Hemodialysis: Core Curriculum 2014

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Presentation transcript:

Hemodialysis: Core Curriculum 2014 Thomas A. Golper, MD, Rachel Fissell, MD, MS, William H. Fissell, MD, P. Matthew Hartle, MD, M. Lee Sanders, MD, PhD, Gerald Schulman, MD American Journal of Kidney Diseases Volume 63, Issue 1, Pages 153-163 (January 2014) DOI: 10.1053/j.ajkd.2013.07.028 Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 An approximation of the difference in clearance between pure diffusive processes and pure convective process by the molecular weight of the solute. Abbreviation: Vit B12, vitamin B12. American Journal of Kidney Diseases 2014 63, 153-163DOI: (10.1053/j.ajkd.2013.07.028) Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions

Figure 2 (A) Instantaneous blood clearance (Cl) in hemodialysis (HD) is the extraction ratio (ER) times blood flow rate (Qb) and is dependent on solute molecular weight, among other things. (B) Cl in HD is the saturation fraction of dialysate concentration (D) over the plasma concentration (P) times dialysate flow rate (Qd) and is dependent on solute molecular weight, among other things. At greater Qd, there is more turbulence, which reduces both dialysate “channeling” and boundary layer effects. Reproduced from Canaud B, Leray-Moragués H (“Conduite de l'hémodialyse et prévention de ses complications” [published online ahead of print October 28, 2013]. EMC-Néphrologie. Doi: 10.1016/S1762-0945(06)43988-7) with the permission of Elsevier. Copyright © 2013 Elsevier Masson SAS. All rights reserved. Abbreviations: d, dalton; UF, ultrafiltration. American Journal of Kidney Diseases 2014 63, 153-163DOI: (10.1053/j.ajkd.2013.07.028) Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions

Figure 3 Using standard Kt/V as originally proposed by Frank Gotch, one can compare frequency and intensity of differing dialysis modalities. Modified and reproduced from Gotch (“The current place of urea kinetic modeling with respect to different dialysis modalities.” Nephrol Dial Transplant. 1998;13[suppl 6]:10-14), with permission of the Oxford University Press. Abbreviations: HD, hemodialysis; PD, peritoneal dialysis. American Journal of Kidney Diseases 2014 63, 153-163DOI: (10.1053/j.ajkd.2013.07.028) Copyright © 2013 National Kidney Foundation, Inc. Terms and Conditions