Hemodialysis 


pH: 7.1-7.3
Dextrose: 0-5.5 mmol/L
 Hemodialysis is one of three renal replacement
therapies (the other two being kidney transplant 3. Blood delivery system:
and peritoneal dialysis).  Blood pump: Moves blood from access site through
 It is a medical procedure to remove fluid and waste the dialyzer and back to the patient.
products from blood and to correct electrolyte  Blood flow rate: 250-500ml/min
imbalance.
 Heparin syringe pump
 Hemodialysis is done using a hemodialysis machine
 2 air traps
and dialyzer aslo called as 'Artificial kidney'
 Air detector
 It can be an outpatient or inpatient therapy.
 Venous line clamp
Hemodialysis is an extracorporeal process (dialysis
Access for Hemodialysis Arterio venous fistula (AVF)
membrane is outside of the body).
- made by joining an artery and vein in arm (first
Indication For dialysis:
preferred choice for a permanent vascular access).
 Acidosis (pH <7.1)
- Arterio venous graft (AVG)-made by using a soft
 Electrolyte imbalance (k + >pH 6.5 mEq/L) tube to join an artery and vein in arm (second
 GFR <10mL/min preferred choice for a permanent vascular access).
 Overload of Fluids (Pulmonary Oedema) - Cuffed tunneled dialysis catheter- a soft tube that is
 Uremic Symptoms (Increased level of nitrogenous placed in a large vein, usually in neck (temporary
waste products) access).
Temporary access sites
Principle of Haemodialysis  Internal jugular vein
1. Diffusion: Passive movement of solute across a  Femoral vein
semipermeable membrane.  Subclavian vein
2. Ultra filtration: solute + Fluid removal across
semipermeable membrane down a pressure gradient. Arterio Venous Fistula
 Subcutaneous anastomosis (surgical connection i.e.
1. Dialyzer (Artificial kidney):
created between two stuctures) of an artery to an
• Plastic chamber that contains bundles of capillary
adjacent native veín.
tube through which blood circulates while dialysis
 Takes 6 weeks for development (arterialization of
solution travels outside the bundle in opposite counter
vein)
current direction.
 Both the dialysis needles are inserted into the
Diffusion and Ultrafiltration happens here.
native vein.
 Membranes using in dialyser:
Types:
 Cellulose
 Radiocephalic (first choice)
 Substituted cellulose: Cellulose acetate
 Brachiocephalic (second choice) Brachiobasilic
 Cellulosynthetic: Cellosyn/Hemophan
(third choice)
 Synthetics: Polyacrylonitrile, polysulfone,
polymethyl methacrylate

2. Dialysate:
Solution used in dialysis which has same solute
concentration as those in plasma.
Water used in the dialysate is purified by reverse
osmosis.
Contents of dialysate:
 Na+:136-140mmol/L
 K+:0-4 mmol/L
 Mg++: 0.25-0.75 mmol/L
 Ca+: 2.5-3.5mEq/L
 Chloride: 100-124 mEq/L
 Bicarbonate: 27-40mmol/L
 Management of hypotension:
 Midodrine (10-20mg 30 min. before dialysis),
 Sertaline (50-100mg daily) and
 IV L-carnitine (20mg/kg at dialysis).

Management of muscle cramps:

• Reduced ultrafiltration and infusion of hypertonic
saline or glucose to improve circulation,
exercise/stretching of affected limb, or vitamin E 400IU
at bedtime with vitamin C 250mg daily for prevention.

Aluminum toxicity (dementia, bone disease, anemia):

Complications of Hemodialysis  Deferoxamine can be used to chelate serum
 Hypotension (22-55%) aluminum.
 Muscle cramps (5-20%)
 Nausea and vomiting (5-15%): due to hypotension
 Headache (5%)- common
 Chest pain (2-5%)
 Back pain (2-5%)
 Itching (5%)- precipitated by dialysis may be due to
hypersensitivity to dialyser membrane
 Fever & chills (<1%)