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Principle of Hemo (dialysis

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HEMODIALYSIS Diffusion

HEMOFILTRATION : Convection

Principle of Hemodialysis • Dialysis removes nitrogenous (and other) waste products. and acid base abnormalities associated with renal failure. . and corrects the electrolyte. but not large molecules. water. • It requires the use of semi-permeable membrane which allow the passage of water and small molecular weight solutes.

.Dialysis: General Principles • Diffusion – Movement of solutes from an area of greater concentration to lesser concentration • Osmosis – Movement of fluid from an area of lesser to an area of greater concentration of solutes. • Ultrafiltration (water & fluid removal) – Movement of fluid across a semipermeable membrane as a result of an artificially created pressure gradient.

Diffusion .

Ultrafiltration .

A B A B Diffusion Membrane Membrane t=0 A t = equilibrium B B A t=0 Ultrafiltration t = later The Process of diffusion (top) and ultrafiltration (bottom) .

Hemodialysis Filter .

Mechanisms of Solute Removal 1. Diffusion + Convection 4. Convection 3. Adsorbtion . Diffusion 2.

Solute Clearance Blood Membrane Dialysate/Ultrafitrate .

Diffusive Solute Clearance Blood Membrane Dialysate/Ultrafitrate .

Diffusive Solute Clearance Blood Membrane Dialysate/Ultrafitrate .

Convection .

Adsorption ADSORPTION: molecular adherence to the surface or interior of the membrane. .

Ultrafiltration ULTRAFILTRATION: The movement of fluid through a membrane caused by a pressure gradient. .

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Water movement during standard hemodialysis Intracellular fluid Extracellular fluid step3 Water movement step1 280 Loss of urea and water Dialyzer Osmolality 320 mosm/kg Osmolality 320 mosm/kg Falling to 290mosm/kg as diffusion occurs step2 Compensatory refilling .

A “Standard” HD Delivery System Informational Display PT = Pressure Transducer Anticoagulant PT Saline Blood from Patient Blood Leak Detector PT Conductivity Meter Dialysate / UF Out (green / yellow) Mixing System Pre-mixed or sorbent Water. Acid Concentrate. regenerated Bicarbonate Concentrate dialysate In Dialysate In PT Drip Chamber Air Detector Venous clamp Blood return to 18 Patient .

Solute Transfer & Ultrafiltration C blood > C Dialysate ≈ P Dialysate P blood > Blood Dialysate .

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Ur Ur Ur Ur Ur Ur A semi-permeable membrane START DIFFUSION SOME DIFFUSION NO DIFFUSION .

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Ur Ur Ur Ur Ur Ur A semi-permeable membrane DIFFUSION DIFFUSION DIFFUSION .