment
George Haas used a
collodion tube
arrangement to
successfully dialyze
human subjects
Allergic reactions to
impurities in Hirudin led
him to abandon his
experiments
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1937:Nils Alwall used
the Alwall Kidney to
perform the first ever
hemodialysis treatment
at the university of Lund,
Sweden
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“ If I have seen farther it is because I have stood on
the shoulders of Giants”
Sir Isaac Newton
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Hemodialysis:History and Current
Perspective
History of Dialysis
Principles of Hemodialysis
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Mechanisms of Solute transfer
Diffusion
Convection
Osmosis
Ultrafilteration
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Diffusive Clearance
A result of random molecular motion
Influenced by concentration gradient of the solute
and its Molecular weight as well as by the
membrane permeability to the solute
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Convective Clearance
Water molecules passing through a SPM carry with
them the solutes in their original concentration. This
is called the “solvent drag phenomenon”
Water can be made to move across a SPM by the
application of either a hydrostatic or an osmotic
gradient
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The Hemodialysis circuit
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Dialysis Membranes
Membrane Hydr.Perm. Examples Biocomp.
Regen. cellulose
Low flux cuprophane Poor
Modif.
Cellulose
Low/High Flux
Cell.acetate
Cell di-acet.
Interm.
Synthetic High/Low flux
PAN,PS,PA,
PC,PMMC
Good
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Dialysis Solution
Component Concentration
mmol/L
Na 140
K 2
Ca 1.25 (5 mg/dl)
Mg 0.5 (1.2 mg/dl)
Acetate 3.0
Chloride 108
Bicarbonate 35
Glucose 5.6 (100 mg/dl)
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Water Purification
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Vascular Access
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Types of Continuous Therapies • Continuous arteriovenous hemofiltration (CAVH)
•Continuous venovenous hemofiltration (CVVH)
• Continuous venovenous hemodialysis (CVVHD) •Continuous venovenous hemodiafiltration (CVVHDF) •Slow low-efficiency diffusion hemodialysis (SLEDD) •Slow continuous ultrafiltration (SCUF)
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Indications for initiating Hemodialysis
In patients with calculated creatinine clearance <20 ml/min/1.73 m2 the onset of:
*Uremic symptoms
Nausea/emesis
Altered sleep pattern
*Altered mental status
Coma
Stupor
Tremor
Asterixis
Clonus
Seizures
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Indications for Hemodialysis
*Pericarditis or Tamponade (urgent indication)
*Uremic platelet dysfunction (urgent indication)
*Refractory volume overload
*Refractory hyperkalemia
*Refractory Metabolic acidosis with anuria
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Non renal :
1. Sepsis
2. Drug removal
3. ARDS
4. Resistant CHF
5. Tumor lysis syndrome
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THANK YOU