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Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad

The document discusses Chapter 5 of the 'Nephrotube Synopsis of Conventional Hemodialysis, First Edition, 2024,' focusing on dialyzers, their structure, efficiency, and various specifications such as flow direction, membrane materials, and sterilization methods. It outlines key parameters like dialyzer efficiency, extraction ratio, and monitoring, while emphasizing the importance of dialyzer reuse and addressing environmental concerns. The content is supplemented with resources available at nephrotube.com and relevant video lectures.

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Mohammed Abdel Gawad MD/PhD Neph, ESENeph Nephrology Unit, School of Medicine, NewGiza University Nephrology Consultant, Alexandria Founder of NephroTube.com Chair of AFRAN Web/Media Committee ISN Education SoMe Team Member Chapter 5 Dialyzers Overview You can get this book free from www.NephroTube.com
Watch the video recording of this lecture on NephroTube YouTube channel www.YouTube.com/NephroTube
Visit www.NephroTube.com to get more Nephrology lectures (pdf and video recordings)
Dialyzer Blood compartment Dialysate compartment Semipermeable membrane NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Parallel plate dialyzer https://homedialysis.org/home-dialysis- basics/machines-and-supplies/dialysis-museum
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Arterial blood port (Blood inlet) Venous blood port (Blood outlet) Dialysate inlet port Dialysate outlet port Header space Potting material Blood compartment Dialysate compartment Capillary hollow fibers
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Arterial blood port (Blood inlet) Venous blood port (Blood outlet) Dialysate inlet port Dialysate outlet port Header space Potting material Blood compartment Dialysate compartment Capillary hollow fibers
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Physical properties of the dialyzer Dialyzer surface area 0.8 to 2.5m2 the surface area of the dialyzer membrane could be roughly equivalent to the patient's body surface area Dialyzer priming volume 60 to 120 mL
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Dialyzer sterilization • 1. Ethelyne oxide (Eto): • It is the most frequently used. • It is crucial to eliminate Eto completely before using the dialyzer by conducting a thorough rinsing. • Type A dialyzer reaction. • 2. Other sterilization methods are gamma radiation, steam autoclaving, and electron beam. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Dialyzer reuse • The rising cost of dialysis supplies without reuse?? • The environmental impact of increased contaminated waste?? • However, there has now been a shift in focus from reuse to no reuse. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Dialyzer Blood urea at inlet is 100 mg/dL Blood urea at outlet is 40 mg/dL Extraction ratio = (100 – 40)/100 = 60%
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion.
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion.
Dialyzer clearance (KD or K) KD = QB X ER NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com The in vitro KD values given by the manufacturer are typically greater than the actual in vivo blood clearance levels It is the volume of blood from which a solute is removed (cleared) in a given unit of time. If the ER of urea is 70% at QB of 200 mL/min, then KD of urea = 0.7 X 200 = 140 mL/min.
Dialyzer clearance (KD or K) NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com • Thickness of the membrane • Density and size of the pores • Surface area of the membrane • Blood flow rate (QB)
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion.
Mass transfer-area coefficient (KoA) • It is the solute's theoretical maximum dialyzer clearance, assuming that both QB and QD are limitless. • “Ko” is the permeability coefficient of the dialyzer membrane for a given solute. It is affected mainly by: • Thickness of the membrane • Density and size of the pores. • “A” is the total effective surface area of the dialyzer membrane. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com KoA Low-efficiency dialyzer membranes KoA urea of <500 ml/min High-efficiency dialyzer membranes KoA urea of >600 ml/min
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Flux Low-flux membrane dialyzer KUF (water permeability or ultrafiltration) of <10mL/h/mmHg. High-flux membrane dialyzer KUF (water permeability or ultrafiltration) of >20mL/h/mmHg. Factors affecting KUF: • Membrane thickness. • Pore size
Issues related to high-flux membrane dialyzers: • Over ultrafiltration with the use of high-flux membrane dialyzers. • Back-filtration (back-leak) with the use of high-flux membrane dialyzers. • Membrane fouling with the use of high-flux membrane dialyzers. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com HEMO study MPO study • The primary outcome (death from any cause) and also secondary outcomes were not significantly different between the high- and low- flux groups. • In the high- flux group, there were significant reductions in the risk of death from cardiac causes and the combined outcome of first hospitalizations or death from a cardiac cause. • No difference in survival was found between the use of high- or low- flux dialysis membranes in patients with normal albumin levels. • Patients with serum albumin ≤4 g/dl had significantly better survival rates in the high- flux group. • A post hoc secondary analysis showed that high- flux membranes may significantly improve survival in diabetic patients.
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
Interrelation between dialyzer efficiency and dialyzer flux • Typically, the high-flux dialyzers usually have high efficiency and vice versa. • But this is not always the situation.
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com • It reduces inflammatory mediators. • It improves erythropoiesis stimulating resistance. • Improves the physical components of QOL. • It improves uremic pruritus. • It provides clinical benefits and better outcomes.
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Albumin loss during hemodialysis Amino acids loss during hemodialysis • Conventional low- flux hemodialysis albumin leakage is usually absent. • Conventional high- flux hemodialysis albumin loss is usually absent or low (<2.4 g/4 h treatment). • Albumin loss with high cut- off dialyzers varied from less than 1 g to nearly 8 g per 4 h hemodialysis session. • With the use of MCO dialyzer, albumin losses of 2.0–4.0 g per session were reported. • Data suggest that patients lose approximately 6–8 g of total amino acids per session • A loss of up to 12 g of amino acids per session has been reported.
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
Blood in Dialysate in Dialysate effluent pump Positive pressure Negative pressure Water movement (Ultrafiltration) Dialysate out Blood out Adjustable inflow resistance by clamp NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Accepted TMP limit • Manufacturers typically provide information about the maximum TMP for dialyzers in their brochure. • The European Renal Best Practice (ERBP) guidelines suggest a TMP limit of +300 mmHg as a safe upper limit. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
Transmembrane pressure alarm NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com TMP may be increased if: - The surface area of the dialyzer decreased due to clotting. - Using a small surface area dialyzer with a targeted high ultrafiltration volume. TMP will decrease in case of opening the dialysate compartment of the dialyzer to the atmosphere.
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com A B + - Conductivity monitor Temperature monitor Dialysate outflow Drain Blood leak detector Balancing chamber (Part of volumetric control system. See Fig. 4.3 for more details of other parts of this system) Bypass valve “Pure” dialysate Bypass circuit Dialyzer Pure water from water unit A B Deaeration Proportionating system Concentrates “Pure” dialysate A B Water preparation system Heater Ruptured dialyzer fibers
Talk Outline: Chapter 5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Clotted
Thank You

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Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad

  • 1.
    Mohammed Abdel GawadMD/PhD Neph, ESENeph Nephrology Unit, School of Medicine, NewGiza University Nephrology Consultant, Alexandria Founder of NephroTube.com Chair of AFRAN Web/Media Committee ISN Education SoMe Team Member Chapter 5 Dialyzers Overview You can get this book free from www.NephroTube.com
  • 2.
    Watch the videorecording of this lecture on NephroTube YouTube channel www.YouTube.com/NephroTube
  • 3.
    Visit www.NephroTube.com to get moreNephrology lectures (pdf and video recordings)
  • 4.
    Dialyzer Blood compartment Dialysate compartment Semipermeable membrane NephroTube Synopsisof Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 5.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Parallel plate dialyzer https://homedialysis.org/home-dialysis- basics/machines-and-supplies/dialysis-museum
  • 6.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 7.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 8.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Arterial blood port (Blood inlet) Venous blood port (Blood outlet) Dialysate inlet port Dialysate outlet port Header space Potting material Blood compartment Dialysate compartment Capillary hollow fibers
  • 9.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 10.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 11.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Arterial blood port (Blood inlet) Venous blood port (Blood outlet) Dialysate inlet port Dialysate outlet port Header space Potting material Blood compartment Dialysate compartment Capillary hollow fibers
  • 12.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 13.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 14.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 15.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Physical properties of the dialyzer Dialyzer surface area 0.8 to 2.5m2 the surface area of the dialyzer membrane could be roughly equivalent to the patient's body surface area Dialyzer priming volume 60 to 120 mL
  • 16.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 17.
    Dialyzer sterilization • 1.Ethelyne oxide (Eto): • It is the most frequently used. • It is crucial to eliminate Eto completely before using the dialyzer by conducting a thorough rinsing. • Type A dialyzer reaction. • 2. Other sterilization methods are gamma radiation, steam autoclaving, and electron beam. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 18.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 19.
    Dialyzer reuse • Therising cost of dialysis supplies without reuse?? • The environmental impact of increased contaminated waste?? • However, there has now been a shift in focus from reuse to no reuse. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 20.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 21.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 22.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Dialyzer Blood urea at inlet is 100 mg/dL Blood urea at outlet is 40 mg/dL Extraction ratio = (100 – 40)/100 = 60%
  • 23.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion.
  • 24.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion.
  • 25.
    Dialyzer clearance (KDor K) KD = QB X ER NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com The in vitro KD values given by the manufacturer are typically greater than the actual in vivo blood clearance levels It is the volume of blood from which a solute is removed (cleared) in a given unit of time. If the ER of urea is 70% at QB of 200 mL/min, then KD of urea = 0.7 X 200 = 140 mL/min.
  • 26.
    Dialyzer clearance (KDor K) NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com • Thickness of the membrane • Density and size of the pores • Surface area of the membrane • Blood flow rate (QB)
  • 27.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion.
  • 28.
    Mass transfer-area coefficient(KoA) • It is the solute's theoretical maximum dialyzer clearance, assuming that both QB and QD are limitless. • “Ko” is the permeability coefficient of the dialyzer membrane for a given solute. It is affected mainly by: • Thickness of the membrane • Density and size of the pores. • “A” is the total effective surface area of the dialyzer membrane. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 29.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com KoA Low-efficiency dialyzer membranes KoA urea of <500 ml/min High-efficiency dialyzer membranes KoA urea of >600 ml/min
  • 30.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 31.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
  • 32.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
  • 33.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Flux Low-flux membrane dialyzer KUF (water permeability or ultrafiltration) of <10mL/h/mmHg. High-flux membrane dialyzer KUF (water permeability or ultrafiltration) of >20mL/h/mmHg. Factors affecting KUF: • Membrane thickness. • Pore size
  • 34.
    Issues related tohigh-flux membrane dialyzers: • Over ultrafiltration with the use of high-flux membrane dialyzers. • Back-filtration (back-leak) with the use of high-flux membrane dialyzers. • Membrane fouling with the use of high-flux membrane dialyzers. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 35.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
  • 36.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 37.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 38.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
  • 39.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com HEMO study MPO study • The primary outcome (death from any cause) and also secondary outcomes were not significantly different between the high- and low- flux groups. • In the high- flux group, there were significant reductions in the risk of death from cardiac causes and the combined outcome of first hospitalizations or death from a cardiac cause. • No difference in survival was found between the use of high- or low- flux dialysis membranes in patients with normal albumin levels. • Patients with serum albumin ≤4 g/dl had significantly better survival rates in the high- flux group. • A post hoc secondary analysis showed that high- flux membranes may significantly improve survival in diabetic patients.
  • 40.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
  • 41.
    Interrelation between dialyzerefficiency and dialyzer flux • Typically, the high-flux dialyzers usually have high efficiency and vice versa. • But this is not always the situation.
  • 42.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
  • 43.
    Expanded hemodialysis (HDx):Medium cut-off (MCO) membrane NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 44.
    Expanded hemodialysis (HDx):Medium cut-off (MCO) membrane NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com • It reduces inflammatory mediators. • It improves erythropoiesis stimulating resistance. • Improves the physical components of QOL. • It improves uremic pruritus. • It provides clinical benefits and better outcomes.
  • 45.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
  • 46.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Albumin loss during hemodialysis Amino acids loss during hemodialysis • Conventional low- flux hemodialysis albumin leakage is usually absent. • Conventional high- flux hemodialysis albumin loss is usually absent or low (<2.4 g/4 h treatment). • Albumin loss with high cut- off dialyzers varied from less than 1 g to nearly 8 g per 4 h hemodialysis session. • With the use of MCO dialyzer, albumin losses of 2.0–4.0 g per session were reported. • Data suggest that patients lose approximately 6–8 g of total amino acids per session • A loss of up to 12 g of amino acids per session has been reported.
  • 47.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
  • 48.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
  • 49.
    Blood in Dialysate in Dialysate effluentpump Positive pressure Negative pressure Water movement (Ultrafiltration) Dialysate out Blood out Adjustable inflow resistance by clamp NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 50.
    Accepted TMP limit •Manufacturers typically provide information about the maximum TMP for dialyzers in their brochure. • The European Renal Best Practice (ERBP) guidelines suggest a TMP limit of +300 mmHg as a safe upper limit. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 51.
    Transmembrane pressure alarm NephroTubeSynopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com TMP may be increased if: - The surface area of the dialyzer decreased due to clotting. - Using a small surface area dialyzer with a targeted high ultrafiltration volume. TMP will decrease in case of opening the dialysate compartment of the dialyzer to the atmosphere.
  • 52.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
  • 53.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com A B + - Conductivity monitor Temperature monitor Dialysate outflow Drain Blood leak detector Balancing chamber (Part of volumetric control system. See Fig. 4.3 for more details of other parts of this system) Bypass valve “Pure” dialysate Bypass circuit Dialyzer Pure water from water unit A B Deaeration Proportionating system Concentrates “Pure” dialysate A B Water preparation system Heater Ruptured dialyzer fibers
  • 54.
    Talk Outline: Chapter5 :Dialyzers Overview • Dialyzer structure • The flow direction of blood and dialysate: Counter-current flow • Materials of the dialyzer membranes • Physical properties of the dialyzer • Dialyzer sterilization • Dialyzer reuse • Dialyzer efficiency and flux: • Extraction ratio (ER) • Dialyzer efficiency: • Dialyzer clearance (KD or K) • Mass transfer-area coefficient (KoA) • Dialyzer flux: • Ultrafiltration coefficient (KUF) • β2-microglobulin clearance, β2-microglobulin sieving coefficient, or membrane pore size • Available evidence comparing the use of low- versus high-flux membranes • Interrelation between dialyzer efficiency and dialyzer flux • Expanded hemodialysis (HDx): Medium cut-off (MCO) membrane • Albumin and amino acids loss during hemodialysis • Dialyzer monitoring and related alarms: • I. Transmembrane pressure (TMP) monitoring • II. Blood leak detector • III. Pressure monitors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com ability to remove small solutes <500 Da by diffusion. ability to remove water and middle molecules 500-15,000 Da
  • 55.
    NephroTube Synopsis ofConventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Clotted
  • 56.