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Dialisis

Dari Wikipedia bahasa Indonesia, ensiklopedia bebas

Proses dialisis.

Dialisis adalah proses perpindahan molekul terlarut dari suatu campuran larutan yang terjadi
akibat difusi pada membran semi-permeabel.[1]Molekul terlarut yang berukuran lebih kecil dari
pori-pori membran tersebut dapat keluar, sedangkan molekul lainnya yang lebih besar akan
tertahan di dalam kantung membran.[1] Selulosa adalah salah satu jenis materi penyusun
membran dialisis yang cukup umum dipakai karena bersifat inert untuk berbagai jenis senyawa
atau molekul yang akan dipisahkan.[1] Laju difusi ditentukan oleh beberapa kondisi:

Konsentrasi molekul pelarut yang akan keluar dari kantung dialisis. Jika konsentrasi
molekul terlarut di lingkungan lebih kecil dibandingkan dengan yang ada di dalam kantung
dialisis maka laju difusi akan semakin cepat.[1]

Luas permukaan kantung dialisis. Semakin luas permukaan membran yang digunakan
maka laju difusi akan semakin cepat.[1]

Volume pelarut. Jika rasio luas permukaan membran dengan volume pelarut besar maka
laju difusi akan berlangsung dengan cepat karena molekul terlarut dapat berdifusi dalam
jarak yang dekat.[1]

Metode dialsis banyak digunakan dalam pemurnian protein (terutama enzim).[2] Dalam proses ini,
dialisis digunakan untuk menghilangkan molekul garam, seperti amonium sulfat, sebelum
dilanjutkan dalam proses pemurnian berikutnya ataupun pada tahap akhir pemurnian. [2] Dialisis
juga banyak digunakan dalam proses pencucian darah pada pasien penderita gagal ginjal.
[3] [4]
Untuk kasus ini, peranan ginjal untuk menghilangkan senyawa beracun, garam
dan air berlebih digantikan dengan sistem buatan.[3]Hemodialisis adalah metode pencucian
darah dengan menggunakan mesin, sedangkan dialisis peritoneal menggunakan membran
peritoneal yang berlokasi di daerah perutuntuk menggantikan peranan ginjal.[3]

Dialisis
Dialisis adalah suatu teknik pemisahan dengan cara menggunakan membran yang
memisahkan dua fasa cairan. Membran tersebut bersifat semipermeabel terhadap partikel
solute. Partikel solut berpindah melalui membran ke larutan dengan konsentrasi rendah.
Dialisis digunakan untuk memisahkan garam-garam dari suspensi dalam biokimia dengan
tujuan mencegah koagulasi. Dialysis adalah metode pemisahan molekul besar (seperti pati
atau protein) dari molekul kecil (seperti glukosa atau asam amino) dengan difusi selektif

melalui membrane semipermeabel. Misalnya, jika larutan campuran pati dan glukosa
dimasukkan dalam wadah tertutup terbuat dari bahan semipermeabel (seperti selofan) lalu
direndam dalam gelas kimia berisi air, maka molekul glukosa yang lebih kecil akan melewati
membrane menuju ke air, sedangkan molekul besar, yaitu pati, akan tertinggal di dalam
wadah. Prinsip dasar dari dialisi ini adalah perbedaan molekul-molekul. Alat yang
digunakan yaitu wadah tertutup terbuat dari bahan semipermeabel (sperti selofun), gelas
piala. Dialysis ini digunakan untuk memisahkan molekul-molekul yang memiliki perbedaan
ukuran. Membrane sel pada makhluk hidup bersifat semipermeabel, dan dialysis berlangsung
secara alami dalam ginjal untuk mengeluarkan limbah bernitrogen. Ginjal buatan (mesin
dialysis) menggunakan asas ini untuk menggantikan fungsi ginjal sakit.

Dialysis
From Wikipedia, the free encyclopedia

This article is about renal dialysis; for the laboratory technique, see dialysis (biochemistry); for
treatment for liver failure, see liver dialysis.

Dialysis
Intervention

Patient receiving dialysis

ICD-9-CM

39.95

MeSH

D006435

MedlinePlus

007434

In medicine, dialysis (from Greek dialusis, meaning dissolution, dia, meaning through,
and lysis, meaning loosening or splitting) is a process for removing waste and excess water
from the blood, and is used primarily as an artificial replacement for lost kidney function in
people with renal failure. Dialysis may be used for those with an acute disturbance in kidney
function (acute kidney injury, previously acute renal failure), or progressive but chronically
worsening kidney functiona state known as chronic kidney diseasestage 5 (previously
chronic renal failure or end-stage renal disease). The latter form may develop over months or
years, but in contrast to acute kidney injury is not usually reversible, and dialysis is regarded
as a "holding measure" until a renal transplant can be performed, or sometimes as the only
supportive measure in those for whom a transplant would be inappropriate. [1] Dialysis is an
imperfect treatment to replace kidney function because it does not correct the compromised
endocrine functions of the kidney. Dialysis treatments replace some of these functions
through diffusion (waste removal) and ultrafiltration (fluid removal).[2]
Contents
[hide]

1 History

2 Principle

3 Types
o

3.1 Hemodialysis

3.2 Peritoneal dialysis

3.3 Hemofiltration

3.4 Hemodiafiltration

3.5 Intestinal dialysis

4 Starting indications

5 Dialyzable substances
o

5.1 Characteristics

5.2 Substances

6 See also
o

6.1 Materials and methods

6.2 Medical applications

7 References

8 External links

History[edit]

Arm showing tubes

A Dutch physician, Willem Johan Kolff, constructed the first working dialyzer in 1943 during
the Nazi occupation of the Netherlands.[3] Due to the scarcity of available resources, Kolff had
to improvise and build the initial machine using sausage casings, beverage cans, a washing
machine, and various other items that were available at the time. Over the following two
years, [1943-1945] Kolff used his machine to treat 16 patients suffering from acute kidney
failure, but the results were unsuccessful. Then, in 1945, a 67-year-old comatose woman
regained consciousness following 11 hours of hemodialysis with the dialyzer, and lived for
another seven years before dying from an unrelated condition. She was the first-ever patient
successfully treated with dialysis.[3] Dr. Nils Alwall modified a similar construction to the Kolff
kidney by enclosing it inside a stainless steel canister. This allowed the removal of fluids, by
applying a negative pressure to the outside canister, thus making it the first truly practical
device for hemodialysis. Alwall treated his first patient in acute renal failure on the September
3, 1946.

Principle[edit]

A hemodialysis machine

Dialysis works on the principles of the diffusion of solutes and ultrafiltration of fluid across
a semi-permeable membrane. Diffusion is a property of substances in water; substances in
water tend to move from an area of high concentration to an area of low concentration.
[4]

Blood flows by one side of a semi-permeable membrane, and a dialysate, or special dialysis

fluid, flows by the opposite side. A semipermeable membrane is a thin layer of material that
contains holes of various sizes, or pores. Smaller solutes and fluid pass through the
membrane, but the membrane blocks the passage of larger substances (for example, red
blood cells, large proteins). This replicates the filtering process that takes place in the
kidneys, when the blood enters the kidneys and the larger substances are separated from
the smaller ones in the glomerulus.[4]
The two main types of dialysis, hemodialysis and peritoneal dialysis, remove wastes and
excess water from the blood in different ways.[5]Hemodialysis removes wastes and water by
circulating blood outside the body through an external filter, called a dialyzer, that contains
asemipermeable membrane. The blood flows in one direction and the dialysate flows in the
opposite. The counter-current flow of the bloodand dialysate maximizes the concentration
gradient of solutes between the blood and dialysate, which helps to remove more urea
andcreatinine from the blood. The concentrations of solutes (for
example potassium, phosphorus, and urea) are undesirably high in the blood, but low or
absent in the dialysis solution, and constant replacement of the dialysate ensures that the
concentration of undesired solutes is kept low on this side of the membrane. The dialysis
solution has levels of minerals like potassium and calcium that are similar to their natural

concentration in healthy blood. For another solute, bicarbonate, dialysis solution level is set
at a slightly higher level than in normal blood, to encourage diffusion of bicarbonate into the
blood, to act as a pH buffer to neutralize the metabolic acidosis that is often present in these
patients. The levels of the components of dialysate are typically prescribed by
a nephrologist according to the needs of the individual patient.
In peritoneal dialysis, wastes and water are removed from the blood inside the body using
the peritoneum as a natural semipermeable membrane. Wastes and excess water move from
the blood, across the peritoneal membrane, and into a special dialysis solution, called
dialysate, in the abdominal cavity.

Types[edit]
There are three primary and two secondary types of
dialysis: hemodialysis (primary), peritoneal
dialysis (primary), hemofiltration (primary), hemodiafiltration (secondary), andintestinal
dialysis (secondary).

Hemodialysis[edit]

Hemodialysis schematic

Main articles: Hemodialysis and Home hemodialysis


In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer,
exposing it to a partially permeable membrane. The dialyzer is composed of thousands of
tiny hollow synthetic fibers. The fiber wall acts as the semipermeable membrane. Blood flows
through the fibers, dialysis solution flows around the outside of the fibers, and water and

wastes move between these two solutions.[6] The cleansed blood is then returned via the
circuit back to the body. Ultrafiltration occurs by increasing the hydrostatic pressure across
the dialyzer membrane. This usually is done by applying a negative pressure to the dialysate
compartment of the dialyzer. This pressure gradient causes water and dissolved solutes to
move from blood to dialysate, and allows the removal of several litres of excess fluid during a
typical 4-hour treatment. In the United States, hemodialysis treatments are typically given in
a dialysis center three times per week (due in the United States to Medicare reimbursement
rules); however, as of 2007 over 2,500 people in the United States are dialyzing at home
more frequently for various treatment lengths.[7] Studies have demonstrated the clinical
benefits of dialyzing 5 to 7 times a week, for 6 to 8 hours. This type of hemodialysis is usually
called "nocturnal daily hemodialysis", which a study has shown a significant improvement in
both small and large molecular weight clearance and decrease the requirement of
taking phosphate binders.[8] These frequent long treatments are often done at home while
sleeping, but home dialysis is a flexible modality and schedules can be changed day to day,
week to week. In general, studies have shown that both increased treatment length and
frequency are clinically beneficial.[9]
Hemo-dialysis was one of the most common procedures performed in U.S. hospitals in 2011,
occurring in 909,000 stays (a rate of 29 stays per 10,000 population). [10]

Peritoneal dialysis[edit]

Schematic diagram of peritoneal dialysis

Main article: Peritoneal dialysis


In peritoneal dialysis, a sterile solution containing glucose (called dialysate) is run through a
tube into the peritoneal cavity, the abdominalbody cavity around the intestine, where the
peritoneal membrane acts as a partially permeable membrane. The peritoneal membrane or
peritoneum is a layer of tissue containing blood vessels that lines and surrounds the
peritoneal, or abdominal, cavity and the internal abdominal organs (stomach, spleen, liver,

and intestines).[11] Diffusion and osmosis drive waste products and excess fluid through the
peritoneum into the dialysate until the dialysate approaches equilibrium with the body's fluids.
Then the dialysate is drained, discarded, and replaced with fresh dialysate. [12]
This exchange is repeated 4-5 times per day; automatic systems can run more frequent
exchange cycles overnight. Peritoneal dialysis is less efficient than hemodialysis, but
because it is carried out for a longer period of time the net effect in terms of removal of waste
products and of salt and water are similar to hemodialysis. Peritoneal dialysis is carried out at
home by the patient, often without help. This frees patients from the routine of having to go to
a dialysis clinic on a fixed schedule multiple times per week. Peritoneal dialysis can be
performed with little to no specialized equipment (other than bags of fresh dialysate).

Hemofiltration[edit]
Main article: Hemofiltration
Hemofiltration is a similar treatment to hemodialysis, but it makes use of a different principle.
The blood is pumped through a dialyzer or "hemofilter" as in dialysis, but no dialysate is
used. A pressure gradient is applied; as a result, water moves across the very permeable
membrane rapidly, "dragging" along with it many dissolved substances, including ones with
large molecular weights, which are not cleared as well by hemodialysis. Salts and water lost
from the blood during this process are replaced with a "substitution fluid" that is infused into
the extracorporeal circuit during the treatment. Hemodiafiltration is the combining of
hemodialysis and hemofiltration in one process.

Hemodiafiltration[edit]
Hemodiafiltration is a combination of hemodialysis and hemofiltration.

Intestinal dialysis[edit]
In intestinal dialysis, the diet is supplemented with soluble fibres such as acacia fibre, which
is digested by bacteria in the colon. This bacterial growth increases the amount of nitrogen
that is eliminated in fecal waste.[13][14][15] An alternative approach utilizes the ingestion of 1 to
1.5 liters of non-absorbable solutions of polyethylene glycol or mannitolevery fourth hour.[16]

Starting indications[edit]
The decision to initiate dialysis or hemofiltration in patients with renal failure depends on
several factors. These can be divided into acute or chronic indications.

Indications for dialysis in the patient with acute kidney injury are summarized with the
vowel acronym of "AEIOU":[17]
1.

Acidemia from metabolic acidosis in situations in which correction with sodium


bicarbonate is impractical or may result in fluid overload.

2.

Electrolyte abnormality, such as severe hyperkalemia, especially when combined


with AKI.

3.

Intoxication, that is, acute poisoning with a dialyzable substance. These


substances can be represented by the mnemonic SLIME: salicylic
acid, lithium, isopropanol,magnesium-containing laxatives, and ethylene glycol.

4.
5.

Overload of fluid not expected to respond to treatment with diuretics


Uremia complications, such as pericarditis, encephalopathy, or gastrointestinal
bleeding.

Indications for chronic dialysis: Chronic dialysis may be indicated when a patients has
symptomatic renal failure and low glomerular filtration rate (GFR). Between 1996 to 2008
there was a trend to initiate dialysis at progressively higher estimated GFR, eGFR. A review
of the evidence shows no benefit or potential harm with early dialysis initiation, which has
been defined by start of dialysis at an estimated GFR of greater than
10ml/min/1.732.Observational data from large registries of dialysis patients suggests that
early start of dialysis may be harmful.[18] The most recent published guidelines from Canada,
for when to initiate dialysis, recommend an intent to defer dialysis until a patient has definite
renal failure symptoms, which may occur at an estimated GFR of 5-9ml/min/1.732.[19]
Some reason for dialysis initiation include difficulty in medically controlling fluid overload or
serum potassium. If a patient has intractable renal failure symptoms or signs, start of dialysis
may be recommended at e GFR levels above 10ml/min/1.732

Dialyzable substances[edit]
Characteristics[edit]
Dialyzable substances have following properties:
1. low molecular mass
2. high water solubility
3. low protein binding
4. prolonged elimination (long half life)
5. small volume of distribution

Substances[edit]

Ethylene glycol

Procainamide

Methanol

Isopropyl alcohol

Barbiturates

Lithium

Bromide

Sotalol

Chloral hydrate

Ethanol

Acetone, Atenolol

Theophylline

Salicylates

See also[edit]
Materials and methods[edit]

Thomas Graham (chemist), the founder of dialysis and father of colloid chemistry

Dialysis tubing

List of US dialysis providers

Medical applications[edit]

Apheresis, also known as plasmapheresis, is another extracorporeal technique that


selectively removes specific constituents from blood

Hemodialysis

Peritoneal dialysis

Acute renal failure

Renal failure

Nephrology

Chronic kidney disease

Hepatorenal syndrome

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2.4. Dialysis
Chapter 2. Units, solutions, dialysis

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2.4. Dialysis
2.4.1. The principle of dialysis

Dialysis is a procedure employed in a number of cases when a change in the


concentration or composition of solutes is necessary. In the biochemical
practice, dialysis is often used to alter the concentration of salts and/or small
molecules in protein solutionsusually aimed at decreasing the concentration
of these solutes. However, the composition of the solution can also be changed
in additional ways.

Dialysis is based on diffusion during which the mobility of solute particles


between two liquid spaces is restricted, mostly according to their size. (In rarely
used versions of dialysis, restriction of diffusion via polarity or charge is also
possible.) Size restriction is achieved by using a porous material, usually a
semi-permeable membrane called dialysis membrane. This membrane is
permeable only for particles below a certain size. In the biochemical laboratory,
this membrane is mostly a hose made from transparent material (also called
dialysis bag) that can be tightly closed (tied) at its ends (Figure 2.2). The
solution to be dialysed (with a volume V1) is loaded into the dialysis bag. The
dialysis bag is then placed into a dialysis solution (with a volume V 2) that is
stirred slowly to aid the diffusion of the subset of solutes that can be released
through the bag membrane, in order to achieve equilibrium between solute
concentrations in the two liquid spaces. If the difference in volume between the
two spaces is large (V2 >> V1, e.g. V2 = 10 L and V1 = 0.1 L, a 100-fold
difference), the onset of the equilibrium will lead to a very significant dilution
of the small solutes that were initially inside the bag (their concentration will
change by a factor V1/(V1+V2), in this case << 1), with only a slight change in
the concentration of small solutes in the outside solution (by a factor V 2/
(V1+V2) 1), whereas the concentration of the molecules inside the bag that
cannot penetrate the membrane remains almost completely unchanged (see in
details below).
Dialisis adalah prosedur yang digunakan dalam sejumlah kasus ketika
perubahan konsentrasi atau komposisi zat terlarut yang diperlukan. Dalam
praktek biokimia, dialisis sering digunakan untuk mengubah konsentrasi garam
dan / atau molekul kecil protein solusi-biasanya ditujukan untuk penurunan
konsentrasi zat terlarut tersebut. Namun, komposisi larutan juga dapat diubah
dengan cara lain.

Dialisis didasarkan pada difusi selama mobilitas partikel zat terlarut antara dua
ruang cair dibatasi, sebagian besar menurut ukuran mereka. (Dalam versi jarang
digunakan dialisis, pembatasan difusi melalui polaritas atau biaya juga
mungkin.) Pembatasan Ukuran dicapai dengan menggunakan bahan berpori,
biasanya membran semipermeabel disebut membran dialisis. Membran ini
permeable hanya untuk partikel di bawah ukuran tertentu. Di laboratorium
biokimia, membran ini adalah sebagian besar selang terbuat dari bahan
transparan (juga disebut dialisis bag) yang dapat tertutup rapat (diikat) pada
ujung-ujungnya (Gambar 2.2). Solusi untuk didialisis (dengan V1 volume)
dimuat ke dalam kantong dialisis. Tas dialisis kemudian ditempatkan ke dalam
larutan dialisis (dengan V2 volume) yang diaduk perlahan untuk membantu
difusi subset zat terlarut yang bisa dilepas melalui membran tas, dalam rangka
mencapai keseimbangan antara konsentrasi zat terlarut dalam dua cair spasi.
Jika perbedaan volume antara dua ruang besar (V2 >> V1, misalnya V2 = 10 L
dan V1 = 0,1 L, perbedaan 100 kali lipat), timbulnya kesetimbangan akan
menyebabkan dilusi yang sangat signifikan dari kecil zat terlarut yang awalnya
di dalam tas (konsentrasi mereka akan berubah dengan faktor V1 / (V1 + V2),
dalam hal ini << 1), dengan hanya sedikit perubahan dalam konsentrasi zat
terlarut kecil dalam larutan di luar (dengan faktor V2 / (V1 + V2) 1),
sedangkan konsentrasi molekul di dalam tas yang tidak dapat menembus
membran tetap hampir sepenuhnya berubah (lihat detail di bawah).

Figure 2.2. Dialysis in the biochemical laboratory practice


2.4.2. Practical aspects and applications of dialysis

The efficiency of dialysis, i.e. the extent to which the concentration and
composition of the inside solution can be changed, is an important aspect. It
follows from the above description of dialysis that the efficiency of dialysis
largely depends on the difference between the volumes of the inside and outside
liquid spaces. This is why we generally seek to use as large volume (V 2) of the
dialysing solution as possible. However, the efficiency of dialysis can be further
increased by performing multi-step dialysis by exchanging the outer solution
after the equilibrium has been reached. In this case, the attainable dilution of the
inside solution will be [V1/(V1+V2)]n where n is the number of steps. It is easy
to see that efficiency that can be achieved by applying a two-step dialysis at a
50-fold volume difference is much higher than the efficiency of a single-step
dialysis at a 100-fold volume difference.
The speed of dialysis can be increased not only by stirring the outside solution
but also by increasing the surface/volume ratio of the inside solution, as the flux
of diffusion is linearly proportional to the cross-section. It is, therefore, more
practical to choose a narrower and longer tube than a wider and shorter one.

The semi-permeable membrane can be crossed not only by salts and small
molecules but also by solvent particles (in most cases, water). The direction and
extent of the net solvent flow is determined by the difference between the total
concentration of solutes in the inside and outside solutions such that the solvent
migrates from the less to the more concentrated solution (with regard to
solutes). This way the equilibrium concentration of the solute(s) of the inside
solution that cannot cross the membrane will be influenced also by the diffusion
of the solvent. As the solute(s) that cannot cross the membrane also contribute
to the total concentration of the inside solution, the net direction of solvent
migration will almost always point towards the inside solution. Therefore, the
volume of the inside solution will increase, thereby selectively decreasing the
concentration of the membrane-impermeable solute(s)but not that of the
membrane-permeable ones, even if the relative increase in the volume is large.
However, the relative increase in the volume is generally not large because (i)
the concentration of the large impermeable solutes is low (much lower than that
of the small permeable ones) (ii) the dialysis tube is largely unable to increase
its volume. The occasional small (5-20 %) volume increase of the inside
solution is associated with the compression of air above the liquid phase that
was originally enclosed in the bag. Taken together, the decrease in the
concentration of the large solutes (proteins) is usually negligibly small. The
increase in the volume of the inside solution is remarkable from a technical
point of view because it is accompanied by a (sometimes substantial) elevation
of the pressure. Therefore, if there is a hidden weakness somewhere in the
material of the membrane, the elevation of pressure may lead to bursting of the
bag and, as a consequence, the complete loss of the dialysed material (e.g.
protein preparation). To avoid this catastrophe, it is recommended to perform
a pressure test on the bag in its water-filled state. The other risk associated with
pressure elevation occurs during the opening of the bag after completion of
dialysis. In the absence of necessary care, the pressurised inside solution can
sprinkle out, causing loss of material.

In the biochemical laboratory practice, solutions of proteins are generally


dialysed following fractioned ammonium sulfate precipitation (detailed in
Chapter 5) as well as before or after ion exchange chromatography (detailed in
Chapter 6). A size selectivity (size exclusion or cut-off) specified as 4 or 11 kDa
means that the pores of the dialysis membrane are impermeable for particles
larger than 4 or 11 kDa, respectively.
Besides the biochemical laboratory, dialysis is utilised in the field of life
sciences also for therapeutic purposes during haemodialysis, i.e. in artificial
kidneys. The principal difference between these two applications is that, in the
artificial kidney, dialysis is executed under continuous counter-flow of the two
solution spaces: both the inside solution (the blood of the patient) and the
outside solution are pumped. Thus, in such a setting, also the inside liquid space
is open: it is not in a bag but flows inside a tube. Moreover, in order to
increase the flux of diffusion, a large number of capillary tubes are employed in
a bundle (which is actually the artificial kidney) by which the surface/volume
ratio is increased enormously. The composition of the outside dialysing solution
is very special as it must meet special requirements. In addition, the artificial
kidney equipment is a very special apparatus because it must be able to ensure
the appropriate pressure and temperature while the blood entering the body of
the patient must be free of entrapped air bubbles that could lead to lethal
consequences.
Efisiensi dialisis, yaitu sejauh mana konsentrasi dan komposisi larutan dalam
dapat diubah, merupakan aspek penting. Ini mengikuti dari uraian di atas
dialisis bahwa efisiensi dialisis sangat tergantung pada perbedaan antara
volume bagian dalam dan luar ruang cair. Inilah sebabnya mengapa kita
umumnya berusaha untuk menggunakan volume yang lebih besar (V2) dari
solusi dialysing mungkin. Namun, efisiensi dialisis dapat lebih meningkat
dengan melakukan multi-langkah dialisis dengan bertukar solusi luar setelah
keseimbangan telah tercapai. Dalam hal ini, pengenceran dicapai solusi
dalam akan [V1 / (V1 + V2)] n di mana n adalah jumlah langkah. Sangat

mudah untuk melihat bahwa efisiensi yang dapat dicapai dengan


menerapkan dua langkah dialisis pada volume perbedaan 50 kali lipat jauh
lebih tinggi dari efisiensi satu langkah dialisis pada perbedaan Volume 100
kali lipat.
Kecepatan dialisis dapat ditingkatkan tidak hanya dengan mengaduk larutan luar
tetapi juga dengan meningkatkan rasio permukaan / volume larutan dalam,
sebagai fluks difusi berbanding lurus dengan penampang. Hal ini, oleh karena
itu, lebih praktis untuk memilih tabung sempit dan lebih lama dari yang lebih
luas dan lebih pendek.
Membran semi-permeabel bisa dilewati tidak hanya oleh garam dan molekul
kecil tapi juga oleh partikel pelarut (dalam banyak kasus, air). Arah dan
tingkat aliran pelarut bersih ditentukan oleh perbedaan antara konsentrasi
total zat terlarut dalam dalam dan solusi luar sehingga bermigrasi pelarut dari
kurang untuk solusi yang lebih pekat (berkaitan dengan zat terlarut). Dengan
cara ini konsentrasi keseimbangan zat terlarut (s) dari solusi dalam yang
tidak dapat menyeberangi membran akan dipengaruhi juga oleh difusi
pelarut. Sebagai zat terlarut (s) yang tidak dapat menyeberangi membran
juga berkontribusi terhadap konsentrasi total solusi dalam, arah net migrasi
pelarut akan hampir selalu menunjuk ke arah solusi dalam. Oleh karena itu,
volume larutan dalam akan meningkat, sehingga secara selektif mengurangi
konsentrasi membran-kedap zat terlarut (s) -tapi tidak satu yang membranpermeabel, bahkan jika peningkatan relatif dalam volume yang besar. Namun,
peningkatan relatif dalam volume umumnya tidak besar karena (i)
konsentrasi zat terlarut kedap besar rendah (jauh lebih rendah daripada yang
permeable kecil) (ii) tabung dialisis sebagian besar tidak dapat meningkatkan
volume. Sesekali kecil (5-20%) peningkatan volume larutan dalam
berhubungan dengan kompresi udara di atas fase cair yang pada awalnya
tertutup dalam tas. Secara keseluruhan, penurunan konsentrasi zat terlarut
besar (protein) biasanya diabaikan kecil. Peningkatan volume larutan dalam
adalah luar biasa dari sudut pandang teknis karena disertai dengan (kadangkadang besar) elevasi tekanan. Oleh karena itu, jika ada tersembunyi
"kelemahan" di suatu tempat di bahan membran, adanya peninggian tekanan
dapat menyebabkan pecahnya kantong dan, sebagai akibatnya, hilangnya
lengkap dari bahan didialisis (misalnya persiapan protein). Untuk menghindari
hal ini "bencana", dianjurkan untuk melakukan tes tekanan pada kantong
dalam keadaan berisi air tersebut. Risiko lain yang terkait dengan

peningkatan tekanan terjadi selama pembukaan tas setelah selesai dialisis.


Dengan tidak adanya perawatan yang diperlukan, bagian dalam solusi
bertekanan dapat taburi keluar, menyebabkan kerugian materi.
Dalam praktek laboratorium biokimia, solusi protein umumnya didialisis berikut
difraksinasi amonium sulfat presipitasi (rinci dalam Bab 5) serta sebelum atau
setelah kromatografi pertukaran ion (rinci dalam Bab 6). Sebuah selektivitas
ukuran (size pengecualian atau cut-off) ditetapkan sebagai 4 atau 11 kDa
berarti bahwa pori-pori membran dialisis yang kedap untuk partikel yang
lebih besar dari 4 atau 11 kDa, masing-masing.
Selain laboratorium biokimia, dialisis digunakan dalam bidang ilmu kehidupan
juga untuk tujuan terapeutik selama hemodialisis, yaitu di ginjal buatan.
Perbedaan utama antara kedua aplikasi ini adalah bahwa, dalam ginjal
buatan, dialisis dijalankan di bawah meja-aliran kontinu ruang dua solusi: baik
di dalam larutan (darah pasien) dan solusi luar dipompa. Dengan demikian,
dalam kondisi seperti ini, juga ruang cairan dalam adalah "terbuka": hal ini
tidak di "tas" tapi mengalir di dalam tabung. Selain itu, dalam rangka
meningkatkan fluks difusi, sejumlah besar tabung kapiler bekerja di sebuah
kemasan (yang sebenarnya adalah ginjal buatan) dimana rasio permukaan /
volume meningkat sangat besar. Komposisi larutan dialysing luar sangat
istimewa karena harus memenuhi persyaratan khusus. Selain itu, peralatan
ginjal buatan adalah alat yang sangat khusus karena harus dapat
memastikan tekanan dan suhu yang sesuai, sementara darah memasuki
tubuh pasien harus bebas dari gelembung udara terperangkap yang dapat
menyebabkan konsekuensi mematikan.