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HD Process
HD Process
HD Process
Learning Outcomes:
1. Define hemodialysis.
2. Distinguish the functions of a normal kidney that can be replaced through dialysis.
Outline
1. Normal Kidney functions vs Dialysis
2. Dialysis Principles
3. Dialysis Components
DEFINITION OF TERMS
• SOLUTION – mixture of solute and solvent
• DIALYSATE – solution used during dialysis
• SOLUTES – electrolytes
• TOXINS – end products of metabolism (creatinine, urea etc.)
• SEMI PERMEABLE MEMBRANE – thin, flexible filter, a barrier that allows certain size of
particles to pass thru it.
TRANSPORT MECHANISMS USED IN DIALYSIS
1. Osmosis
Movement of FLUID across a semipermeable membrane from an area of LOWER solute
concentration to an area of HIGHER solute concentration.
2. Diffusion
Movement of dissolved particles (solutes) across a semipermeable membrane from an
area of HIGHER solute concentration to an area of LOWER solute concentration.
FACTORS AFFECTING THE RATE OF DIFFUSION
1. Molecular Size
– Small molecules are cleared faster than larger molecules
2. Membrane Permeability
– Pore size: the larger the pore size, the faster the diffusion
– Number of pores: the higher the number of pores, the faster the diffusion
– Thickness: Thin membranes facilitates better diffusion
– Design
3. Surface Area
– The greater the surface area of the semi-permeable membrane, the more rapidly
diffusion occurs.
4. Temperature
– Molecules moves faster than larger molecules in higher temperature
5. Concentration Gradient
– Difference in the concentration of solutes of the two different fluids
– The higher the concentration gradient, the faster the diffusion occurs
6. Flow Geometry
– Direction of blood flow in relation to the direction of dialysate flow.
Two flow geometries in dialysis:
• Concurrent flow
– Blood flows in same direction with the dialysate.
• Counter-Current flow
– Blood flows in a direction opposite to dialysate flow.
3. Convection
- Transfer of heat and solutes by physical circulation or movement of the parts of a
liquid or gas.
- In dialysis, convective transport (ultrafiltration) leads to SOLVENT DRAG.
- As solvent crosses a semi-permeable membrane, it drags along smaller solutes.
4. Ultrafiltration (UF)
- A convective transport in which solutes move with the solvent
- Water / fluid is driven by either a hydrostatic or osmotic force though the
membrane.
- UF rate is dependent on:
o Total pressure gradient
o Water permeability of membrane (dialyzer)
o Surface area of membrane (dialyzer)
- Can be used to remove water during hemodialysis (HD) sessions, or as means of
solute clearance (by convection) for convective therapies like Hemofiltration(HF) and
Hemodiafiltration (HDF).
DIALYSIS COMPONENTS
1. Dialyzer
- The artificial kidney made of semi – permeable membrane (hollow fibers)
- Two compartments:
Blood
Dialysate
- Compartments are separated by a semi-permeable membrane
- Compartments are enclosed in a clear plastic cylinder which acts a support for the
fibers
FLUX
- Movement of water and solutes through a dialysis membrane
- Measure of Ultrafiltration capacity
- Dependent to particle size, pore size, UF rate and surface area
- Can be low flux or high flux based on Ultrafiltration Coefficient (Kuf)
o Low Flux: <20 ml/hr/mmHg
o High Flux: >20 ml/hr/mmHg
PERMEABILITY
- Measure of clearance of the middle molecular weight molecule (eg; β -2
microglobulin)
- Low permeability: β -2 microglobulin clearance <10 ml/min
- High permeability: β -2 microglobulin clearance >20 ml/min
- Correlated to flux
EFFICIENCY
- Measure of urea clearance
- Based on Urea KoA value, where:
o Ko – mass transfer coefficient
o A – surface area
- Low efficiency: KoA <500ml/min
- High efficiency: KoA >600 ml/min
2. Dialysate
- Is the fluid that is pumped into the filter canister, surrounding the hollow fibers.
- The concentration of solutes in the dialysate fluid determines the diffusion gradients.
- Composed of concentrated electrolytes, bicarbonate and treated water / permeate.
b. Bicarbonate Bath
o Utilizes two concentrate solutions:
Acid Solution (“A”) – contains most of electrolytes (Na, Ca, Mg, K, Cl)
Bicarbonate Solution – Contains sodium (Na) and bicarbonate (HCO3)
REFERENCES
1. Daugirdas J., Handbook of Dialysis, 4th Ed: 2007.
2. Arakama M., Principles of Hemodialysis: Lecture Presentation, 2012.
3. Hemodialysis Training Program for Nurses Course Manual. AESCULAP Academy, B.Braun
Avitum, Philippines Inc.