Principle of

Hemo (dialysis)
 HEMODIALYSIS
Diffusion

HEMOFILTRATION :
Convection
 Principle of Hemodialysis

• Dialysis removes nitrogenous (and other)

waste products, and corrects the electrolyte,
water, and acid base abnormalities associated
with renal failure.
• It requires the use of semi-permeable
membrane which allow the passage of water
and small molecular weight solutes, but not
large molecules.
 Dialysis: General Principles

• Diffusion
– Movement of solutes from an area of greater
concentration to lesser concentration

• Osmosis
– Movement of fluid from an area of lesser to an area of
greater concentration of solutes.

• Ultrafiltration (water & fluid removal)

– Movement of fluid across a semipermeable membrane
as a result of an artificially created pressure gradient.
Diffusion
Ultrafiltration
 A B A B

Diffusion

t=0 t = equilibrium
Membrane

Membrane
A B A B

t=0 t = later
Ultrafiltration

The Process of diffusion (top) and ultrafiltration (bottom)

Hemodialysis Filter
Mechanisms of Solute Removal

1. Diffusion

2. Convection

3. Diffusion + Convection

4. Adsorbtion
 Solute Clearance
Blood Membrane Dialysate/Ultrafitrate
Diffusive Solute Clearance
Blood Membrane Dialysate/Ultrafitrate
Diffusive Solute Clearance
Blood Membrane Dialysate/Ultrafitrate
Convection
 Adsorption

ADSORPTION: molecular adherence to the surface

or interior of the membrane.
 Ultrafiltration

ULTRAFILTRATION: The movement of fluid through a membrane

caused by a pressure gradient.
Water movement during standard hemodialysis

Intracellular fluid Extracellular fluid Dialyzer

step3

Water movement step1

280
Loss of urea
and water

Osmolality
Osmolality 320 mosm/kg
320 mosm/kg Falling to
step2
290mosm/kg
as diffusion occurs

Compensatory refilling
 A “Standard” HD Delivery System
Informational Display Saline

PT = Pressure
Transducer Anticoagulant

PT
Blood from Patient

Dialysate / UF Out (green

/ yellow)
Blood Leak Conductivity
Detector
PT
Meter
Mixing
Dialysate In System Pre-mixed or
sorbent
Water, Acid Concentrate,
PT regenerated
Bicarbonate Concentrate
dialysate
In

Air Venous
Drip Chamber clamp
Detector

Blood return to
18
Patient
Solute Transfer & Ultrafiltration

C blood > C Dialysate

P blood >≈ P Dialysate

Blood Dialysate
Ur Cr Ur Cr Ur Cr Ur Ur Ur Ur
Cr Cr
Cr
Ur Cr Ur Cr
Cr Ur Cr Ur Ur Ur Ur

A semi-permeable membrane

Ur Cr Ur Ur Ur
Ur Cr
Ur Cr
Ur Ur
Cr

START DIFFUSION SOME DIFFUSION NO DIFFUSION

 Ur
Ur
Ur Ur
Ur Ur

A semi-permeable membrane

START DIFFUSION SOME DIFFUSION NO DIFFUSION

Ur Cr Ur Cr Ur Cr Ur Ur
Cr
Cr Ur Cr
Cr Ur
Ur Ur Cr Cr Ur Ur Cr
Ur

A semi-permeable membrane

Ur Ur Ur Ur Ur
Cr Cr
Cr
Ur Ur Ur

DIFFUSION DIFFUSION DIFFUSION

 Ur
Ur
Ur Ur
Ur Ur

A semi-permeable membrane

DIFFUSION DIFFUSION DIFFUSION