DIALYSIS

A NOVEL SEPARATION TECHNIQUE

Contents
1.

What is dialysis?

2.

History of Dialysis

3.

Factors affecting rate of Dialysis

4.

Principle involved

5.

Types of dialysis

6.

Details of purification of blood

What is Dialysis?
Dialysis

FromGreek
dialusis Dissolution
dia -through
lysis - loosening or splitting

is a process for removing waste and excess water

from theblood, and is used primarily to provide
anartificial replacementfor lostkidney functionin
people withrenal failure

What is Dialysis?

Dialysis is the movement of molecules by diffusion from high

concentration to low concentration through a semi-permeable
membrane.

Only those molecules that are small enough to fit through the
membrane pores are able move through the membrane and
reach equilibrium with the entire volume of solution in the
system.

Once equilibrium is reached, there is no further net movement

of the substance because molecules will be moving through
the pores into and out of the dialysis unit at the same rate.

By contrast, large molecules that cannot pass through the

membrane pores will remain on the same side of the
membrane as they were when dialysis is initiated.

What is Dialysis?

To remove additional unwanted substance, it is necessary to

replace the dialysis buffer so that a new concentration
gradient can be established.

Once the buffer is changed, movement of particles from high

(inside the membrane) to low (outside the membrane)
concentration will resume until equilibrium is once again
reached.

With each change of dialysis buffer, substances inside the

membrane are further purified by a factor equal to the
volume difference of the two compartments.

What is Dialysis?
Example

If one is dialyzing 1 ml of sample against 200 ml of

dialysis buffer, the concentration of the dialyzable
substance at equilibrium will be diluted 200 less than at
the start.

Each new exchange against 200 ml of new dialysis buffer

will dilute the sample 200 times more.

For three exchanges of 200 ml, the sample will be diluted

200 x 200 x 200 or 8,000,000 times, assuming complete
equilibrium was reached each time before the dialysis
buffer was changed.

History of Dialysis

Dr.Willem Kolff, a Dutch physician, constructed the first working

dialyzer in 1943 during theNazi occupation of the Netherlands.
Due to the scarcity of available resources, Kolff had to improvise and
build the initial machine usingsausage casings,beverage cans,
awashing machine, and various other items that were available at
the time.

Over the following two years, Kolff used his machine to treat 16
patients suffering fromacute kidney failure, but the results were
unsuccessful.

Then, in1945, a 67-year-old comatose woman regained

consciousness following 11 hours of hemodialysis with the
dialyzer, and lived for another seven years before dying of an
unrelated condition. She was the first-ever patient successfully
treated with dialysis.

History of Dialysis
Kolffs original rotating drum (1943)

Factors Affecting Rate of

Dialysis
Factors that affect the completeness of dialysis
(1) Dialysis buffer volume
(2) Buffer composition
(3) The number of buffer changes
(4) Time
(5) Temperature
(6) Particle size vs. pore size.

Principle

Dialysis works on the principles of thediffusionof

solutes andultra - filtrationof fluid across asemipermeable membrane.

A semipermeable membrane is a thin layer of material

that contains holes of various sizes, or pores.

Diffusion describes a property of substances in water.

Substances in water tend to move from an area of high

concentration to an area of low concentration.

Principle

The main fluid (eg blood) flows by one side of a semipermeable membrane, and a dialysate, or special
dialysis fluid, flows by the opposite side.

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.

Types of Dialysis
There are three primary and two secondary types of
dialysis:
I.

Hemodialysis (primary),

II.

Peritoneal dialysis(primary)

III.

Hemofiltration(primary)

IV.

Hemodiafiltration(secondary)

V.

Intestinal dialysis (secondary)

Types of Dialysis
Hemodialysis

This process removes wastes and water by circulating blood

outside the body through an external filter, called adialyzer,
that contains asemipermeable membrane.

The blood flows in one direction and thedialysateflows in

the opposite.

The counter-current flow of thebloodand dialysate

maximizes the concentration gradient of solutes between
the blood and dialysate, which helps to remove more urea
andcreatininefrom the blood.

Types of Dialysis

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 synthetic hollow

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.

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 3- to 5-hour treatment

Schematic Diagram for Hemodialysis

Types of Dialysis
Peritoneal Dialysis

Inperitoneal dialysis, wastes and water are removed

from the blood inside the body using theperitoneal
membrane of theperitoneumas 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 theabdominal
cavitywhich has a composition similar to the fluid
portion of blood.

Types of Dialysis

In peritoneal dialysis, a sterile solution containing glucose is run

through a tube into theperitoneal cavity, theabdominalbody cavity
around theintestine, where the peritoneal membrane acts as a
partially permeable membrane.

The dialysate is left there for a period of time to absorb waste

products, and then it is drained out through the tube and discarded.

This cycle or "exchange" is normally repeated 4-5 times during the

day, (sometimes more often overnight with an automated system).
Each time the dialysate fills and empties from the abdomen is called
one exchange.

A drain process is the process that follows in which the dialysate full
with waste products and extra fluid is drained out of patient's blood.

Ultrafiltration occurs viaosmosis; the dialysis solution used contains

a high concentration of glucose, and the resulting osmotic pressure
causes fluid to move from the blood into the dialysate.

Schematic Diagram for Peritonial

Dialysis

Types of Dialysis
Comparison

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.

Although support is helpful, it is not essential.

It does free patients from the routine of having to go to a

dialysis clinic on a fixed schedule multiple times per week,
and it can be done while travelling with a minimum of
specialized equipment.

Types of Dialysis
Hemofiltration

It 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
theextracorporealcircuit during the treatment.

Types of Dialysis
Hemodialfiltration

It is a combination of hemodialysis and hemofiltration. In

theory, this technique offers the advantages of both
hemodialysis and hemofiltration.

Intestinal dialysis

In this process, the diet is supplemented with soluble fibres

such asacacia fibre, which is digested by bacteria in the
colon. This bacterial growth increases the amount of nitrogen
that is eliminated in fecal waste. An alternative approach
utilizes the ingestion of 1 to 1.5 liters of non-absorbable
solutions ofpolyethylene glycolormannitolevery fourth hour.

Purification of Blood by Dialysis

As we know, dialysis is the transfer of solute molecules

across a membrane by diffusion from a concentrated
solution to a dilute solution.

This phenomenon is used to remove solutes from liquid

mixtures in the biomedical, biotechnology, and chemical
industries.

The largest commercial market is for hemodialysis

membranes. These membranes are used to manufacture
artificial kidneys that can replace the function of human
kidneys.

The current market for hemodialyzers is approximately one

billion dollars per year.

Purification of Blood by Dialysis

Hemodialyzers consist of a bundle of 10,000 15,000 hollow fibre

membranes.

The ends of the bundle are encased in tubesheets and the tubesheets
seal to an external plastic housing that encloses the fibre bundle.

The case possesses two external ports on either end of the fibre bundle
and two ports along the periphery of the case.

This design allows introduction of a fluid stream through one of the end
ports into the fibre lumens (i.e., interior) and withdrawal from the
opposing end.

Similarly, one may introduce a fluid stream into the shell (i.e., space
external to the fibres) through a peripheral port and withdraw it from
the other.

Such hollow fibre modules are the mass transfer equivalent of a shell
and tube heat exchanger two fluid streams flow through the hollow
fibre or tube bundle, without direct mixing, while mass or heat transfer
occurs across the fibre or tube wall.

Purification of Blood by Dialysis

Schematic diagram of a typical hollow fibre membrane
module and the case that holds it.

Purification of Blood by Dialysis

The blood and dialysate flow counter-currently to each other as

in heat exchangers.

In operation, blood flows through the fibre lumens while

dialysate flows through the shell.

The wastes produced by cell metabolism diffuse from the blood

to the diaysate, due to a concentration difference, which
cleans the blood.

The fibre wall is porous with pores large enough to permit

passage of low molecular wastes but small enough to prevent
loss of proteins, blood cells, and other large plasma
components. The dialysate serves as a reservoir into which the
wastes accumulate and are removed ultimately.

A Hemodialyzer Machine