Osama El-Shahat
Consultant Nephrologist
Head of Nephrology Department
New Mansoura General Hospital (international)
ISN Educational Ambassador
Basics of hemodialysis:
◦ Definition.
◦ Technique of hemodialysis:
◦ Main principles:
Diffusion.
Osmosis.
Filtration.
Convection.
◦ Varieties of hemodialysis.
When a semi permeable membrane is placed between different
solutions the solutes move across this membrane until they
reach equilibrium
◦ expensive
The number of ml/hour of water the dialyzer can remove
for every 1 mm Hg rise in TMP
500 ml/min
TMP
+ve -ve
pressure pressure
Definition:
extracorporeal removal of waste products from the
blood of patient who has poorly functioning kidneys with
replacement of some materials deficient in the patient.
Difussion:
The process by which particles, atoms or molecule move from
area of higher concentration to lower concentration across
semipermeable membrane.
Factors affecting :
Concentration gradient
MW of solutes.
Problems with conventional diffusive hemodialysis
Excessive cardiovascular mortality
Countercurrent circulation
Hemoperfusion therapy (DHP) is a method of treatment to
eliminate causal substances of disease in the blood by adsorption
that takes place by passing the blood directly through an adsorbent.
CVVHD Diffusion
◦ Kt/V target is ≥ 1.3, so that one can be sure that the delivered
dose is at least 1.2. In peritoneal dialysis the target is ≥
1.7/week.
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Accumulation Of Waste products
◦ Urea, creatinine, others
◦ Hyperkalemia (increased potassium)
◦ Acidosis
Water intoxication
◦ Volume overload, pulmonary edema
Endocrinal Manifestations
◦ Anemia
◦ Osteodystrophy
◦ Hypertension
Mechanism &mol. HD mostly LMW Small & middle with Small &middle with
removed HD/F CVV HDF
Use Ambulatory CRF Critically ill CRF/ Critically ill
AKI CRF/AKI
Blood flow rate 300-500 ml/min 200-300 ml/mi 50-200 ml/min
DFR 500-800 ml/min 1-2 L/h 2-3 L/h
Efficiency high Moderate low
HD stability Poor Good good
Duration 3-4hx3t/w 6-12 h/d Continuous
Anticoagulant Not needed According According
DDS May occur N/A N/A
Toxicology &drugs Risk of rebound Unclear Slower removal
logistics Less complicated Higher cost, low Ph costly
ESNT-CNE 2nd Course, Cairo Jan 2-5, 2013
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