DIALYSIS AND UREMIC COMPOUNDS

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DIALYSIS AND UREMIC COMPOUNDS
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• KIDNEY
• Remove end products of the metabolism
• Adjust water and electrolyt concentration
• Endocrine function
• UREMIC SYNDROME
• renal failure irreversible
• ? Retention of "uremic compounds UREA,
  p-CRESOL, B2-M
• ? Biologic toxicity

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UREMIC COMPOUNDS

• Free water-soluble low-molecular-weight solutes
  (lt500 D)
• Guanidinoacetic acid
• Creatinine
• Urea
• Protein-bound solutes (lt500 D)
• Hippuric acid
• Indoxyl sulfate
• p-cresol
• Middle molecules gt500 D
• B2-microglobulin
• Cystatin C
• Leptin
• normal concentration (CN)
• uremic concentration (CU),
• highest concentration ever reported in uremia
  (CMAX)

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• THERAPY
• Hemodialysis
• CAPD (chronic ambulantory peritoneal dialysis)
• Transplantation

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HEMODIALYSIS
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HEMODIALYSIS
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CHRONIC AMBULANTORY PERITONEAL DIALYSIS
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DIALYSIS STRATEGIES
HEMODIALYSIS
HEMODIAFILTRATION
HEMOFILTRATION
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DIALYSIS
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DIALYSATE
COMPOSIYION
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GENIUS
Flow chart of the Genius dialysis system. The
circulator (1), closed container with 75 L
dialysate (2), spent dialysate (3), unused
dialysate (4), dialyzer (5), ultrafiltrate
recipient (6), arterial bloodline (7), venous
bloodline (8), sampling port at the inlet
dialysate line (9), and sampling port at the
outlet dialysate line (10).
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DIALYZERS
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DIALYZERS
Top-view on Embedded Capillary Membranes after
Final Cut
Principle of P.E.T. Membrane capillaries are
specially combined with multifilament yarn
P.E.T. Performance Enhancing Technology
Ondulation of Capillary Membranes
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DIALYZERS
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DIALYZERS
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DIALYZERS
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QUALITY STANDARDS OF MODERN DEIALYZERS
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(No Transcript)
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DIALYSIS CHARACTERISTICS
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CLEARANCE
Solute clearances in the three studied
hemodialyzers. Blood flow conditions were 250-300
and 350 mL/min. Dialysis conditions were high
flux dialysis, HDF (9L), and on-line HDF (15L).
Hemodialysius (black box) HDF (cross-hatch box)
on-line HDF (dot-shaded box).
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CONCENTRATION DURING AND AFTER DIALYSIS
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B2-MICROPGLUBULIN
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P-CRESOL ORIGIN
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P-CRESOL TOXICITY In vitro inhibition of
NADPH-oxidase by p-cresol
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60

Staph A

50

zymosan



production, DPM x 10
latex
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30


2
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CO

10
0
1
2
3
p-cresol (mg/100ml)
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HPLC
IN indoxylsulfate TR tryptophan HA hippuric
acid IAA indole-3-acetic acid CMPF
3-carboxy-4-methyl-5-propyl- 2-furanpropionic
acid IS internal standard
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CONCENTRATION
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TOXICITY