Lee Kong Chian Faculty of Engineering and Science

UEMB3113 Artificial Organs

LAB 2: Dialysis Machine

Name : Koo Jia Chun (P2)

Student ID : 17UEB02882

Course : BI

Lecturer : Dr. Tan Lee Fan

Date of Submission : 1 April 2020

Title: Dialysis Machine

Objective

 To gain practical experience into the functions of a dialysis machine.

 To evaluate the effects of flow rates on the efficiency of dialysis.

Introduction

Hemodialysis is one of the most common method applied for acute renal failure (ARF)
management. It is a membrane-based process in which the toxin removal occurs by toxin
diffusion through the membrane (Annesini, Marrelli, Piemonte, & Turchetti, 2017). The
driving force for mass transfer in hemodialysis is by the concentration difference between
blood and dialysate. There is no solvent flux through the membrane in pure dialysis process.
Hemodialysis has high permeability for low molecular weight solutes while decrease in
permeability as the solute molecular weight increases. Higher molecular weight solutes which
are above 500 kDa are not significantly eliminated by hemodialysis.

Dialysate can be obtained by diluting a concentrated solution of electrolytes (even

glucose in some cases). In more specifically, dialysate should contain sodium, chloride, and
magnesium ions at the same concentration as in normal plasma and adjustment of potassium
concentration is required. Besides, acetate or bicarbonate is added to buffer the solution pH.
The two parameters to characterise the efficiency of the device in removing waste product are
clearance and dialysance, which depends on blood concentration and flow rate in inlet and
outlet. Clearance describes overall performance of a dialyzer; dialysance describes the intrinsic
module efficiency and ability of dialysate regeneration. Moreover, operating parameter KoA
shows that both high blood flux (>350 ml/min) and high dialysate flux (>500 ml/min) can fully
exploit the capacity of high-efficiency modules. Usually, blood flow rate is maintained between
75–300 ml/min and dialysate flow rates at 500 ml/min (Pal, 2014).

In this experiment, different dialysate and blood flow rate will be conducted by different
groups and the effects of flow rates on the efficiency of dialysis will be studied. Besides,
experience into the functions of a dialysis machine will be gained throughout the experiment.
Moreover, graph will be plotted and the relationship between the parameters will be studied.
Methods and Materials

 Equipment and Materials:

Dialysis machine, dialyser, universal bloodline 3 in 1, saline solution – sodium chloride
0.9% (250 mL/pack), acidic hemodialysis solutions, alkaline bicarbonate solution (8.4%),
artificial urea, 1 L plastic beaker, urinometer, 30% citric acid solution, distilled water.

 Procedure:
1. In this experiment, there was no real blood from the patient as the inlet, in replace of
this, urea solution was used.
2. The instruction given in operating the dialysis machine was followed. Extra care was
given in making sure the right connections were done for inlet and outlet of the urea
solution and dialysate.
3. Each group was conduct the experiment with different flow rates; results were recorded
and accumulated to be distributed to all groups for the lab report. The flow rates were
set based on Table 1.
4. Specific gravity of the sample collected was measured at the following outlets:
a. Starting solution (measure once only before the start of experiment)
b. Outlet of dialysate (measure every 2 minutes’ intervals)
c. Outlet of at the urea solution (measure every 2 minutes’ intervals)
5. The dialysis was conducted for 12 minutes and the time and specific gravity of the
experiment was recorded.
6. All recorded data were given to laboratory demonstrator and distributed after the last
group has completed the laboratory session.

Flow rate
Group
Dialysate Blood
A 300 100
B 500 100
C 300 50
D 500 50
Table 1: Flow rates for different groups
Result

The initial specific gravity of urea solution is 1.050.

Group A Flow rate: 300 Flow rate: 100

Time (mins) Specific gravity of dialysate at the Specific gravity of urea at the
outlet outlet
2 1.010 1.020
4 1.020 1.010
6 1.010 1.010
8 1.030 1.030
10 1.030 1.030
12 1.040 1.020
Table 2: Group A result

Graph of SG of dialysate against time

1.045
Specific Gravity of Dialysate

1.04
1.035
1.03
1.025
1.02
1.015
1.01
1.005
0 2 4 6 8 10 12 14
Time (min)

Figure 1: SG of dialysate at the outlet with dialysate flow rate of 300 ml/min (Group A)

Graph of SG of urea against time

1.035

1.03
Specific Gravity of Urea

1.025

1.02

1.015

1.01

1.005
0 2 4 6 8 10 12 14
Time (min)

Figure 2: SG of urea at the outlet with blood flow rate of 100 ml/min (Group A)
 Group B Flow rate: 500 Flow rate: 100
Time (mins) Specific gravity of dialysate at the Specific gravity of urea at the
outlet outlet
2 1.010 1.050
4 1.000 1.050
6 1.000 1.060
8 1.000 1.050
10 1.020 1.020
12 1.010 1.050
Table 3: Group B result

Graph of SG of dialysate against time

1.025
Specific Gravity of Dialysate

1.02

1.015

1.01

1.005

0.995
0 2 4 6 8 10 12 14
Time (min)

Figure 3: SG of dialysate at the outlet with dialysate flow rate of 500 ml/min (Group B)

Graph of SG of urea against time

1.065
1.06
Specific Gravity of Urea

1.055
1.05
1.045
1.04
1.035
1.03
1.025
1.02
1.015
0 2 4 6 8 10 12 14
Time (min)

Figure 4: SG of urea at the outlet with blood flow rate of 100 ml/min (Group B)
 Group C Flow rate: 300 Flow rate: 50
Time (mins) Specific gravity of dialysate at the Specific gravity of urea at the
outlet outlet
2 1.001 1.068
4 1.002 1.064
6 1.003 1.062
8 1.005 1.061
10 1.007 1.060
12 1.009 1.057
Table 4: Group C result

Graph of SG of dialysate against time

1.01
1.009
Specific Gravity of Dialysate

1.008
1.007
1.006
1.005
1.004
1.003
1.002
1.001
1
0 2 4 6 8 10 12 14
Time (min)

Figure 5: SG of dialysate at the outlet with dialysate flow rate of 300 ml/min (Group C)

Graph of SG of urea against time

1.07

1.068
Specific Gravity of Urea

1.066

1.064

1.062

1.06

1.058

1.056
0 2 4 6 8 10 12 14
Time (min)

Figure 6: SG of urea at the outlet with blood flow rate of 50 ml/min (Group C)
 Group D Flow rate: 500 Flow rate: 50
Time (mins) Specific gravity of dialysate at the Specific gravity of urea at the
outlet outlet
5 1.010 1.018
10 1.010 1.000
Table 5: Group D result

Graph of SG of dialysate against time

1.2
Specific Gravity of Dialysate

0.8

0.6

0.4

0.2

0
0 2 4 6 8 10 12
Time (min)

Figure 7: SG of dialysate at the outlet with dialysate flow rate of 500 ml/min (Group D)

Graph of SG of urea against time

1.02
1.018
Specific Gravity of Urea

1.016
1.014
1.012
1.01
1.008
1.006
1.004
1.002
1
0.998
0 2 4 6 8 10 12
Time (min)

Figure 8: SG of urea at the outlet with blood flow rate of 50 ml/min (Group D)
Discussion

In this experiment, dialysate and blood with different flow rate were conducted by different
groups and the specific gravity of urea and dialysate at the outlet was determined. Specific
gravity of urea and dialysate was plotted in graph against time to study how the change of flow
rate influence the result. Specific gravity (SG) is a measure of the ratio of the density of a
solution to the density of water. The specific density of water will be 1.000 ideally while for
urine specific density, it normally ranges from 1.002 to 1.030 for normal kidneys (Stuempfle
& Drury, 2003). The initial specific gravity of urea solution was measured by a urinometer,
and the value acquired was 1.050.

1. Discuss your results obtain and the relationship shown in the graphs you have plotted. How
does changing of flow rate influence your results?

For Group A, the dialysate and blood flow rates were set at 300 ml/min and 100 ml/min
respectively. The specific gravity of dialysate at the first interval was 1.010 and ends with
1.040; specific gravity of urea at the first and last interval was 1.020. Specific gravity of
dialysate increased gradually along the time while specific gravity of urea decreased to
1.010 at fourth and sixth minutes, and raised again. The total urea specific gravity decreased
by 0.030 for Group A.
Group B had dialysate flow rate of 500 ml/min and blood flow rate of 100 ml/min. The
specific gravity of dialysate and urea remained the same for initial and final with value of
1.010 and 1.050 respectively. At sixth minute, specific gravity of urea increased to 1.060
while specific gravity of dialysate decreased to 1.000; at tenth minute, specific gravity of
urea decreased to 1.020 while specific gravity of dialysate increased to 1.020. Urea specific
gravity raised back to 1.050 at twelfth minute as initial for Group B.
For Group C, dialysate flow rate was set as 300 ml/min while 50 ml/min for blood flow
rate. The specific gravity of dialysate increased from 1.001 to 1.009; specific gravity of
urea decreased from 1.068 to 1.057. The increasing and decreasing of dialysate and urea
specific gravity was almost linear. Although specific gravity of urea decreased throughout
the 12 minutes, but the value was still higher than the initial specific gravity.
Lastly, the dialysate and blood flow rates were set at 500 ml/min and 50 ml/min
respectively for Group D. Specific gravity of dialysate remained at 1.010 for initial and
final while specific gravity of urea was 1.018 for first interval and 1.000 for last interval.
The dialysate specific gravity remained almost constant and urea specific gravity decreased
 nearly linear, therefore, the reading was recorded only at the fifth and tenth minute. Overall
reduction of urea specific gravity for Group D was 0.050.
Group D has the greatest urea specific gravity drop among the groups. By comparing
Group C and D, latter has better urea removal rate as it has lower urea specific gravity at
the outlet. When if the dialysate flow rate is increased by keeping the blood flow rate
constant, the clearance will increase as well (Annesini, Marrelli, Piemonte, & Turchetti,
2017). Group C has the least performance as it has both low flow rate for dialysate and
blood. From that, increase in flow rate will increase the urea removal rate can be concluded.

2. Discuss what other methods can be used to measure concentrations of the different
solutions you have measured.

For urea concentration, it can be determined by DAM method, which is a common chemical
method. Urea mixed in an acidic medium condenses with diacetyl monoxime, which is a
colour reagent at 100 °C to form a red coloured complex. The intensity of the colour formed
is directly proportional to the concentration of urea in the sample (Urea Kit (DAM method),
n.d.).
By enzymatic method with the aid of Berthelot reaction, the urea concentration can be
determined by absorbance from spectrophotometer. Urea is hydrolysed by enzyme urease
into ammonia and carbon dioxide. Ammonia generated reacts with alkaline hypochlorite
and sodium salicylate in presence of sodium nitroprusside as coupling agent to obtain a
green chromophore. The intensity of the colour formed is proportional to the concentration
of urea in the sample (UREA Berthelot, n.d.). By using spectrophotometer with wavelength
of 600 nm, more accurate urea concentration can be calculated by the absorbance value
obtained. Moreover, urine specific gravity can be obtained by refractometer, hydrometer
and reagent strips as well (Stuempfle & Drury, 2003).

3. Discuss what you can evaluate by knowing these concentrations.

By knowing the concentration of urea and dialysate, urea transfer rate can be calculated
with flow rate of blood or dialysate:

𝑁 = 𝑄𝐵 (𝑐𝐵𝑖 − 𝑐𝐵𝑜 ) = 𝑄𝐷 (𝑐𝐷𝑜 − 𝑐𝐷𝑖 )

 where cBi = Inlet blood concentration [mg/ml]
cBo = Outlet blood concentration [mg/ml]
cDi = Inlet dialysate concentration [mg/ml]
cDo = Outlet dialysate concentration [mg/ml]
N = Urea transfer rate [mg/min]
QB = Blood flow rate [ml/min]
QD = Dialysate flow rate [ml/min]

Besides from urea transfer rate, clearance and dialysance of the membrane module can
be evaluated as well. Clearance describes the impact of the dialysis process on the patient
and allows to predict the evolution of the toxin concentration in the patient body with time
(Annesini, Marrelli, Piemonte, & Turchetti, 2017). On the other hand, dialysance deduce
the intrinsic module efficiency especially when dialysate regeneration is applied in
recirculating devices.

4. Discuss how your results would differ if the measurements are done in a real patient.

If the measurements are done in a real patient, the results that obtained will be different
compared to experiment which used artificial urea. The viscosity of human blood is higher
than artificial urea solution, thus, the blood flow rate will be lower and affect the filtration
rate and diffusion process. To increase the efficiency of hemodialysis, the blood flow rate
need to recalibrate from the urea solution based on patient blood characteristic. Besides,
blood pressure and blood flow vary to the categories of the patient such as age, body size
and health condition.

5. Discuss the effects of using the same cartridge for every group in this series of experiments.

Decrease in urine filtration efficiency happen when using the same cartridge for every
group in this series of experiments. This is because of deposition of large molecular size
substances on the dialyser membrane and caused the diffusion of small molecules through
the membrane to be less effective. Clotting in the dialyser makes the dialysis less effective
and lower the Kt/V of the dialyser (Dialyzer Reuse for Dialysis, n.d.). Hence, constant
replacement of cartridge helps to ensure the urea filtration efficiency is in optimum.
 There are several precautions need to take note throughout the experiment. First, make sure
the inlet and outlet connections are tight enough to avoid pressure change and air trapped.
Besides, gloves must be worn during the handling of experiment for personal hygiene and
cleanness of dialysis machine.

Conclusion

The objective of this experiment has been partially achieved as no hands-on experiment on
dialysis machine due to movement control order implementation and temporary closure of
UTAR. The cleansing of blood by varying the flow rates in dialysis process has been studied.
The specific gravity of urea and dialysate at the outlet has been analysed for each groups with
different flow rate of dialysate and blood. Urea diffusion happen in the dialyser and different
flow rate may have different urea removal rate. Dialysate flow rate of 500 ml/min and blood
flow rates of 50 ml/min (Group D) shown the best urea clearance.

References
Annesini, M. C., Marrelli, L., Piemonte, V., & Turchetti, L. (2017). Artificial Organ
Engineering. London: Springer-Verlag.

Dialyzer Reuse for Dialysis. (n.d.). Retrieved from Davita Kidney Care:
https://www.davita.com/treatment-services/dialysis/dialyzer-reuse-for-dialysis

Pal, S. (2014). Design of Artificial Human Joints & Organs. New York: Springer.

Stuempfle, K. J., & Drury, D. G. (2003). Comparison of 3 Methods to Assess Urine Specific
Gravity in Collegiate Wrestlers. Journal of athletic training, 38(4), 315–319.
Retrieved from NCBI.

UREA Berthelot. (n.d.). Retrieved from Linear Chemicals:

http://linear.es/ficheros/archivos/1156010I_.pdf

Urea Kit (DAM method). (n.d.). Retrieved from Tulip Group:

http://www.tulipgroup.com/Coral_New2/html/pack_inserts/Urea%20Kit%20DAM%2
0Method.pdf