Principles of Hemodialysis

Hemodialysis (HD) involves the exposure of blood to a semipermeable membrane (dialyzer) against which a physiologic solution (dialysate) is flowing (Fig. 26—6). The dialyzer is composed of thousands of capillary fibers made up of the semipermeable membrane, which are enclosed in the dialyzer, to increase the surface area of blood exposure to maximize the efficiency of removing substances. The dialysate is composed of purified water and electrolytes, and is run through the dialyzer countercurrent to the blood on the other side of the semipermeable membrane. The process allows for the removal of several substances from the bloodstream, including water, urea, creat-inine, electrolytes, uremic toxins, and drugs. Although the dialysate is not sterilized, the membrane prevents bacteria from entering into the bloodstream. However, if the membrane ruptures during hemodialysis, infection becomes a major concern for the patient.

Table 26-8 Advantages and Disadvantages of Hemodialysis

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