The Urinary System

The kidney is the bodys main purification system Excretion, Regulation of blood volume and pressure, Regulation of the concentration of solutes in the blood. Etc

Renal Failure
R.I.F.L.E Risk of renal dysfunction; Injury to the kidney; Failure of kidney function, Loss of kidney function and End-stage kidney disease

Renal Replacement Therapy

R.R.T

Peritoneal Dialysis Haemodialysis Intestinal Dialysis

Haemofiltration

Renal Replacement (Transplant)

History of Haemodialysis
1861 1913 1943 1945 coma 1946 1948 1956 1965

Thomas Graham Abel, Rowntree and Turner Kolff and Berk 67-year-old woman in uremic Dr. Nils Alwall Skeggs and Leonards Marketed Gambro

Principles of Haemodialysis
Diffusion

osmosis

Ultrafiltration

(Concentrations of major constituents only)

Dialysate Composition
Dialysis

fluid is produced by the blending of treated water with electrolytes. The classical approach to dialysis fluid composition was to make the electrolyte composition identical to that of the plasma of a healthy individual. Today with the availability of technology as well as the awareness of the influence of various components on patient well being and treatment

Dialysate Composition
Constituent Water Estimated required concentrations use of ultra-pure water (as close to 100% purity as is possible using RO processes) 140145 mmol/l (hypernatraemic) used to avoid
excessive sodium losses arising from ultrafiltration (has draw backs) *

Sodium

Calcium Potassium Magnesium Chloride Glucose Bicarbonate (Buffer)

1.25 mmol/l (max calcium load 2000 mg/day)

according to current K/DOQI guidelines

2 mmol/l (avoids post-dialysis hypokalaemia) 0.25 to 0.75 mmol/l 98 and 112 mmol/l 100 mg/dl (prevents hypoglycaemia) 35 mmol/l

Ultrafiltration
In the Kidneys

Ultrafiltration occurs at the barrier between the blood and the filtrate in the renal corpuscle or Bowman's capsule in the kidneys. The Bowman's capsule contains a dense capillary network called the glomerulus. Blood flows into these capillaries through the afferent arteriole and leaves through the efferent arteriole The blood pressure in the afferent arteriole is higher than the blood pressure in the efferent arteriole The high pressure forces small molecules such as water, glucose, amino acids, sodium chloride and urea through the filter, from the blood in the glomerular capsule across the basement membrane of the Bowman's capsule and into the nephron This type of high pressure filtration is called ultrafiltration

Ultra Filtration (in kidneys) Illustration depicting

the steps involved in waste removal via the nephrons of the kidney

Ultrafiltration
In dialysis Ultrafiltration (UF) (also referred to as convection) is a variety of membrane filtration in which hydrostatic pressure forces a liquid against a semipermeable membrane Suspended solids and solutes of high molecular weight are retained, while water and low molecular weight solutes pass through the membrane could also be described as fluid flow through the membrane, forced by a difference in pressure on the two sides of the dialyzer (pressure gradient).

Dialysis, the Process.

Dialysis is a treatment used when the kidneys do not work well. A process of filtering and removing waste products from the bloodstream. Two main types are hemodialysis and peritoneal dialysis. . Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

Types of Dialysis

Peritoneal Dialysis
A procedure where the peritoneum surrounding the abdominal cavity is used as a dialyzing membrane for removal of waste products or toxins accumulated.

Hemodialysis
A procedure in which the patient's blood is shunted from the body through a machine called a dialyzer for diffusion and ultrafiltration and then returned to the patient's circulation.

Peritoneal Dialysis & Hemodialysis

Hemodialysis - step by step process the time the patient arrives for his/her Before or around

scheduled session, a dialysis machine will be prepared. The patient arrives and is carefully weighed. Standing and sitting blood pressures are taken. Temperature is taken. Access is set up and the patient is then connected to the dialyzer creating a complete loop through the pump and filter. The pump and a timer are started. Hemodialysis is underway. During treatment, you sit or recline in a chair while blood flows through the dialyzer. Blood pressure and heart rate can fluctuate as excess fluid is pulled from the body. A member of the health care team will check blood pressure and heart rate several times during each treatment.

When treatment is complete, the needles will be removed from the access site and a pressure dressing will be applied to the site to prevent bleeding. Standing and sitting blood pressures and temperature are taken again. The patient is free to go about their usual activities until the next treatment session.

Side Effects of Haemodialysis

Low blood pressure (hypotension) Muscle cramps Itching Sleep problems Anemia Bone diseases Inflammation of the membrane surrounding the heart (pericarditis) Infection Depression Amyloidosis. Dialysis-related amyloidosis (DRA)

Recent Advances

Bioengineered materials to improve types of grafts for venulaur access. Educational programmes for nutritional maintenance of renal failure, benefits for patients on Dialysis. Guidelines implemented worldwide provides for safer, standardised methods of dialysis. New improved equipment provide better filtration rates, as well as dialysis at home. New implant techniques provide for longer lifespan of patients, also freedom of immunosuppressive drugs and risks of rejection.

Limitations
Economic costs Maintenance of state run dialysis centers is a costly experience, especially with the incidence of persons developing renal failure due to diabetes etc. There are also not enough centers to facilitate the populous so dialysis at private clinics is sometimes sought which is also expensive. Education More resources are needed to educate persons on dialysis about maintenance of access points, nutrition and other aspects of dialysis. Too many times complications arise from persons failing to follow certain procedures that could have been avoided. Medical complications as stated in the section on side effects, dialysis is a complicated procedure and there are several medical side effects which put a further strain on the individual as well as resources. There are also the problems associated with transplants including rejection of the organ, depression due to post surgical stress etc. Time delays Unavailability of dialyzing equipment due to bookings, breakdowns etc puts excessive strain on subjects both emotionally and physically. Hence the need for continuous research.

Conclusion