How Hemodialysis Works

Dialysis is a treatment for people in the later stage of kidney failure (chronic renal insufficiency). This treatment cleans the blood and removes wastes and excess fluid from the body, which are normally removed by healthy kidneys. Sometimes dialysis is a temporary treatment (acute). However, when the loss of kidney function is permanent, as in end-stage kidney failure, dialysis is required on a regular basis (chronic). The only other treatment for kidney failure is a kidney transplant. There are two types of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, blood is passed through an artificial kidney (hemodialyzer) to clean it. Peritoneal dialysis uses a filtering process similar to hemodialysis, but the blood is cleaned inside the body rather than in a machine. This description only talks about hemodialysis. In hemodialysis, blood is removed from the body and circulated through an extracorporeal fluid circuit (outside the body), then returned to the patient. This circuit includes a hemodialyzer, which is where the blood is cleaned. The hemodialyzer contains a selectively permeable membrane, which is a filter that allows fluids and waste (uremic toxins) to pass through, but prevents the exchange of blood components, microorganisms and the "skeletons" of dead microorganisms (endotoxins). The fluid used to clean the blood (dialysate) flows in the opposite direction to the blood on the opposite side of the membrane, while waste and extra fluid are removed from the blood and end up in the dialysate by controlling three processes: Diffusion, ultrafiltration and osmosis.

Diffusion is the exchange of things dissolved in fluid

(solutes) across the membrane due to differences in the amounts of the solutes on the two sides (concentration gradient). If there is a higher concentration of a given solute on one side of the membrane than on the other, then diffusion will occur to try to make the concentrations on both sides of the membrane the same. By controlling the chemicals in the dialysate, the dialysis machine controls this transfer of solutes according to the doctor's prescription. Dialysis machines control the chemicals in the dialysate by mixing dialysis fluid concentrates, which are strong versions of the chemicals, (acetate or sodium bicarbonate plus acetic acid based solutions) with purified water. The mixing is generally controlled using either conductivity control (measuring how well the fluid conducts electricity) or by volumetric control (how much water is mixed with how much chemical) of the water and concentrates. Sodium profiling (changing the amount of sodium in the dialysis fluid at different times during the treatment) is used in many modern dialysis machines to vary the conductivity of the dialysate over the course of the treatment to improve the total amount of solute removed by diffusion.

Ultrafiltration, also referred to as convection, is fluid flow through the membrane, forced by a difference in pressure on the two sides of the dialyzer (pressure gradient). This controls the patient's weight loss over the course of the treatment. While earlier dialysis machines either controlled dialysate pressure or the pressure difference across the membrane in order to achieve ultrafiltration, modern dialysis machines are generally volumetric, meaning they control the volume of fluid removed from the patient directly and allowing dialysate pressure to change as it will in order to achieve the prescribed weight loss. Volumetric control is generally achieved either by controlling the flow of dialysate in and out of the dialyzer at different rates with two flow controllers, or by having equal flow rates in and out of the dialyzer and removing fluid between these equal flows. Volumetric control allows the doctor to take advantage of more effective "high flux" dialyzers, which allow a great deal of fluid movement with very little pressure differences.

Osmosis is the net movement of water across a selectively permeable membrane driven by a difference in the amounts of solute on the two sides of the membrane. In dialysis, this refers not to water movement across the hemodialyzer membrane, but across cell membranes within the body-either from within the red cells to the blood plasma, or from within cells of the various tissues in the body (like muscles) to interstitial fluid (the fluid in between cells). Sodium profiling, as described in the "diffusion" section, can be used to increase the rate of osmosis early in the treatment by increasing the sodium level of the plasma


Ultrafiltration (UF) is basically a pressure-driven separation process, governed by a screening principle and dependent on particle size. Ultrafiltration membranes have a pore size between 1 nm and 100 nm, thus allowing retention of compounds with a molecular weight of 300 to 500 000 Dalton. Typically, the process is suitable for retaining biomolecules, bacteria, viruses, polymers, colloidal particles and sugar molecules.

Ultrafiltration membranes are defined by their nominal molecular weight cut-off (MWCO). The MWCO generally represents the smallest molecular weight for which the membrane has a retention value of more than 90%. In many cases, however, separation efficiency is not only influenced by cut-off but also by interaction between the membrane and the raw solution. The operating pressure for ultrafiltration is usually between 0.1 and 1 MPa.

The following operations are typical for the application of ultrafiltration:

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Filtration of raw solutions Concentration of substances Fractionating of substances

In the fractionating of dissolved substances or the separation of dissolved substances and solvents, a sufficient degree of separation is reached when the size of the particles differs by the factor 10. Nowadays, different applications for ultrafiltration can be found in nearly all industrial sectors:

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Sterile filtration of drinking and beverage water Treatment of surface water Recovery of filter backflushing water Separation of oil/water emulsions Recovery of electrodeposition paint Removal of metal hydroxides in wastewater treatment Separation of biomass in biotechnology Wastewater treatment and re-use Membrane bioreactors

Great significance is given to the use of ultrafiltration for sterile filtration because only a suitable ultrafiltration process can ensure a retention of >log 4 for bacteria, viruses, Legionella and possibly even endotoxins. Ultrafiltration is, therefore, the choice process for point-of-use filtration for the safe production of drinking water. One of the most sophisticated uses of ultrafiltration lies in the application of membrane bioreactors (MBR) for wastewater. The ultrafiltration can operate in the normal way on a cross-flow by-pass system, or submerged in the bioreactor vessel by means of vacuum suction at low trans-membrane pressures. The combination of activated sludge with membrane separation in the MBR results in efficiencies of footprint, effluent quality and residuals production that cannot be attained when these same processes are operated in sequence.

ltra-Filtration (UF) is a kind of membrane filtration method. It is a filtration process which utilizes trans-membrane pressure differential to separate particles according to molecular weights. By using hollow fibers UF membrane as filtration media, raw water particles which are smaller than “pore” of UF membrane will permeate through and collected as permeate; whilst, particles which are larger than UF membrane pore size will be separated as concentrate under certain pressure applied. UF membrane is an asymmetric semi-permeable membrane made of high molecular material by special technology. Its' hollow fiber tube cover densely by micro-pores which allow solution flowing in or out the membraneunder the influence of pressure. UF membrane pore size range from 0.1 to 0.005 μm or molecular weight (200,000 to 10,000 Daltons) for different applications. Generally, it is used to remove high molecular-weight substances, colloidal materials, bacteria, organic and inorganic polymeric molecules. UF system requires ONLY 20% energy consumption of reverse osmosis system. Low operating pressures are sufficient to achieve high flux rates from UF membrane. It has outstanding advantages as followings: Minimum pumping energy required, thus energy saving Chemical resistance, wide PH range Back-washable Easy to operate & maintenance Low investment cost No phase change No contaminant residue caused by chemical reaction Recovery ratio up to 98% UF had been wide applied in industries such as: 1. Surface Water Clarification 2. RO Pre-Treatment 3. Waste Water Treatment Point%20UF%20System%20Spec%20Sheet%20310124.pdf

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