Activity No.

5
Principles of Dialysis

1. Explain completely the principles and importance of dialysis.

Our survival depends on the ability of our kidneys to function effectively. In order
to survive if the kidneys fail, additional methods of replacing kidney functions, such
as dialysis or transplant, are required to cleanse the system of wastes and maintain
blood homeostasis. [1] Dialysis is most often used in life science research to remove
unwanted micromolecules, such as salts, reducing agents, or coloring agents, from
larger macromolecules, such as proteins, DNA, or polysaccharides. Dialysis is also
widely used for drug binding and buffer exchange experiments.. [2]

Dialysis includes transferring the patient's blood through a semi-permeable

membrane onto the other side of which is a dialysis solution. Three procedures can
occur at this point to eliminate undesired waste products.

First is when a high to low concentration gradient exists between the patient's
blood and the dialysis solution (dialysate) utilized, passive diffusion occurs.
Diffusion stops after balance is reached, and waste products in the blood diffuse into
the dialysate solution while necessary minerals diffuse into the circulation.

Next is by moving fluid from a high to a low pressure area utilizing a positive
(blood) or negative (dialysate) pressure gradient, ultrafiltration ensures that excess
fluid is excreted from the body.

Lastly, Convection provides for the efficient removal of larger molecules from
the circulation, resulting in the passive movement of solutes distributed in fluid, by
raising the hydrostatic pressure in the blood (using a blood pump). Solutes in fluids
passing through the membrane are managed by convection, whereas fluid
movement under pressure is managed by ultrafiltration. [3]

2. Explain the relationship of the function of the human kidney to the principles
of dialysis.

The kidneys' primary function is to rid the body of waste and excess fluid. These
waste products, as well as excess fluid, are excreted in the urine. Urine is made up
of a complex array of excretion and resorption activities. This process is necessary
for the body to maintain a constant chemical balance. The kidneys regulate the
levels of salt, potassium, and acid in the body. The hormones produced by the
kidneys impact the operation of other organs, such as blood pressure and calcium
 metabolism, which are both helped by other hormones produced by the kidneys. [1]
[4]

Whereas, many people assume that dialysis is a substitute for healthy kidneys.
This is just partially accurate. The primary function of the kidneys as stated above is
to filter excess fluid and waste from the bloodstream. When your kidney function is
less than 15% of normal, dialysis is performed to eliminate these substances from
your blood. When your kidneys are unable to perform these functions due to disease
or injury, dialysis can help keep your body operating normally. Without dialysis, salts
and other waste materials accumulate in the blood, damaging the body and
endangering other organs. Dialysis, on the other hand, does not treat kidney disease
or other renal problems. Other treatments may be necessary to address such
problems. [1][4][5]

3. Discuss the operating principles, procedures and functions of a hemodialysis

machine.

A hemodialysis machine will filter your blood whether you conduct home
hemodialysis or in-center hemodialysis. Your blood is filtered via a dialyzer,
commonly known as an artificial kidney, which has built-in safety checks to ensure
the process is safe and effective. It filters excess salt, waste, and fluid in the same
way as a kidney does. The cleaned blood is reintroduced into your body through the
second needle in the arm. The functions of home and in-center hemodialysis
machines are essentially similar, though the home unit is somewhat smaller. [6][7]

The hemodialysis process are as follows. First is that, the patient must sit or lean
back on a chair while undergoing hemodialysis treatment. Second, the patient's
weight, temperature, and blood pressure are monitored before to initiating and after
finishing treatment. On the patient's arm, where the fistula or graph is located, two
needles will be inserted. A pump in the dialysis machine gently pulls your blood out
and puts it through a dialyzer. The dialyzer filters out excess salt, fluid, and waste,
similar to a kidney. Then, with the assistance of a second needle in the arm, the
clean blood is returned to the body. Hemodialysis is a three-time-a-week treatment
that lasts 3-5 hours. Many of them are hemodialysis patients who receive treatment
at home every 6-7 days for 2-3 hours. After one patient's dialysis is finished, the
tubing and filters must be cleaned with sterilizing solution. The patient's plumbing is
then unplugged, and the needle wounds are bandaged. [7]

4. What clinical cases or who are the patients that needs to undergo dialysis? If
they do not undergo dialysis, what will happen to them? Explain.

A physical injury or a condition such as diabetes, high blood pressure, or other

diseases can cause kidney impairment. Kidney illness is frequently exacerbated by
other chronic conditions and it is most commonly caused by high blood pressure,
hypertension and diabetes. When you reach end-stage renal failure, which occurs
when you've lost 85 to 90% of your kidney function and have a GFR of less than 15,
you'll need dialysis. [1][4][7]
 Depending on your health and residual kidney function, you may only live for a
few days to a few weeks if you decline dialysis or transplant therapy
treatment following renal failure. When they refuse dialysis, for instances, toxins
build up in the blood, resulting in uremia. The patient will be given whatever
medications are required to treat uremia symptoms and other medical problems.
Death can take anything from a few days to several weeks, depending on how
rapidly the toxins build up. A person's physical and emotional state may alter as the
toxins accumulate. The body begins to shut down in the final years of life. [1][7]

5. Give at least 10 tips or recommendations in taking care of your kidneys.

1. Maintain an active and healthy lifestyle. Regular exercise promotes your

health in a number of ways. It has the potential to reduce the risk of chronic
kidney disease. It can help lower blood pressure and improve heart health,
both of which are critical to preventing kidney dysfunction.
2. Maintain a healthy blood sugar level. Kidney damage can occur in people
who have diabetes or another illness that produces high blood sugar. You
decrease the chance of harm if you can keep your blood sugar under control.
Your doctor can also take actions to lessen or prevent further damage if the
damage is detected early.
3. Monitor your blood pressure. Kidney injury can be caused by high blood
pressure. When high blood pressure is combined with other health problems
such as diabetes, heart disease, or high cholesterol, the effects on your body
can be fatal. At this stage, lifestyle and dietary modifications may help
reduce your blood pressure. You should consult your physician about
frequently monitoring your blood pressure, making lifestyle modifications,
and potentially taking medication.
4. Maintain a healthy weight and eat a balanced diet. Obese or overweight
persons are at risk for a range of health issues, including kidney damage. A
diet reduced in salt, processed meats, and other kidney-damaging foods
may help to reduce the risks. Fresh, naturally low-sodium foods such as
cauliflower, blueberries, salmon, whole grains, and more should be
encouraged.
5. Drink plenty of water. The old adage of drinking eight glasses of water a
day isn't miraculous, but it is an excellent aim to strive for since it keeps you
hydrated. Drinking lots of water on a daily basis is good for your kidneys.
Water helps in the kidneys' elimination of salt and toxins. It also lowers the
risk of getting chronic kidney disease.
6. Quit smoking. The blood vessels in your body are damaged when you
smoke. As a result, blood flow throughout your body and to your kidneys is
slowed.
7. Pay attention to the number of OTC pills you are taking. If you use over-
the-counter (OTC) pain medications on a regular basis, you might be
harming your kidneys. Nonsteroidal anti-inflammatory drugs (NSAIDs), such
as ibuprofen or naproxen, might damage your kidneys if taken on a regular
 basis for chronic pain, headaches, or arthritis. People who use the medicine
on a daily basis and do not have kidney issues are most likely safe.
However, if you use these drugs on a regular basis, your kidneys' health may
be jeopardized.
8. If you're at high risk, get your kidney function checked. Regular renal
function testing are recommended if you are at high risk of kidney injury or
illness. Testing on a regular basis is your best option for diagnosing chronic
renal disease early. Early medication is the most effective and might help
you avoid further health issues.
9. Stop binge drinking. Alcohol that is measured and consumed on a regular
basis typically has no negative consequences. Heavy drinking, on the other
hand, has been linked to a twofold increase in the risk of renal disease.
Always check with your doctor to be sure that drinking alcohol is safe for you.
Even though it is safe to drink, it is essential to do so in moderation.
10. Be aware of your signs and symptoms. Unfortunately, kidney disease
symptoms aren't often obvious, and 40% of people with significantly
decreased kidney function are unaware they have it. As a result, it's critical to
understand whether you're at danger. Annual physical exams are
recommended by healthcare professionals, who may request bloodwork or
urine testing to detect kidney disease in its early stages and assist limit its
progression.
[8]

REFERENCE/S:

[1] Mundt LA, Shanahan K, Graff L. Graff's textbook of routine urinalysis and body
fluids. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2011.

[2] What is dialysis? National Kidney Foundation. 2021 [cited 2021Oct18]. Available
from: https://www.kidney.org/atoz/content/dialysisinfo#:~:text=When%20your
%20kidneys%20fail%2C%20dialysis,helping%20to%20control%20blood%20pressure

[3]Green A. Dialysis: Principles and treatment options. The Pharmaceutical Journal.

2021 [cited 2021Oct18]. Available from: https://pharmaceutical-
journal.com/article/ld/dialysis-principles-and-treatment-options

[4] Brunzel NA. Fundamentals of Urine & Body Fluid Analysis. St. Louis, MO:
Elsevier/Saunders; 2013.

[5] Krans B. Dialysis: Purpose, types, risks, and more. Healthline. Healthline Media;
2019 [cited 2021Oct18]. Available from:
https://www.healthline.com/health/dialysis#types-of-dialysis
[6] Miller K. Dialysis (hemodialysis): Purpose, procedure, and complications [Internet].
WebMD. WebMD; [cited 2021Oct18]. Available from: https://www.webmd.com/a-to-z-
guides/kidney-dialysis#:~:text=A%20pump%20in%20the%20hemodialysis,second
%20needle%20in%20your%20arm.

[7] Nissenson AR, Fine RN. Handbook of dialysis therapy. India: Saunders Elsevier;
2009.

[8] Choi, J., 8 tips for keeping your kidneys healthy. Healthline. Healthline Media; 2020
[cited 2021Oct18]. Available from: https://www.healthline.com/health/kidney-
health#stay-hydrated