Principle of Hemo (dialysis)

HEMODIALYSIS Diffusion

HEMOFILTRATION : Convection

Principle of Hemodialysis
Dialysis removes nitrogenous (and other) waste products, and corrects the electrolyte, water, and acid base abnormalities associated with renal failure. It requires the use of semi-permeable membrane which allow the passage of water and small molecular weight solutes, but not large molecules.

Dialysis: General Principles

Diffusion Movement of solutes from an area of greater concentration to lesser concentration Osmosis Movement of fluid from an area of lesser to an area of greater concentration of solutes.

Ultrafiltration (water & fluid removal) Movement of fluid across a semipermeable membrane as a result of an artificially created pressure gradient.

Diffusion

Ultrafiltration

Diffusion
Membrane Membrane

t=0 A

t = equilibrium B

t=0

Ultrafiltration

t = later

The Process of diffusion (top) and ultrafiltration (bottom)

Hemodialysis Filter

Mechanisms of Solute Removal

1. Diffusion

2. Convection
3. Diffusion + Convection 4. Adsorbtion

Solute Clearance
Blood
Membrane Dialysate/Ultrafitrate

Diffusive Solute Clearance

Blood
Membrane Dialysate/Ultrafitrate

Diffusive Solute Clearance

Blood
Membrane Dialysate/Ultrafitrate

Convection

Adsorption

ADSORPTION: molecular adherence to the surface

or interior of the membrane.

Ultrafiltration

ULTRAFILTRATION: The movement of fluid through a membrane caused by a pressure gradient.

Water movement during standard hemodialysis

Intracellular fluid Extracellular fluid step3 Water movement step1
280
Loss of urea and water

Dialyzer

Osmolality 320 mosm/kg

Osmolality 320 mosm/kg Falling to 290mosm/kg as diffusion occurs

step2

Compensatory refilling

A Standard HD Delivery System

Informational Display
PT = Pressure Transducer Anticoagulant PT Saline

Blood from Patient

Blood Leak Detector

PT

Conductivity Meter

Dialysate / UF Out (green / yellow) Mixing System Pre-mixed or sorbent Water, Acid Concentrate, regenerated Bicarbonate Concentrate dialysate In

Dialysate In
PT

Drip Chamber

Air Detector

Venous clamp

Blood return to 18 Patient

Solute Transfer & Ultrafiltration

C blood > C Dialysate P Dialysate P blood >

Blood

Dialysate

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DIFFUSION