Hemodialysis Kinetics 101

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Basics

The Absolute Basics

July 31, 2017 itg

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The Absolute Basics

  • We conduct DIALYSIS to remove ‘uremic solutes/toxins’ from blood in a patient with kidney failure.
    • Urea is one of the many uremic toxins (>100 identified). It is considered a low molecular weight toxin (molecular weight: 60 Daltons) that is water soluble. Its volume of distribution is the total body water. It is produced by the liver and is also the end product of protein catabolism.
    • It is only mildly toxic by itself. However it is considered an easily measurable surrogate for other small molecular weight uremic toxins.
    • We frequently measure ‘success’ of dialysis in terms of how effectively we clear the patients blood of urea.
    • This is also called urea clearance.
  • Blood is cleared of urea by its movement across the dialysis filter membrane  into the dialysate.
  • This occurs via both diffusion (diffusive clearance) and convection (convective clearance)
  • Hemodialysis removal of urea (urea clearance) during a dialysis session is measured numerically as Kt/V
  • The 'key' to KT/V

    • Basics
      • The Absolute Basics
      • The Hemodialysis Filter
      • Transport Across Membrane
        • Diffusion
        • Convection
      • Transmembrane Pressure
      • High Efficiency vs High Flux
      • Dialyzer Kuf
      • High Efficiency vs Conventional Dialyzers
      • Human Kidney vs Dialyzers
    • Kt/Vurea
      • What is Kt/Vurea?
      • How to Measure Kt/V?
      • What is the goal Kt/V?
      • Why Care About Kt/V?
      • Troubleshooting Low Kt/V
      • Limitations of Kt/V
      • Playground
        • Playground Debrief
    • Clinical Cases
      • Case 1: Dialysis Prescription
      • Case 2: Constrained T
      • Case 3: Access Flow
      • Case 4: Dialyzer Size
      • Case 5: Dialysis Disequilibrium Syndrome
      • Case 6: Access Recirculation
        • Access Recirculation Debrief
      • Case 7: Dialysis Related Amyloidosis
      • End Module

    Namrata Krishnan, MD

    Yale University School of Medicine
    Veterans Affairs Medical Center
    2017

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