IN THE NAME OF GOD - PowerPoint PPT Presentation

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IN THE NAME OF GOD

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Title: Author... Last modified by: Mehdi Created Date: 6/17/2006 8:55:30 PM Document presentation format – PowerPoint PPT presentation

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Title: IN THE NAME OF GOD


1
IN THE NAME OF GOD
2
????? ? ??????? ???? ??
  • ???? ????
  • ????? 1388

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1- ??? ????
  • ??? ???? ?? ????? ?????
  • (Parallel Plate )
  • ? ???? ????????? ??????
  • ( Hollow Fiber )

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??????? ?????
  • ????? ????? ????? ??????? ??? ??? ? ???? ?????
    ?? ???? ??? ?????? ?? ????? ???? ????????? ????
    ?? ????? .
  • ???? ???? ??? ????????? ? ???? ??? ??????? ?
    ???? ???? ????? ??????? ???? ?? ???? ?? ???????
    ?? ??? .

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??? ???? Surface Area
  • ??? ???? ????? ?????? ??? ?? ????
    ??? ?????????
  • ??? ???? ????? ????? ?? ???? ???
    ????
  • ???? ?? ????? ???? ????? ?? 0.4??? ???? ??
    1.3???????
  • ?? ????? .
  • ?? ?? ??? ???? ????? ???? ? ??? ??????? ?? ??
    ????? ??? .

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Mass Transfer coefficient
  • KOA ?? ???? ??? ?????? ???? ??Mass Transfer
    coefficient ) ( ?????? ???? ???? ???? ??? ?? ??
    ???? ???? ????? ? ????? ???? ? ?????? ???? ?
    ????? ????? ??? ? ???? ?????? ???? ?? ??? .
  • KOA ?? ???? ????? ??? ?? ???? ??? ??????? ??
    ???? ?? ??????? ?? ???? ?? ??? ?? ????.
  • KOA ?? ??? ????? ?????? ????? ?? ????? ???? ????
    ?? ????? ???? ?? ???? ??? ?? ?? ????? ???? ?????
    ??? ? ????? ?????? ???.
  • KOA ???? ???? ??????? ?? ???? ??? ?????? ??? 200
    ?? 1100 ?? ????? ????? ????.

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??? ?? ??????? ?? ( Fluid Removal )
  • ??????? ???? ?? ???? ?? ?? ???? ????? ????
    ?????? ??
  • ??? ?????? ?????? ???? ????
  • ???? ???????? ????? ?? ???? ?????? ??

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KUF
  • ???? ????? ???? ?? ??
  • ??? ???? ????? ??? ?? ???? ???? ?? ???? ?? ??
    ?????
  • ????? ?? ??? ?? ???? ( MM Hg ) ???? ??? ???? ????
  • ???? ??????????????? ?? KUF ?????? ?? ??? .
  • KUF ????? ???? ???? ????? ????? ???? ?? ??
    TMP
  • KUF ???????? ???? ????? ????? ???? ?? ??
    TMP

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High-Efficiency andHigh-Flux Hemodialysis
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Definitions of flux, Permeability, and efficiency
  • Flux Measure of ultrafiltration capacity
    Low and high flux are based on the
    ultrafiltration coefficient(Kuf) Low
    flux Kuf lt 10 ml/h/mmHg High flux Kuf
    lt 20 ml/h/mmHgPermeability Measure of the
    clearance of the middle molecular weight molecule
  • (eg, ß2-microglobolin) General
    correlation between flux and Permeability
    Low Permeability ß2-microglobolin
    clearancelt10ml/h/mmHg High Permeability
    ß2-microglobolin clearancelt20ml/h/mmHgEfficiency
    Measure of urea clearance Low and
    high efficiency are based on the urea KoA value
    Low efficiency KoA lt500 ml/min
    High efficiency KoA lt500 ml/min

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Classification of High-Performance Dialysis
  • High-Efficiency Low-flux hemodialysis
  • High-Efficiency High-flux hemodialysis
  • Low-Efficiency High-flux hemodialysis

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Characteristics ofHigh-Efficiency Dialysis
  • Urea clearance rate is usually gt210 ml/min
  • Urea KoA of the dialyser is usually gt600 ml/min
  • Ultrafiltration coefficient of the dialyser(Kuf)
  • maybe high or low
  • Clearance of middle molecular weight molecules
  • maybe high or low
  • --------------------------------------
  • Ko- mass transfer coefficient A- surface area

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Differences between High and Low-Efficiency
Hemodialysis
High Efficiency, ml/min Low Efficiency, ml/min
Dialyzer KoA 600 lt500
Blood flow 350 lt350
Dialysate flow 500 lt500
Bicarbonate dialysate Necessary optimal
  • Ko- mass transfer coefficient A- surface area

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Causes of High-Efficiency Dialysis Failure
  • Access-related Low blood flow rate
    High recirculation rate
  • Time-related Patient not adherent to
    prescribed time Staff not adherent to
    prescribed time Failure to adjust time
    for conditions
  • such as alarm, dialysate bypass, and
  • hypotention

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Benefits High-Efficiency Dialysis
  • Higher clearance of small solutes, such
  • as urea, compared with conventional
    dialysis without increase in treatment
  • time
  • Better control of chimistery
  • Potentially reduced morbidity
  • Potentially higher patient survival rates

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Characteristics of High-Flux dialysis
  • Dialyzer membranes are characterized by a high
  • ultrafiltration coefficient(Kufgt20
    ml/h/mmHg
  • High clearance of middle molecular weight
    molecules
  • occurs (eg, ß2-microglobolin)
  • Urea clearance can be high or low, depending on
    the
  • urea KoA of the dialyzer
  • High-flux dialysis requires an automated
  • ultrafiltration control system

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Technical requirements for High-Flux dialysis
  • High-Flux dialyzers
  • Automated ultrafiltration control system

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Potential Benefits of High-Flux Dialysis
  • Delayed onset and risk of dialysis-related
    amyloidosis
  • because of enhanced ß2-microglobolin
    clearance
  • Increased patient survival resulting from higher
  • clearance of middle molecular weight
    molecules
  • Reduced morbidity and hospital admissions
  • Improved lipid profile
  • Higher clearance of aluminum
  • Improved nutritional status
  • Reduced risk of infection
  • preserved residual renal function

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Limitation of High-Flux Dialysis
  • Enhanced drug clearance, requiring
  • supplemental dose after dialysis
  • High cost of dialyzers

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  • ?????? ???? ????? ??? ?? ????? ?????? ??
  • ??????? ??? ????? ??? ???? ???? ?????
  • ?? ??? ?? ????? ?? ????? ?? ????? ??????
  • ????? ? ???? ??? ??? .

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???? ???????
  • ?????????? 60kg ?? 160cm ?? ?? ???? .
  • 1 ?????? ??? (V)? ?? ??? ??? 32 ???? ?? 32000
    ???? ????
  • 2 - ?????? ???? (T) ? 4 ???? ?????? ????? ?? 240
    ?????
  • 3 - ????? K.T/V ??? ? K.T/V ????? ?? ?? ????
    ??????3/1
  • K.T/V 1/3
  • ( K . 240) / 32000 1/3
  • K ( 1/3 . 32000) / 240173
  • K 173
  • ??????? ???? ???? R5 ?? ???? ??? 200 ???? ???? ??
    ????? ???? 170 ???? ???? ?? ???? ?? ???? ??
    ?????? ??? ???? ? ????? ????? ??? ?????? ?? 200
    ???? ???? 250 ???? ???? ?? ????? ?? ??????? ?????
    ???? .
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