PRINCIPLES OF DIALYSIS

• DIFFUSION

• ULTRAFILTRATION

• OSMOSIS

• COUNTER CURRENT FLOW

 DIFFUSION
• SPONTANEOUS PASSIVE TRANSPORT OF SOLUTES FROM BLOOD TO

DIALYSATE ACROSS THE DIALYSIS MEMBRANE BY CONCENTRATION

GRADIENT

• THE VELOCITY OF A MOLECULE IN SOLUTION IS INVERSELY PROPORTIONAL

TO ITS MOLECULAR WEIGHT (MW)

• TRANSPORT RATE OF LOW MW SOLUTES >> HIGH MW SOLUTES

 MOLECULAR WEIGHT

• UREA 60

• CREATININE 113

• GLUCOSE 180

• BETA 2-MICROGLOBULIN 11,600

• ALBUMIN 68,000
 ULTRAFILTRATION
• SIMULTANEOUS TRANSPORT OF SOLVENT & SOLUTES FROM THE BLOOD

COMPARTMENT TO THE DIALYSATE COMPARTMENT ACROSS THE DIALYSIS

MEMBRANE BY PRESSURE GRADIENT

• DEPEND UPON THE DIAMETER OF MEMBRANE PORES & NUMBER OF

PORES PER UNIT MEMBRANE AREA

• HIGH PERMEABILITY MEMBRANE HAVE SIEVING COEFFICIENTS CLOSE TO

NATURAL KIDNEY GLOMERULAR BARRIER

 COUNTER CURRENT FLOW

• THE DIALYSATE IS FLOWING IN THE OPPOSITE DIRECTION TO BLOOD

FLOW IN THE EXTRACORPOREAL CIRCUIT

• COUNTER-CURRENT FLOW MAINTAINS THE CONCENTRATION

GRADIENT ACROSS THE MEMBRANE AT A MAXIMUM AND INCREASES

THE EFFICIENCY OF THE DIALYSIS

 DIALYSATE PREPARATION
• PREPARED FROM SALTS ( MINERAL IONS) OF PHARMACEUTICAL

GRADE DILUTED IN TREATED ULTRA PURE WATER

• TWO TYPES OF DIALYSATE - ACETATE VS BICARBONATE-CONTAINING

DIALYSATE (ACETATE: MORE DIALYSIS-RELATED COMPLICATIONS; LESS

COMMON NOW)
• UREA AND OTHER WASTE PRODUCTS DIFFUSE INTO THE DIALYSIS
SOLUTION

• POTASSIUM AND PHOSPHATE ARE KEPT IN LOW CONCENTRATION

• CONCENTRATIONS OF SODIUM AND CHLORIDE ARE SIMILAR TO

THOSE OF NORMAL PLASMA TO PREVENT LOSS

• SODIUM BICARBONATE IS ADDED IN A HIGHER CONCENTRATION

THAN PLASMA TO CORRECT BLOOD ACIDITY

• A SMALL AMOUNT OF GLUCOSE IS ALSO COMMONLY USED