1 / 66

Hemodialysis: History and Current Perspective

Hemodialysis: History and Current Perspective. Nadeem A Siddiqui MD Dallas Nephrology Associates. Hemodialysis:History and Current Perspective. History of Dialysis Principles of Hemodialysis Practice of Hemodialysis Complications of Hemodialysis. Dialysis.

josborn
Download Presentation

Hemodialysis: History and Current Perspective

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Hemodialysis: History and Current Perspective Nadeem A Siddiqui MD Dallas Nephrology Associates

  2. Hemodialysis:History and Current Perspective • History of Dialysis • Principles of Hemodialysis • Practice of Hemodialysis • Complications of Hemodialysis

  3. Dialysis Process by which the solute composition of a solution “A” is altered by exposing it to a second solution “B” through a semi-permeable membrane

  4. Necessary pre-requisites for Hemodialysis 1) Semi-permeable membrane 2) Anticoagulation 3) Knowing what to remove and how much of it

  5. 1773: Nurepuel isolates Urea by boiling urine in a pan

  6. 1828: Wohler synthesizes Urea and describes its molecular structure

  7. Thomas Graham (1805-1869)

  8. 1850 Glasgow, Scotland: Thomas Graham ‘s experiment to demonstrate diffusion across a semi-permeable membrane (Pergamon paper)

  9. Dialysis Membranes • 1750:Advances in the dovelopment of smokeless gunpowder led to the synthesis of a strong Nitrocellulose called “collodion”. It was a combination of Nitric acid and cotton • Addition of Camphor to this substance led to the synthesis of stable and strong “plastics” • 1957:Helmut Staldiger polymerized “Cellulose”

  10. 1913:The First Hemodialysis Experiment

  11. 1937: William Thalhimer successfully lowers BUN by performing Hemodialysis in anephric dogs

  12. 1926:The First Human Experiment • George Haas used a collodion tube arrangement to successfully dialyze human subjects • Allergic reactions to impurities in Hirudin led him to abandon his experiments

  13. 1937:Nils Alwall used the Alwall Kidney to perform the first ever hemodialysis treatment at the university of Lund, Sweden

  14. “ If I have seen farther it is because I have stood on the shoulders of Giants” Sir Isaac Newton

  15. Hemodialysis:History and Current Perspective • History of Dialysis • Principles of Hemodialysis

  16. Mechanisms of Solute transfer • Diffusion • Convection

  17. Diffusive Clearance • A result of random molecular motion • Influenced by concentration gradient of the solute and its Molecular weight as well as by the membrane permeability to the solute

  18. Convective Clearance • Water molecules passing through a SPM carry with them the solutes in their original concentration. This is called the “solvent drag phenomenon” • Water can be made to move across a SPM by the application of either a hydrostatic or an osmotic gradient

  19. Hemodialysis:History and Current Perspective • History of Dialysis • Principles of Hemodialysis • Practice of Hemodialysis

  20. The Hemodialysis circuit

  21. Dialysis Membranes

  22. Dialysis Solution

  23. Water Purification

  24. Water Treatment System for Hemodialysis

  25. Vascular Access

  26. Indications for initiating Hemodialysis • In patients with calculated creatinine clearance <20 ml/min/1.73 m2the onset of: *Uremic symptoms Nausea/emesis Altered sleep pattern *Altered mental status Coma Stupor Tremor Asterixis Clonus Seizures

  27. Indications for Hemodialysis *Pericarditis or Tamponade (urgent indication) *Uremic platelet dysfunction (urgent indication) *Refractory volume overload *Refractory hyperkalemia *Refractory Metabolic acidosis with anuria

  28. Indications for Hemodialysis • Steadily worsening renal function in a patient with measured 24 hour urinary creatinine clearance<15 ml/min when accompanied by worsening azotemia, poor nutritional status and refractory edema

  29. Equations for estimation of renal function • Cockcroft and Gault equation • MDRD Formula

  30. The Cockcroft-Gault equation • Cr Cl =(140-age) x wt/72(serum Cr) Decrease 15% for women Decrease 20% for paraplegia,40% for quadriplegia Increase 12% for AA males

  31. The MDRD formulaModification of diet in renal disease study JASN2000 • GFR (ml/min/1.73m2)= 186 x Pcr -1.154 x age -0.203 x1.212 if black X0.742 if female The MDRD equation calculates GFR, hence values are lower than those of creatinine clearance by Cockcroft Gault equation.

  32. Measurement of nutritional status • Physical Exam Skin fold thickness Mid arm muscle thickness • Protein catabolic rate <1* • Serum Albumin • Serum Cholesterol • Blood Lymphocyte count

  33. Monitoring Dialysis Adequacy

More Related