Escolar Documentos
Profissional Documentos
Cultura Documentos
Current Perspective
Nadeem A Siddiqui MD
Dallas Nephrology Associates
History of Dialysis
Principles of Hemodialysis
Practice of Hemodialysis
Complications of Hemodialysis
Dialysis
Process by which the solute composition
of a solution A is altered by exposing it
to a second solution B through a semipermeable membrane
1828: Wohler
synthesizes Urea and
describes its
molecular structure
1850 Glasgow,
Scotland:
Thomas Graham s
experiment to
demonstrate diffusion
across a semipermeable membrane
(Pergamon paper)
Dialysis Membranes
East
West
North
1937: William
Thalhimer successfully
lowers BUN by
performing
Hemodialysis in
anephric dogs
History of Dialysis
Principles of Hemodialysis
Diffusion
Convection
Diffusive Clearance
Convective Clearance
History of Dialysis
Principles of Hemodialysis
Practice of Hemodialysis
Dialysis Membranes
Membrane
Hydr.Perm. Examples
Regen.
cellulose
Low flux
cuprophane Poor
Modif.
Cellulose
Synthetic
Low/High
Flux
Cell.acetate Interm.
Cell di-acet.
PAN,PS,PA, Good
PC,PMMC
High/Low
flux
Biocomp.
Dialysis Solution
Component
Na
K
Ca
Mg
Acetate
Chloride
Bicarbonate
Glucose
Concentration
mmol/L
140
2
1.25 (5 mg/dl)
0.5 (1.2 mg/dl)
3.0
108
35
5.6 (100 mg/dl)
Water Purification
Vascular Access
*Uremic symptoms
Nausea/emesis
Altered sleep pattern
*Altered mental status
Coma
Stupor
Tremor
Asterixis
Clonus
Seizures
GFR (ml/min/1.73m2)=
186 x Pcr -1.154 x age -0.203 x1.212 if black
X0.742 if female
Physical Exam
Skin fold thickness
Mid arm muscle thickness
Protein catabolic rate <1*
Serum Albumin
Serum Cholesterol
Blood Lymphocyte count
History of Dialysis
Principles of Hemodialysis
Practice of Hemodialysis
Complications of Hemodialysis
Complications of Hemodialysis
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Dialysis Reactions
Intradialytic Hypotension
Neuromuscular complications
Dialysis dysequilibrium
Hemolysis
Intradialytic hypoxemia
Postdialysis syndrome
Cardiac arrhythmia and sudden death
Steal syndrome
Dialysis associated hypoxemia
Air embolism
Metabolic derangements
Dialysis Reactions
Management of Intradialytic
Hypotension
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Neuromuscular Complications:
Muscle Cramps
Neuromuscular complications
Seizures
Restless legs syndrome
Headache
DDS
1.
2.
3.
Pathogenesis:
Reverse urea effect ( rapid reduction of
serum urea while CSF urea concentration
remains high)
Paradoxical CSF acidosis
Intracerebral accumulation of idiogenic
osmoles in uremia
DDS
1.
2.
3.
4.
Treatment
Early detection of uremia, early intervention
with dialysis
First few treatments should aim to achieve
modest reduction in serum urea concentration
( 30% or less)
Sodium modeling, use of Bicarbonate dialysis,
slow QB
Prophylactic use of Mannitol is not
recommended
Intradialytic Hemolysis
Uncommon
From contamination of dialysate with
Chloramine or Copper (deionization
failure)
From Methemoglobinemia from nitrate
contamination
Intradialytic Hypoxemia
Intradialytic Hypoxemia