1. By Zachary Jacobson

2.  First practiced on animals in early 1900’s  Developed by Dr. Willem Kolff in 1943  First successful treatment administered in 1945  In 1950’s Dr. Belding Scribner uses Teflon tubing  Scribner heralded as father of bioethics  Scribner starts first outpatient facility in 1962

3.  Function of Kidneys  Nephrons, glomeruli and waste tubules  Hormone secretion support homeostasis  Causes of Chronic Kidney Disease/Failure  Hypertension  Diabetes mellitus (3 types)  Diagnosing KidneyDisease/Failure  Elevated proteins and/or blood in urine  Function of Dialysis  Filter waste and excess fluid from blood

4.  Dialysis requires surgery to develop access site  3 types: fistula, graft, catheter  Filter Membrane  Semi-permeable quality allows only smaller materials(i.e. waste) to diffuse across  Larger waste products and excess fluid require ultrafiltration  Dialysate  Composed of sterile water, electrolytes/chemicals and dextrose  Dextrose concentration determines osmotic pressure in PD exchange

5.  Peritoneal Dialysis  Creation of access site  Permenant Peritoneal Catheter  Dialysate drawn into abdominal cavity  Peritoneum acts as filter  Waste stored in dialysate  Dextrose level determines ultrafiltration rate  2 types: CAPD, CCPD  Dialysate drained from cavity

6.  Hemodialysis  Blood filtered outside of body  Dialyser  Filters through synthetic membrane  Thousands of thin hollow fibers  Countercurrent ultrafiltration  Different types of filters  Dialysis Machine  Monitors time, temp, pressure  Blood returned to body through access

7.  PD vs. HD  HD uses more predictable membrane  PD is easier to use and more convenient  PD less likely to cause Hypotension  PD may cause trouble breathing  Dialysis patients require special diet and medication to replace hormonal function.

8.  PD and HD do not replicate all kidney functions  Access sites can move or become infected  Limited movement  Body image  Time per treatment  Blood clotting  Expensive without health coverage

9.  Shorter Dialysis Time  Increased Efficiency in Filtration  Increased Portability  Recycling of Dialysate  Simultaneous monitoring and introduction of synthetic hormones

10. 1. Salvatore, David. "Evolution and Physical Principles of Convection-based Dialysis Treatment." Giornale Italiano Di Nefrologia 29.55 (2012): 3-11. Print. 2. Wakasugi, M., Kawamura, K., Yamamoto, S., Kazama, J. J. and Narita, I. (2012), High Mortality Rate of Infectious Diseases in Dialysis Patients: A Comparison With the General Population in Japan. Therapeutic Apheresis and Dialysis, 16: 226–231. doi: 10.1111/j.1744-9987.2012.01062.x 3. Saran, R., J. L. Bragg-Gresham, N. W. Levin, Z. J. Twardowski, V. Wizemann, A. Saito, N. Kimata, B. W. Gillespie, C. Combe, J. Bommer, T. Akiba, D. L. Mapes, E. W. Young, and F. K. Port. "Longer Treatment Time and Slower Ultrafiltration in Hemodialysis: Associations with Reduced Mortality in the DOPPS." Kidney International 69.7 (2006): 1222-228. Print. 4. "Home Dialysis Central." Home Dialysis Central. Medical Education Institute, Inc, Oct. 2012. Web. 22 Oct. 2012.. 5. Vienken, Jörg, Michael Diamantoglou, Werner Henne, and Bernd Nederlof. "Artificial Dialysis Membranes: From Concept to Large Scale Production." American Journal of Nephrology 19.2 (1999): 355-62. Print. 6. Misra, Madhukar. "The Basics of Hemodialysis Equipment." Hemodialysis International 9.1 (2005): 30-36. Print. 7. "Dialysis." Wikipedia. Wikimedia Foundation, 22 Oct. 2012. Web. 22 Oct. 2012..