Hemodyalisis

Renal raplacment therapy
Hemodyalisis
Tbilisi referral hospital, Tbilisi, Georgia

Nephrologist
Nino Maglakelidze
Hemodialysis
•Falling kidneys may reach a point when they no longer excrete water
and ions at rates that maintain body balances of these substances, nor
can they excrete waste products as fast as they are produced;
•An elevation waste products, as measured in the blood, is called

,,azotemia”. When waste products accumulate they cause sick feeling
throughout the body called ,,Uremia”.
For patients with ESRD renal replacement therapy is achieved by
•Hemodialysis
•Peritoneal dialysis
•Kidney transplantation
Creatinine clearance < 10 ml/min patient needs dialysis

Hemodyalisis
Hemodialysis uses special filters to remove excess waste products

and water from the body
Hemodialysis
The apparatus used to conduct hemodialysis consists of the

following components:
Dialyzer
Dialysis solutions
Tubing for transport blood and dialysis
Machine to power and mechanically monitor the procedure

Hemodialysis modalities:
Hemodialysis
Hemofiltration
SLEDD – slow low-efficiency daily dialysis
CRRT-continues renal replacement therapy
CVVH – continues venovenous hemofiltration
CVVHD –continues venovenous hemodialysis
CVVHDF –continues venovenous hemodiafiltration

Solute clearance
Solute is cleared from the intravascular compartment inside dialyzer

by:
diffusive and
convective transport;
Blood flow/dialysate flow:
Blood flow 300-450 ml/min
Dialysate flow 500ml/min

Dialyzers
Types of dialyzers:
Hollow fiber dialyzers – contains thousands of hollow fibers

similar to human capillary;
Parallel plate Dialyzers – operates similarly to the hollow fiber and

are fashioned with flat sheets of membrane
Dialyzer
Type of membrane
Blood volume capacity
Surface area
Ultrafiltration coefficient
Clearance of various substances
Sterilization requirement
Types of membrane
•Unmodified cellulose – cuprophan is polysaccharide – based

membrane obtained from pressed cotton
•Substituted cellulose membrane obtained by chemical bonding

of the free hydroxyl groups at the surface of the cellulose
polymer.
•Cellulosynthetic membrane are modified by the addition of a

synthetic material to liquid cellulose during its formation and
have higher permeability and compatibility than cellulose
membrane.
Blood volume capacity
Is the priming blood volume required to fill dialyzers fiber

•Hollow –fiber dialyzer volume capacity is less than parallel –plate
dialyzers
•Blood volume capacity of hollow – fiber dialyzer is fixed and will not
increase with increasing transmembrane pressure.
•Priming volume depends on upon dialyzer surface area and ranges
from 60 to 120 ml;
Surface area
Dialyzers differs by surface areas

•And ranges from 0.8 to 2.1 m2
Clearance:
Clearance of various solutes from blood is a function of dialyzer
efficiency
Dialyzer clearance are routinely reports as urea or creatinine

clearance (small solutes) and vitamin B12 and beta – 2
microglobulines(large solutes)
The dialyzer mass transfer – area coefficient (KoA) quantitative

measure of dialyzer efficiency of clearance depends on membrane
porosity and thickness, solute size and blood and dialysate flow;
High efficiency : high KoA urea >600 ml/min;
High flux – high ultrafiltration (convenction) capacity

High clearance beta-2 microglobulines : 11 800 and vit. B12
Ultrafiltration coefficient:
The ultra filtration coefficient correlates directly with its

permeability
The volume of fluid that is transferred across the membrane per

mmHg of pressure gradient is called ultra filtration coefficient. (KUf)
A low KUf denotes a low permeability to water. The lower

permeability to water the higher TMP is needed to achieve ultra
filtration.
Sterilization and reuse:
Dialyzers are sterilized with ethylene oxide

Gamma irradiation
Steal autoclaving
Dialysate composition:
Water: ultrapure water, no bacteria and endotoxin should not be

detected;
These can be reached by reverse osmosis, deionization resins and
activated charcoal;
Dialysate composition:
Na+ - 135-142 mmol/l;
K+ - 0-4mmol/l;
Ca ++ - 1.25-1.75mmol/l;
Mg ++ - 0.25-1mmol/l;
Cl – 112mmol/l;
HCO3 – 28-35mmol/l;
Acetate – 2.5-10mmol/l;
Glucose – 0-200 mg/dl;

Anticoagulation during hemodialysis:
Heparin; control aPTT;
Low molecular heparin
Citrate
Evodialmembrane – heparin coated membrane
Xa factor inhibitor – Fondaparunix, Arixtra;
Refludan – Hirudin
No anticoagulation, saline infusion

GI bleeding, Hemorrhagic stroke and etc.
Vascular access
•Native arteriovenous fistula
•AV graft
•Temporary catheter
•Permanent tunneled catheter
Dialysis dose:
•Adequate dialysis dose Kt/v -1.4 per session; eKt/v 1.2;

K- dialyser clearance of urea; t-time for treatment in minutes;
volume of distribution of urea in the body;
•Urea reduction rate URR >65%
Dialysis machines:
Dialysis machines contains blood pump, which moves blood from

patient to dialyzer and back;
Dialysis monitors:
temperature monitor
air detector
arterial and vein blood line pressure monitors
dialysate conductivity monitor
Complications during dialysis sessions:
Hypotension
Cramps
Disequilibrium syndrome: headache, vomiting,
Allergy to the membrane, first use syndrome
Heparin induced thrombocytopenia
Airembolism , hemolysis

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Renal raplacment therapy

Tbilisi referral hospital, Tbilisi, Georgia

•An elevation waste products, as measured in the blood, is called

Creatinine clearance < 10 ml/min patient needs dialysis

Hemodialysis uses special filters to remove excess waste products

The apparatus used to conduct hemodialysis consists of the

Tubing for transport blood and dialysis

Machine to power and mechanically monitor the procedure

SLEDD – slow low-efficiency daily dialysis

CRRT-continues renal replacement therapy

CVVH – continues venovenous hemofiltration

CVVHD –continues venovenous hemodialysis

CVVHDF –continues venovenous hemodiafiltration

Solute is cleared from the intravascular compartment inside dialyzer

Blood flow/dialysate flow:

Blood flow 300-450 ml/min

Dialysate flow 500ml/min

Hollow fiber dialyzers – contains thousands of hollow fibers

Parallel plate Dialyzers – operates similarly to the hollow fiber and

Blood volume capacity

Clearance of various substances

•Unmodified cellulose – cuprophan is polysaccharide – based

•Substituted cellulose membrane obtained by chemical bonding

•Cellulosynthetic membrane are modified by the addition of a

Is the priming blood volume required to fill dialyzers fiber

Dialyzers differs by surface areas

Dialyzer clearance are routinely reports as urea or creatinine

The dialyzer mass transfer – area coefficient (KoA) quantitative

High efficiency : high KoA urea >600 ml/min;

High flux – high ultrafiltration (convenction) capacity

The ultra filtration coefficient correlates directly with its

The volume of fluid that is transferred across the membrane per

A low KUf denotes a low permeability to water. The lower

Dialyzers are sterilized with ethylene oxide

Water: ultrapure water, no bacteria and endotoxin should not be

Na+ - 135-142 mmol/l;

Glucose – 0-200 mg/dl;

Heparin; control aPTT;

Low molecular heparin

Evodialmembrane – heparin coated membrane

Xa factor inhibitor – Fondaparunix, Arixtra;

No anticoagulation, saline infusion

•Adequate dialysis dose Kt/v -1.4 per session; eKt/v 1.2;

Dialysis machines contains blood pump, which moves blood from

Disequilibrium syndrome: headache, vomiting,

Allergy to the membrane, first use syndrome

Heparin induced thrombocytopenia

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