What is Hemodialysis?

Shahrzad Ossareh-M.D.

300-500 ml/min

500-800 ml/min

Diffusion

Convection

Arterial line Venous line

Dialysis Solution

Component Concentration (meq/L) Na 135-145 K 0-4 Ca 2.5-3.5 Mg 0.5-0.75 Cl 98-124 Acetate 2-4 Bicarbonate 30-40 Dextrose 11 PCO2 40-110 pH 7.1-7.3

The acetate is in the form of acetic acid in the acid component. On mixing with the HCO3 component the H+ in acid acetic reacts with an equimolar amount of HCO3 to form CO2

Complications During HD: Hypotension

Decreased Blood

Volume:

High UF rate,

Low dialysate Na

Lack of vasoconstriction:

Acetate dialysate

Warm dialysate

Food ingestion

Tissue ischemia

Autonomic neuropathy

Antihypertensives

Cardiac factors: Diastolic dysfunction β-blockers Uremic autonimc

neuropathy Aging Poor myocardial

contractility Pericardial Tamponade MI Occult Hemorrhage Septicemia Dialyzer Reaction Hemolysis Air Embolism

Other Complications: Muscle cramps

Hypotension Patient below dry weight Low dialysate Na Chronic leg cramps Nausea and vomiting

Chest pain and back pain Itching Fever and chills Disequilibrium syndrome Dialyzer reactions

Type A: Anaphylactic type: E.O., AN 69, PAN, contaminated dialysis solution, reuse, heparin

Type B: Complement activation, less severe Arrhythmia, Tamponade, IC bleeding, Seizures, Hemolysis,

Air embolism, Neutropenia and complement activation

KT/V=1.4

60 kg female V= 60 0.55= 33 L = 33,000 ml T= 4 hours = 240 min K ? KT/V=1.4 → (K 240 )/33,000 = 1.4 → K 240 = 46,200 → K = 192.5 (PS13)

Peritoneal DialysisPeritoneal Dialysis

Definition

The transport of solutes and water across a membrane that separates 2 fluid containing compartments: Blood in the peritoneal capillaries Dialysis solution in the peritoneal

cavity

Stagnant fluid film over the endothelium

of peritoneal capillary walls

Capillary endothelium

Stagnant fluid filmoverlying

the peritoneal membrane

Endothelial B.M.

Mesothelium

Interstitium