New Strategies for High Efficiency Hemodialysis

  • Prakash R. Keshaviah
  • Allan J. Collins
Part of the International Yearbooks of Nephrology book series (IYNE, volume 1)

Abstract

Advances in dialysis technology have permitted reductions in treatment times from 36 hours per week to between 12 and 15 hours per week over a period of two decades. These technological advances include the development of single pass dialysate delivery systems, active perfusion of the extracorporeal circuit using blood pumps, more efficient dialyzer designs with thinner membranes and lower priming volumes, advances in blood access techniques and the ability to attain higher blood flow rates in the extracorporeal circuit. In reducing treatment time, the major concerns are adequacy of solute removal, adequacy of fluid removal and patient tolerance of the shorter, more efficient treatment. It has been documented that rapid removal of osmotically active solutes such as urea can provoke the disequilibrium syndrome with accompanying symptoms of headache, nauseau and vomiting, and in the extreme, seizures (1,2). It is also well documented that the combination of more efficient diffusive solute transport and more rapid removal of fluid can result in cardiovascular instability with symptoms such as nauseau, vomiting, cramps, lightheadedness and hypotension (3,4,5,6). Most of these studies of cardiovascular instability were performed using acetate containing dialysate, it being well recognized that acetate is a potent vasodilator (7).

Keywords

Cellulose Phosphorus Urea Creatinine Anemia 

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Copyright information

© Kluwer Academic Publishers 1989

Authors and Affiliations

  • Prakash R. Keshaviah
    • 1
  • Allan J. Collins
    • 1
  1. 1.Regional Kidney Disease ProgramHennepin County Medical CenterMinneapolisUSA

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