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Hemodialysis-History And Current Perspective PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Hemodialysis-History and Current Perspective” by Nadeem A Siddiqui, MD.

This medical PowerPoint presentation is about hemodialysis, a medical procedure used to treat patients with advanced kidney disease by removing waste and excess fluid from the blood. Hemodialysis was first developed in the 1940s and has since become a vital treatment option for those with end-stage renal disease (ESRD).

The earliest forms of hemodialysis involved direct blood exchange between two patients. However, these methods were often ineffective due to the risk of infection and difficulty in maintaining proper fluid balance. In the 1960s, the development of the artificial kidney machine allowed for more efficient and effective hemodialysis.

Currently, hemodialysis is typically performed in a clinical setting, where patients are connected to a dialysis machine via a surgically created access point. The machine pumps the patients blood through a filter, known as a dialyzer, which removes waste and excess fluids before returning the clean blood back to the patients body.

Advancements in technology have allowed for the development of more portable and home-based hemodialysis machines, which offer patients greater flexibility and independence in managing their condition. However, there are still many challenges in providing adequate hemodialysis access and care to patients, particularly in developing countries.

Despite its limitations, hemodialysis remains an important treatment option for patients with ESRD. With ongoing research and technological advancements, it is likely that hemodialysis will continue to evolve and improve in the coming years.

Tags : Hemodialysis, kidney disease, end-stage renal disease, ESRD, Nephrology, Nephrology PowerPoint presentation

Published on : Jun 07, 2023 | Views : 853 | Downloads : 1

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Hemodialysis: History and Current Perspective Nadeem A Siddiqui MD Dallas Nephrology Associates
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Hemodialysis:History and Current Perspective History of Dialysis Principles of Hemodialysis Practice of Hemodialysis Complications of Hemodialysis
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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
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Necessary pre-requisites for Hemodialysis 1) Semi-permeable membrane 2) Anticoagulation 3) Knowing what to remove and how much of it
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1773: Nurepuel isolates Urea by boiling urine in a pan
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1828: Wohler synthesizes Urea and describes its molecular structure
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Thomas Graham (1805-1869)
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1850 Glasgow, Scotland: Thomas Graham ‘s experiment to demonstrate diffusion across a semi-permeable membrane (Pergamon paper)
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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”
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1913:The First Hemodialysis Experiment
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1937: William Thalhimer successfully lowers BUN by performing Hemodialysis in anephric dogs
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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
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1937:Nils Alwall used the Alwall Kidney to perform the first ever hemodialysis treatment at the university of Lund, Sweden
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“ If I have seen farther it is because I have stood on the shoulders of Giants” Sir Isaac Newton
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Hemodialysis:History and Current Perspective History of Dialysis Principles of Hemodialysis
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Mechanisms of Solute transfer Diffusion Convection
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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
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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
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Hemodialysis:History and Current Perspective History of Dialysis Principles of Hemodialysis Practice of Hemodialysis
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The Hemodialysis circuit
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Dialysis Membranes
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Dialysis Solution
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Water Purification
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Water Treatment System for Hemodialysis
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Vascular Access
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Indications for initiating Hemodialysis In patients with calculated creatinine clearance <20 ml/min/1.73 m2 the onset of: *Uremic symptoms Nausea/emesis Altered sleep pattern *Altered mental status Coma Stupor Tremor Asterixis Clonus Seizures
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Indications for Hemodialysis *Pericarditis or Tamponade (urgent indication) *Uremic platelet dysfunction (urgent indication) *Refractory volume overload *Refractory hyperkalemia *Refractory Metabolic acidosis with anuria
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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
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Equations for estimation of renal function Cockcroft and Gault equation MDRD Formula
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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
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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.
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Measurement of nutritional status Physical Exam Skin fold thickness Mid arm muscle thickness Protein catabolic rate <1* Serum Albumin Serum Cholesterol Blood Lymphocyte count
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Monitoring Dialysis Adequacy
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Hemodialysis:History and CURRENT Perspective History of Dialysis Principles of Hemodialysis Practice of Hemodialysis Complications of Hemodialysis
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Complications of Hemodialysis 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
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Dialysis Reactions
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Management of Intradialytic Hypotension Assess dry weight frequently Avoid BP meds before HD Avoid rapid UF Use sequential UF and HD Avoid feeding patients on HD Use Sodium modeling Use HCO3 based dialysate Keep Hct >33 Use non Cellulosic membranes Keep Dialysate temperature<37 degrees Celsius Assess cardiac function, r/o pericardial effusion/tamponade
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Neuromuscular Complications: Muscle Cramps Etiology: Hypo-osmolality, Carnitine deficiency, Hypomagnesemia, excessive inter-dialytic weight gain Rx: Dietary counseling, Sodium modeling, Saline or 50% dextrose bolus, ? Prophylactic Quinine sulfate or Oxazepam
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Neuromuscular complications Seizures Restless legs syndrome Headache
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Dialysis Disequilibrium Syndrome (DDS) Risk factors: Young age, severe and chronic azotemia, Initial dialysis treatment, High flux/ large surface area dialyzer Symptoms: Headache, nausea, emesis, blurred vision, hypertension, disorientation, muscle twitching
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DDS 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
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DDS 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
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Intradialytic Hemolysis Uncommon From contamination of dialysate with Chloramine or Copper (deionization failure) From Methemoglobinemia from nitrate contamination
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Intradialytic Hypoxemia Arterial p O2 drops by 5 to 30 mm Hg during Hemodialysis due to central Hypoxemia. This is a result of a drop in CO2 that accompanies correction of acidosis on dialysis V/Q mismatch can occur due to pulmonary sequestration of activated leukocytes Acetate can induce respiratory muscle fatigue
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Intradialytic Hypoxemia Treatment : Supplemental oxygen during Hemodialysis in susceptible patients