M6506 Clinical Engineering

Topic 5: Haemodialysis and

Artificial Kidney
 Kidney Dialysis
• Cleans the blood and restores water balance
by a combination of dialysis (exchange of
solutes), and ultrafiltration.
• Dialysis patients need 3-4 sessions per week
of 3-4 hours
• Dialysis is for life - if you can’t get a
transplant
 Short history of Dialysis
1861 - Diffusion of solutes across semi permeable
membrane (dialysis) discovered (Thomas Graham)
1912 - First animal dialysis experiments
1924 - 1st Human dialysis. Patient was little improved
1945 - 1st successful clinical dialysis (Willem Kolff)
1960 - External arteriovenous shunt (fistula) introduced
1960s -Introduction of hollow fibre membranes allows
significant reduction in priming volume
1970-Present - improvements in biocompatibilty
and reduction in membrane area
 Then and Now

Kolff’s rotating drum

dialyser,1945

The first hollow fibre

dialyser, 1970
 Dialysis Today
• 800,000 people worldwide depend on
kidney Dialysis
– 1600 in Singapore
– 182000 in USA
 Principle of dialysis
Semi permeable membrane
Dialysate out Dialysate
in

Blood in Blood out

Urea, Creatinine, Water removed by dialysis

and ultrafiltration
 Dialysis Circuit
Single/double needle
access via fistula
 Dialysis in Practice
• Quality of Life
– Controlled diet
– Controlled water intake
– Immune system compromise
– Regular anticoagulation
+ EPO can counter anaemia
 Vascular Access
• Before 1960, repeated vascular access was a
problem
– Dialysis limited to acute use
• Scribner Shunt creates a shunt between
radial artery and radial vein
– Native vein fistula
– PTFE Graft
 Vascular Access
• Shunt created between radial artery and
radial vein
– Pressure in radial vein increases
– Wall thickens to adapt
– Result is a thick-walled vessel with high
pressure close to the skin.
Dialysis in Practice -
Vascular access
‘shunt’ between
radial artery and radial vein
Single pool model of Dialysis

Volume = V
Concentration = C

Cout Cin =C
Dialysate flow rate = q
Single pool model of Dialysis

Urea Removal = q( C in − C out )

Define Clearance Cl (equivalent volume of
blood completely cleansed of urea)
 C in − C out 
Cl = q 
 C in 
Single pool model of Dialysis

Neglecting Ultrafiltration
dC
V = g − Cl × C
dt
dC g − Cl × C
=
dt V
 Single pool model of Dialysis

dC g − Cl × C
=
dt V
Two ways to solve the problem :
1 - Seperate Variables and Integrate
2 - Solve as differential equation with PI and GS
 Method 1
C (t ) t
1 dt t
∫
C (0)
g − ClC
dC = ∫ =
0
V V
 g − C(t ) 
− 1  Cl  t
ln  =
Cl  g − C ( 0 )  V
 Cl 
g  g  −Clt V
C(t ) = +  C ( 0 ) − e
Cl  Cl 
 Method 2

dC g − ClC
=
dt V
dC
PI is solution of =0
dt
g
PI : C ( t ) =
Cl
 Method 2

dC -ClC(t)
General Solution is solution of = :
dt V
Clt
-
By inspection, it will have form C(t) = Be V

g −Clt
∴ C ( t ) = GS + PI = + Be V
Cl
 Method 2
g −Clt
C( t ) = + Be V
Cl
Boundary Conditions :
C (t ) = C (0) at t = 0
 g 
B =  C ( 0) − 
 Cl 
g  g  −Clt V
C( t ) = +  C ( 0 ) − e
Cl  Cl 
 Worked Example
A Patient is treated on a dialyser for 6 hours every
3 days. Determine the body urea concentration
after 2 hours of dialysis given the following data :
V = 50 litres
G = 0.06 mmol/min
Cl = 120 ml/min
C (0) = 10mmol/litre
 Worked Example
g  g  −Clt V
Using the formula : C ( t ) = +  C ( 0 ) − e
Cl  Cl 
(Equation 5.4 in the notes)
Remember to be careful and consistent with units!
− 0.12×120
0.06  0.06 
C( 120 ) = + 10 − e 50
0.12  0.12 
= 0.5 + 9.5 × 0.750 = 7.62mmol / litre
 Concentration during session
concentration (mmol/litre

12
10.00
10 8.73
7.62
8 6.67
5.84
6 5.12
4.50

0
0 60 120 180 240 300 360

time (mins)
Reading from graph: Solute concentration at 120 mins
= 7.62 mmol/litre
 Dialysis Prescription
• Between sessions, urea is produced by
metabolism
• Clinic prescribes dialysis to achieve
“healthy” urea concentration at end of
session and achieve correct dry weight by
ultrafiltration
• Measure is Kt/V (Clt/V)
 Dialysis Prescription

12
Solute concentration (mmol/l)

10

0
0 20 40 60 80 100 120 140 160
time (hours)