INTRODUCTION

The kidneys have important roles in maintaining health. When

healthy, the kidneys maintain the body's internal equilibrium

of water and minerals
The kidneys also function as a part of the endocrine system,

producing erythropoietin and calcitriol.

Erythropoietin is involved in the production of red blood cells

and calcitriol plays a role in bone formation.

Dialysis treatments replace some of these functions through

diffusion (waste removal) and ultrafiltration (fluid removal).

Dialysis
It 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.

Goals of Dialysis
Solute clearance
Diffusive transport (based on countercurrent flow of blood and

dialysate)
Convective transport (solvent drag with ultrafiltration) Fluid removal

Dialysis Types
Hemodialysis
Peritoneal dialysis Hemofiltration Hemodiafiltration Intestinal dialysis

Dialysis Types (cont..)

Hemodialysis In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer. The cleansed blood is then returned via the circuit back to the body. Peritoneal dialysis A sterile solution containing glucose (called dialysate) is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine The dialysate is drained, discarded, and replaced with fresh dialysate. It is repeated 4-5 times per day

Dialysis Types(cont..)
Hemofiltration
Hemofiltration is a similar treatment to hemodialysis. 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.

Dialysis Types(cont..)
Hemodiafiltration
Hemodiafiltration is a combination of hemodialysis and

hemofiltration.

Intestinal dialysis
In intestinal dialysis, the diet is supplemented with soluble

fibers 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.

Hemodialysis
It is a method that is used to achieve
the removal of waste products such as creatinine and urea and free water from the blood when the kidneys are in a state of renal failure.

PRINCIPLE
It involves diffusion of solutes across a semipermeable

membrane.
It utilizes counter current flow, where the dialysate is flowing

in the opposite direction to blood flow

Counter-current flow maintains the concentration gradient

across the membrane at a maximum and increases the

efficiency of the dialysis.

Fluid removal (ultrafiltration) is achieved by altering the

hydrostatic pressure of the dialysate compartment.

PRINCIPLE(cont..)
Sodium bicarbonate is added in a higher concentration than

plasma to correct blood acidity. A small amount of glucose is also commonly used.
The cleansed blood is then returned via the circuit back to the

body. Ultrafiltration occurs by increasing the hydrostatic

pressure across the dialyzer membrane.
Allows the removal of several litres of excess fluid during a

typical 3- to 5-hour treatment.

Types
Conventional hemodialysis
Daily hemodialysis Nocturnal hemodialysis.

Conventional hemodialysis
It is usually done three times per week, for about 34 hours

for each treatment, during which the patient's blood is drawn out through a tube at a rate of 200-400 mL/min.
The blood is then pumped through the dialyzer, and then the

processed blood is pumped back into the patient's

bloodstream through another tube (connected to a second

needle or port).

Daily hemodialysis
Used by those patients who do their own dialysis at home.
It is less stressful (more gentle) but does require more

frequent access.
This is simple with catheters, but more problematic with

fistulas or grafts.
Daily hemodialysis is usually done for 2 hours six days a week.

Nocturnal hemodialysis
The procedure of nocturnal hemodialysis is similar to

conventional hemodialysis except it is performed three to six nights a week and between six and ten hours per session while

the patient sleeps.

Advantages
Low mortality rate Better control of blood pressure and abdominal cramps Less diet restriction

Better solute clearance effect for the daily hemodialysis, better

tolerance and fewer complications with more frequent dialysis

Disadvantages
Requires more supplies such as high water quality and

electricity
Requires reliable technology like dialysis machines

The procedure is complicated and requires that care givers

have more knowledge

Requires time to set up and clean dialysis machines, and

expense with machines and associated staff

Thank You