HEMODIALYSIS

AND
ARTIFICIAL KIDNEY
INTRODUCTION

 Dialysis is the artificial replacement of lost

kidney functions.
 Used in Chronic Kidney Disease(CKD) stage 5
or End Stage Renal Disease(ESRD).
 Typically needed when 90% or more kidney
function is lost.

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DAILY WASTE PRODUCTION IN A
NORMAL AND URIMIC PERSON
Component Normal Uremic
man patient
(g/day) (g/day)
Water 1500 300
Urea 30 12
Creatinine 0.6 0.2
Uric acid 0.9 0.4
Na+ 5 0.4
Cl- 10 1.2
Ca2+ 0.2 0.1
PO4 3- 3.7 1.8
K+ 2.2 0.5
HSO4+ 8.2 -

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KIDNEY FAILURE :CAUSES

 Diabetes mellitus
 Hypertension
 Glomerulonephritis(GN)
 Polycystic kidney
 Overuse of common drugs such as aspirin,
ibuprofen, codeine

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TREATMENT: ARTIFICIAL WASTE
REMOVAL
Component g/liter Component Meq/liter
 A body fluid is contacted with a “dialysate” solution
NaCl 5.8 Na+ 132
across a semipermiable membrane.
NaHCO3 4.5 K+ 2.0
 Dialysate contains no waste material.
KCl 0.15 Cl- 105
 Body fluid will loose those materials to dialysate via
CaCl2 0.18 HCO3- 33
diffusion through SPM.
MgCl2 0.15 Ca2+ 2.5
 Clean body fluid is returned back to the body.
Glucose 2.0 Mg2+ 1.5
DIFFERENT METHODS OF WASTE DISPOSAL

A. Internal method

1. Peritoneal dialysis.

2. Gastro dialysis.

3. Intestinal dialysis.

4. Pleural dialysis.

B. External Method

1. Filter Bed absorption column

2. Ultrafiltration method

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ADVANTAGES AND DISADVANTAGES OF
INTERNAL DEVICES

Advantages:
 Avoidance of handling blood

 Simplicity of equipment

Disadvantages:
Poor efficiency in most cases
Uncomfortableness
Loss of protein
Membrane infection
The necessity that the dialysate must be extremely
sterile
HEMODIALYSIS
 It is the most commonly used process
 Purpose - removal of wastes from the body
 Water retention / removal
 Salt retention / removal
 Protein retention

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HEMODIALYSIS MACHINE
DESIGN CRIETERIONS

1. Efficient to remove nitrogenous & toxic waste and

excess ionic species.

2. Efficient in removing excess water.

3. Small internal blood-side volume(~500ml or less).

4. low blood-side flow resistance.

5. Constructed of blood-compatible material.

6. Reliable, repeatable and easy to operate.

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 DIALYZER

 It is called an artificial kidney

 It is designed to provide controllable transfer of solutes

and water across a semi permeable membrane
separating flowing blood and dialysate streams.

 The transfer processes are diffusion (dialysis) and

convection (ultrafiltration).

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Types of hemodialyzer:

i. Flat plate

ii. Coil type

iii. Tubular

iv. Hollow fiber

FLAT PATE TYPE OF HEMODIALYSER

 The assembled unit consists of

parallel epoxy boards having
lengthwise channels and grooves.

 Two cellophane sheets are

inserted between each board-to-
board joint.

 Headers direct blood to the

channels between two cellophane
sheets and dialysate to the gap
between cellophane and board.

 Flow is normal counter-current.

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COIL TYPE OF HEMODIALYSER
 Most popular type is called
Kolff Twin Coil.

 The membrane consists of

two cellophane tubes
flattened and placed on a
support screen and tightly
wound around a plastic core.

 Flow is “cross-flow”.

 Limitation:
Coil design don’t produce
uniform dialysate flow.

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HOLLOW FIBRE DEVICES
 This is the most effective
type of dialysis unit
consisting up to 11000
capillaries made of
regenerated cellulose.

 No blood pump in
needed.

 It provides low blood

flow resistance and high
efficiency.

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RECIRCULATION OF DIALYSATE SYSTEM
(ReDy)

 A recirculating dialysate system is used with artificial

kidney to eliminate toxic substance from the
dialysate solution.

 It is used to maintain continuously a normal

dialysate solution.

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Recirculating dialysis system consist of
several layers:
1. Urease: it converts urea
into ammonium carbonate
2. Zirconium phosphate:
absorbs ammonium ion.
3. Hydrated zirconium oxide:
absorbs phosphate ion.
4. Activated carbon: absorbs
uric acid, creatinine and
other organic waste
MASS TRANSFER EQUATION OF THE DIALYZER

WALL

MEMBRANE

Mass transfer in a differential length of a dialyzer

dW  K o  C B  C D  dA
and
dW  QD dC D  QB dC B
  QB   QB 
  dW   QD dC D  QB dC D
 QD   QD 
&
 QB 
dW   dW  QB dC B  QB dC D
 QD 
 QB 
dW 1    QB  dC B  dC D   QB d  C B  C D 
 QD 
d  CB  CD 
 dW  QB
QB
1
QD
Equating the dW’s,
d  CB  CD 
QB  K o  C B  C D  dA
QB
1
QD
d  CB  CD   1 1 
 K o   dA
 CB  CD   QB QD 

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Integrate assuming constant Ko
  C B i  C Do    1 1 
ln    K o    A
  C Bo  C Di    QB QD 
1 1 C Bi  C Bo C Do  C Di
Since   
QB QD W W
 
 
W  Ko A   C Bi  C Do    C Bo  C Di  
  C Bi  C Do  
 ln  
  C Bo  C Di  
W  K o A C  log mean
REFERENCES
 Lysaght MJ. Maintenance dialysis population dynamics:
current trends and long-term implications. J Am Soc
Nephrol 2002; 13: 37–40
 Moeller S, Gioberge S, Brown G. ESRD patients in 2001:
global overview of patients, treatment modalities and
development trends. Nephrol Dial Transplant 2002; 17:
2071–2976
PRESENTED BY

Debarati Saha
4th year,7th sem
Roll
No.071090131013

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