PRINCIPLE

OF
HAEMODIALISIS
 Hemodialysis = solute passively diffuses down concentration
gradient
 Dialysate flows countercurrent to blood flow.
 Urea, creatinine, K move from blood to dialysate
 Ca and bicarb move from dialysate to blood.
 Hemofiltration: uses hydrostatic pressure gradient to induce
filtration / convection plasma water + solutes across
membrane.
 Hemodiafiltration: combination of dialysis and filtration
 Goals of HD

To manage :
- uremia
- fluid overload
- electrolyte imbalance
 Artificial kidney
• Called a dialyzer.
• Contains 2 compartment :
- blood and dialysate.
• Compartment are separated by a
semipermeable membrane.
• Compartments are encased in a clear plastic
cylinder which acts a support for the fibre.
Solutions

• Solvent is a fluid (water).

• Solute is a subtance that can be dissolved in a
solvent.
• Examples: potassium, sodium and calcium.
Semipermeable membrane.
• Thin layer of material with pores or openings that
acts as a sieve.
• Allow smaller molecules to pass through but not
larger molecules .
• Solute particles than these opening cannot pass
through and are retained.
• Rate depend on particles size.
• Blood cells are too large to pass through.
• Waste products ,excess chemicals and excess
fluid can pass through.
Dialysate.
• Composed of concentrated electrolytes,
bicarbonate and RO water.
• Electrolyte concentration is removed or given
to the patient..
• Tailored to each pt’s need based on blood
cemistries.
• Regulates electrolyte and acid/base balance in
the blood..
• Enable to removal of
-wastes products.
-excess fluid.
• Prevent excess removal of
-essential electrolytes.
-excessive fluid depletion.
 Molecular weight of some common
substances.

• Urea- 60 DA
• Hemoglobin – 68,800 Da
• Creatinine – 113 Da
• Albumin – 68,000 Da
• Glucose – 180 Da
 Factors affect toxin removal.

• Dialysate temperature.
• Dialysate flow rate.
• Blood flow rate.
• Molecular weight.
• Concentration gradient.
• Membrane permeability.
 Flow geometry
• Direction of the flow of blood and dialysate.
• Countercurrent flow = blood and dialysate
flow opposite directions ,creating an optimal
concentration.
• Concurrent flow = the blood and dialysate
both flow in the same direction , creating a
much smaller concentration gradient..
 Principle of dialisis
• Dialysis = diffusion = passive
movement of solutes across
a semi-permeable
membrane down
concentration gradient
– Good for small molecules
• (Ultra)filtration = convection
= solute + fluid removal
across semi-permeable
membrane down a pressure
gradient (solvent drag)
– Better for removal of fluid and
medium-size molecules
Diffusion
• Movement of solute
• Across semipermeable membrane
• From region of high concentration to one of
low concentration
Diffusion will occur until equilibrium is
reached.
• The process..
1)

2)  Blood cells are too big to pass through the dialysis

membrane, but body wastes begin to diffuse (pass) into
the dialysis solution.
3)

 Diffusion is complete. Body wastes have

diffused through the membrane,
 and now there are equal amounts of
waste in both the blood and the
 dialysis solution.
 Factors that affect the rate of
diffusion.
• Molecular size.
• Membrane permeability.
• Surface area.
• Temperature.
• Concetration gradient.
• Flow geometry.
Ultrafiltration.
1)

2)

  Blood cells are too big to pass through the semi-permeable membrane,
 but water in the blood is drawn into the dialysis fluid by the glucose.
3)

Ultrafiltration is complete. Water has been drawn through

the peritoneum by the glucose in the dialysis fluid  by the
glucose in the dialysis fluid. There is now extra water in
the dialysis fluid which need to be changed.
 osmosis
• Movement of fluid across a semipermeable
membrane from an area of lower solute
concentration to an area of higher solute
concentration.
 Convection.
• When water moves across a membrane
becouse of a pressure gradient
(ultrafiltration), there is a friction effect on
solute molecules. Low molecules weight
molecules or particles can be swept through
the membrane along with the ultrafiltrate.
convection
End