1. What is Hemodialysis?
Shahrzad Ossareh-M.D.

3. ml/min
Diffusion
Convection
ml/min

7. Arterial line
Venous line

8. Dialysis Solution Component Concentration (meq/L) Na 135-145 K 0-4Ca Mg Cl
Acetate
Bicarbonate
Dextrose
PCO pH
The acetate is in the form of acetic acid in the acid component. On
mixing with the HCO3 component the H+ in acid acetic reacts with
an equimolar amount of HCO3 to form CO2

12. Complications During HD: Hypotension
Decreased Blood Volume:
High UF rate,
Low dialysate Na
Lack of vasoconstriction:
Acetate dialysate
Warm dialysate
Food ingestion
Tissue ischemia
Autonomic neuropathy
Antihypertensives
Cardiac factors:
Diastolic dysfunction
β-blockers
Uremic autonimc neuropathy
Aging
Poor myocardial contractility
Pericardial Tamponade MI
Occult Hemorrhage
Septicemia
Dialyzer Reaction
Hemolysis
Air Embolism

13. Other Complications: Muscle cramps Chest pain and back pain Itching
Hypotension
Patient below dry weight
Low dialysate Na
Chronic leg cramps
Nausea and vomiting
Chest pain and back pain
Itching
Fever and chills
Disequilibrium syndrome
Dialyzer reactions
Type A: Anaphylactic type: E.O., AN 69, PAN, contaminated dialysis solution, reuse, heparin
Type B: Complement activation, less severe
Arrhythmia, Tamponade, IC bleeding, Seizures, Hemolysis, Air embolism, Neutropenia and complement activation

14. KT/V=1.4 60 kg female V= 60  0.55= 33 L = 33,000 ml
T= 4 hours = 240 min
K ?
KT/V=1.4 → (K  240 )/33,000 = 1.4
→ K  240 = 46,200
→ K = (PS13)

15. Peritoneal Dialysis

16. Definition
The transport of solutes and water across a membrane that separates 2 fluid containing compartments:
Blood in the peritoneal capillaries
Dialysis solution in the peritoneal cavity

18. Stagnant fluid film over the endothelium of peritoneal capillary walls
Endothelial B.M.
Interstitium
Stagnant fluid film over
the endothelium
of peritoneal capillary walls
Stagnant fluid film
overlying
the peritoneal membrane
Capillary endothelium
Mesothelium