DIALYZER

By
Daniel V
Dialysis Lecturer
OBJECTIVE
 DIALYZER
 TYPES OF DIALYZER
 MEMBRANES
 TYPES OF DIALYZER MEMBRANE
 PORE SIZE (FLUX)
 SURFACE AREA (EFFICIENCY)
 BIOCOMPATIBILITY
 STERILIZATION METHOD
 INTRODUCTION

The dialyzer is where the blood and dialysis solution circuits meet, and where the
movement of molecules between dialysis solution and blood across a
semipermeable membrane occurs

Basically the dialyzer shell is a box or tube with four ports . Two ports communicate
with blood compartment and two with a dialysis solution compartment
The membrane within the dialyzer separates the two compartment
BASIC STRUCTURE OF
DIALYZER
TYPES OF DIALYZER
CONFIGURATION
 Rotating Drum Dialyzer
 Coiled Dialyzer
 Parallel Plate Dialyzer
 Hollow Fiber Dialyzer
ROTATING DRUM DIALYZER
 Willem Kolff of the Netherlands, was able to secure a success in Kampen in
1945
 Kolff used a rotating drum kidney to treat a 67-year-old patient with ARF.
 Kolff’s rotating drum kidney used membranous tubes made from a new
material known as cellophane.
 During the treatment, the blood-filled tubes were wrapped around a wooden
drum that rotated through an electrolyte solution known as “dialysate”.
 As the membranous tubes passed through the bath, the uremic toxins would
pass into this rinsing-liquid using physical principles of diffusion.
COIL DIALYZER
 Coil dialyzers are constructed from one or several pieces of cellulose
membrane tubing wound around a central core. A support screen maintains the
tubing in position. Blood flows through the tubing while dialysate flows
through the supporting screen
  They are highly compliant with high blood flow resistance
 ultrafiltration was unpredictable and blood leaks were more frequent
 coil dialyzer are no longer in use
COIL DIALYZER
 PARALLEL PLATE DIALYZER
 Parallel plate dialyzer was introduced by Skegg’s Leonard followed by development
and modification by Kiil.
 Membranes were assembled in layers like a sandwich.
 Sheets of membranes are placed between supporting plates or mesh.

 The plates have ridges grooves or cross hatches to support the membrane and allow
flow of dialysate along it.
 Resistance to blood flow is low.
 A variety of membranes are available with surface area from about 0.25 m² to 1.5m².

 Blood volume is about 50-100 ml at 100 mmHg with a 10-25% increase at 200
mmHg depending upon the compliance of the particular membrane .
ADVANTAGE
 Heparin requirements are low.

 Minimal clotting in the blood compartment

 Ultrafiltration is reasonable, predictable and controllable.

 They are very inexpensive.

 Contained blood volume is relatively small.

 DISADVANTAGE
 The uneven blood flow around the inlet and outlet parts and in the corners of the

blood compartment could produce local thrombi.

 Resistance to rising and are potential sources of bacterial growth and endotoxin

formation.

 They are very complaint, (the volume of blood they hold increase as the TMP

increases).

 They do not reuse very well, and efficiency of the reprocessed plate cannot be
determined by total cell volumes due to their compliancy .
HOLLOW FIBER DIALYZER
 Hollow fiber dialyzers are the most common type of dialyzers in use nowadays.

 They are marketed in a variety of sizes and membranes.

 They are constructed of rigid hollow tubes that are made of semi permeable

membrane materials.

 Tiny hollow fibers of approximately 150-250 μm in diameter are used.

 These are formed from a variety of materials.

 The number of fibers may be 5,000-20,000 or more, depending upon length,

kind of membrane and the surface area of the dialyzer.

STRUTURE OF HOLLOW FIBRE
DIALYZER
 In the hollow fibre dialyzer the blood flows into a chamber at one end of the
cylindrical shell called a header
 from there blood enters thousands of small capillaries tightly bound in a
bundle
 The dialyzer is designed so that blood flows through the fibres and dialysis
solution flows around the outside
 once through the capillaries the blood collects in a header at the other end of
the cylindrical shell and is then routed back to the patient through the venous
tubing and venous access device
 STRUCTURE OF HOLLOW

FIBER DIALYZER
Hollow fiber dialyzers are chemically
complex, having several compounds
incorporated in their structural
components:
 Housing material (polycarbonate)
 End cap compartments (header and
o ring)
 Potting material (polyurethane PUR)
 Fiber bundle (Membrane)
ADVANTAGE
 Resistance to blood flow is low because of the large number of blood

passages.

 They are non compliant, that is they hold the same value of blood at high

pressure as they do at low pressures.

 Ultrafiltration can be precisely controlled.

 They are well adopted to reuse.

 DISADVANTAGE
 Deration of the fiber bundle is necessary when starting a dialysis procedure,
otherwise fibers may airlock and not admit blood.

 There is uneven distribution of blood at the inflow header space. Relative

stagnation occurs centrally with reduced perfusion of some center fibers.

 Most patient require more heparin.

 Residual toxic products of ethylene oxide sterilization, retained in the

polyurethane potting material of the headers can cause adverse reactions.

DIALYZER CATEGIZED ON
BASIS OF
DIALYZER MEMBRANE

SURFACE AREA(EFFICIENCY)

PORE SIZE(FLUX)
DIALYZER MEMBRANE
DIALYZER MEMBRANE
 Membranes are the structural and functional unit of the hemodialysis dialyzer

 Membrane performance, as determined by the effectiveness of solute

clearance and biocompatibility, is of greatest concern when choosing a

dialyzer.

 Membrane is made up of different materials in which each has their own

advantage and disadvantage
TYPES OF MEMBRANES:
 Cellulose
 Substituted Cellulose
 Cellulosynthetic
 Synthetic
CELLULOSE MEMBRANE
 Cellulose membrane is made up of cotton or wood products
 Cellulose membrane are relatively thin (6.5-15µm) in order to achieve high
diffusive solute transport and have a uniform symmetric structure of the fibre
wall.
 Molecular weight cut off 3000 Da
 Low hydraulic permeability and good diffusive performance for low molecular
weight clearance because of its small membrane wall thickness
 Unfortunately, these membranes have poor biocompatibility.
CELLULOSE MEMBRANE

 Cuprophan
 Saponified Cellulose Ester
 Cuprammonium Rayon
ADVANTAGE
 Transport characteristics is very consistent in cellulose membrane
 Hollow cellulose membranes have minimal complications
 Cellulose membrane are very inexpensive
 Reuse is very easy and clearance increases with reuse
DISADVANTAGES:
 Membrane compatibility is less than desired during the first use
 Poor biocompatibility and its biocompatibility improves only with reuse
 using bleach for reuse can cause high protein loss during dialysis
SUBSTITUTED CELLULOSE
 Cellulose membrane are made up of molecular chains that contain hydroxyl

(OH) groups. These hydroxyl group are responsible for poor biocompatibility

 in order to improve biocompatibility by chemically replacing the hydroxyl

group with acetate

 such membranes are cellulose acetate , cellulose diacetate, cellulose triacetate

 These membranes are more hydrophobic than cellulose

CELLULOSYNTHETIC

 Synthetic material is added to liquefied cellulose during formation of the

membrane

 substitution of hydroxyl groups of the cellulose by N,N, diethylamino ethyl

(DEAE) produce a subtype of membrane named Hemophan OR cello synthetic

 As a result the surface of the membrane is altered and biocompatibility is

increased
SYNTHETIC MEMBRANE
  Synthetic material are made up of polymer like polyvinylpyrrolidone (PVP)
 Molecular weight 15000 Daltons
 all synthetic polymers are hydrophobic
 synthetic membranes was to create more porous membranes which could
better stimulate the filtration process
 in this way one can improve the removal of middle molecules and higher
molecular weight uremic toxins β2 microglobulin
 Synthetic membranes are developed for increasing the dialysis efficiency and
to reduce the complications related to biocompatibility.
 TYPES
 Polysulfone

 Polycarbonate

 Polyamide

 Polymethyl meth Acrylate

 Polyacrylonitrile

 Polyethylene Vinyl Alcohol

 Polypropylene
ADVANTAGE
 Usage of synthetic membranes provides improves biocompatibility

 High water permeability.

 Higher molecular weight cut off

 Well adopted to reuse

 Ultrafiltration coefficient more

 Less complement activation

 Beta-2 microglobulin removal is more

DISADVANTAGE
 Synthetic membranes are several times more expensive than the cellulose
membranes.

 Ultrafiltration control is required to control the UF.

 Protein loss is present due to adsorption of protein to the membrane.

 High hydraulic permeability creates possible back filtration from dialysate,
with the risk of bacterial and endotoxin contamination
SURFACE AREA
 Total area of fibre bundle in square meter that hold blood within
 Surface area of most dialyzers suitable for the treatment of adult patients
ranges between 0.8 to 2.5 m²
 Smaller size dialyzers are used for Pediatric patients

 Larger surface area dialyzers normally have high urea clearances, although
dialyzer design and thickness of the membrane are also important properties
 Dialyzer with more surface area can expose more blood to dialysate this
means more solutes can be removed from the blood
MEMBRANE PORE SIZE
( FLUX)
 Hydraulic permeability are the
functions of pore size
 LOW FLUX DIALYZER : AVERAGE
PORE SIZE 1nm

 MIDDLE FLUX DIALYZER: PORE SIZE

2nm

 HIGH FLUX DIALYZER: PORE SIZE

3nm
MEMBRANE FLUX

 Measures Ultrafiltration capacity

 It also measures middle molecular weight solute clearance
 Dialyzer membranes can be classified into low flux or high flux varieties
based on Ultrafiltration co efficient
 Ultrafiltration co efficient (Kuf) defined as the number of millilitre of fluid
per hour that ill be transferred across a membrane per mmHg pressure gradient
across the membrane
LOW FLUX AND HIGH FLUX
DIALYZER
 Low flux dialyzer - <10 ml/hr/mmHg
 High flux dialyzer- > 20 ml/hr/mmHg
 Dialyzer which have Kuf 10 -20 ml/hr/mmHg are middle flux
dialyzer
 LOW FLUX DIALYZER
 Dialyzers with membranes which have smaller pores are called low flux dialyzers.

 Low flux dialyzers are characterized having ultrafiltration coefficient < 10

ml/hr/mmHg
ADVANTAGE:
Better hemodynamic and cardiovascular stability

DISADVANTAGES:

Large molecular weight waste products like Beta 2 Microglobulin are not removed
HIGH FLUX DIALYZERS
 Dialyzers with membranes which have larger pores are called high flux dialyzers.

 High flux dialyzers are the dialyzers which have high ultrafiltration coefficient

(KUF) and large molecules clearance.

 High flux dialyzers are characterized by having ultrafiltration coefficient of > 20
ml/hr/mmHg

 High flux dialyzer has larger pores hence It has a high middle molecular clearance
and high molecular weight clearance.

 It is especially used for CRRT.

 High flux dialysis requires an automated UF control.

ADVANTAGE
 Increased patient survival resulting from higher clearance of middle
molecular weight

 Improved nutritional status

 Preserved residual renal function

 High aluminum clearance

 Reduced mortality
DISADVANTAGE
 Needs dialysis machine with volumetric UF control

 Needs high quality dialysate fluid to prevent backflow of impurities from

dialysate into the blood

 Possibility of bacterial growth is more

 Very expensive

 Enhanced drug clearance, requiring of supplemental dose after dialysis

CLEARANCE
 The solute removal efficiency can be expressed in terms of clearance
CLEARANCE :
Clearance is defined as the volume of blood (plasma) from which a solute is
removed per unit time during its transit through the dialyzer. Clearance can be
expressed as
Ks = QB (Cbi – Cbo)
Cbi
Ks = Clearance of solutes
QB = blood flow rate
Cbi = blood concentration of S at dialyzer inlet ( arterial)
Cbo = blood concentration of S at dialyzer outlet (venous)
 MEMBRANE EFFICIENCY
 Measure of solute clearance
 Membrane classified into low and high efficiency are based on the mass area
transfer co efficient (KoA) that is surface area coefficient

MASS TRANSFER AREA COEFFICIENT (KoA)

 KoA is the maximum theoretical clearance of the dialyzer in millilitre per

minute for a given blood and dialysis solution flow rate
 KoA will be proportional to the surface area of the membrane
LOW AND HIGH EFFICIENCY
 low efficiency dialyzer - <500 ml/min
 high efficiency dialyzer - >800 ml/min
 dialyzer which have KoA 500-800 are moderate efficiency dialyzer
LOW EFFICIENCY DIALYZER

 KoA of a low efficiency dialyzer is <500 ml/min

 Dialyzer with KoA <500 ml/min should only be used for low efficiency
dialysis or for small patients.
HIGH EFFICIENCY DIALYZER
 High efficiency means the capacity to give high clearance
 KoA of high efficiency dialyzer is >600 ml/min
 Good clearance of middle molecular weight molecules is the main advantage of
high efficiency dialyzers.
 High efficiency dialyzers needs high blood flow rate of ≥350 ml/min and high
dialysate flow rate ≥500 ml.
 It gives the ultrafiltration of 5-15 ml/min.
 Use of High flux dialyzer helps in reduced morbidity and increased survival rate
on the patients on hemodialysis due to high clearance
ADVANTAGE
 High clearance of small solute such as urea compared to conventional
dialysis without increase in time.

 Better control of biochemical parameter

 Potentially reduced morbidity

 Potentially higher patients survival rate.

DISADVANTAGE
 Hemodynamic instability, Cardiovascular instability

 Dialysis Disequilibrium Syndrome

 However low blood flow rate and high recirculation rate can cause the high
efficiency dialysis to fail or have reduced benefits.
BIOCOMPATIBILITY
 Biocompatibility is one of the important element to be considered in the choice
of a dialyzer
 An ideal membrane would be inert in terms of blood activation (maximal
biocompatibility)
 Generally membranes activate complement and leucocyte to some extent. The
activation of complement determines the production of anaphylotoxins which
may cause allergic reactions during dialysis
BIOINCOMPATIBLE MEMBRANE
 Bioincompatibility Depends on evidence of activation.
 Thrombogenesis
 Complement activation
 Leukocyte activation
 Cytokine induction
 Oxidative stress
MODE OF DIALYZER
STERILIZATION
 The four primary methods of sterilization are electron-beam, γ-irradiation,
steam autoclaving, or ethylene oxide gas.
 The use of ethylene oxide has lost popularity because of (a) the rare but serious
occurrence of anaphylactic reactions during dialysis in occasional patients who
are allergic to ethylene oxide