Hemodialysis System

Part of the Studies in Computational Intelligence book series (SCI, volume 404)

Abstract

The function of the dialysis system is to eliminate toxic wastes products, to restore “internal milieu composition” and to correct extracellular fluid overload. When complete renal failure occurs, the use of an artificial kidney is required. An artificial kidney is a machine that provides a means for removing uremic toxins from the blood and adding deficient components to it (e.g., bicarbonate, calcium). This is done using the principle of dialysis. There are two types of dialysis treatment: peritoneal dialysis (PD) and hemodialysis (HD). The peritoneal dialysis (PD) uses the abdominal cavity and its largely perfused serous membrane as a “built-in dialyzer” by creating and renewing periodically an artificial ascites. PD is a simple and safe technique that does not imply an extracorporeal blood circuit and usually performed at home. The hemodialysis and its related techniques are a much more complex and risky procedure that requires an extracorporeal blood circuit. HD is usually performed in hemodialysis facilities (center, self-care) but may be alternatively performed at home after training.

Hemodialysis machines deliver a patient’s dialysis prescription by controlling blood and dialysate flows through the dialyzer. In addition, they incorporate monitoring and alarm systems that protect the patient against adverse events that may arise from equipment malfunction during the dialysis treatment. This chapter will focus on essential principles of hemodialysis, the major components of HD machines and their respective monitoring devices.

Keywords

Hemodialysis Diffusion Convection Extracorporeal Blood Circuit Dialysate Delivery Circuit Hemodialyzer Biocompatibility 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ahmad, S.: Manual of Clinical Dialysis, 2nd edn. Springer, Heidelberg (2009)CrossRefGoogle Scholar
  2. 2.
    Alter, M.J., Favero, M.S., Moyer, L.A., Bland, L.A.: National surveillance of dialysis-associated diseases in the United States. Trans. ASAIO 37, 97–109 (1991) (1989)Google Scholar
  3. 3.
    Andrulli, S., Colzani, S., Mascia, F., et al.: The role of blood volume re-duction in the genesis of intradialytic hypotension. Am. J. Kidney Dis. 40(6), 1244–1254 (2002)CrossRefGoogle Scholar
  4. 4.
    Azar, A.T.: Effect of dialysate temperature on hemodynamic stability among hemodialysis patients. Saudi J. Kidney Dis. Transpl. 20(4), 596–603 (2009)MathSciNetGoogle Scholar
  5. 5.
    Ayoub, A., Finlayson, M.: Effect of cool temperature dialysate on the quality and patients’ perception of haemodialysis. Nephrol. Dial. Transplant. 19(1), 190–194 (2004)CrossRefGoogle Scholar
  6. 6.
    Argiles, A., Kerr, P.G., Canaud, B., et al.: Calcium kinetics and the long-term effects of lowering dialysate calcium concentration. Kidney Int. 43(3), 630–640 (1993)CrossRefGoogle Scholar
  7. 7.
    Berkes, S.L., Kahn, S.I., Chazan, J.A., Garella, S.: Prolonged hemolysis from overheated dialysate. Ann. Intern. Med. 83(3), 363–364 (1975)Google Scholar
  8. 8.
    Byrne, J.H., Schultz, S.G.: An introduction to membrane transport and bioelectricity: foundation of general physiology and electrochemical signalling, 2nd edn. Raven Press, New York (1994)Google Scholar
  9. 9.
    Calò, L.A., Naso, A., D’Angelo, A., et al.: Molecular biology-based as-sessment of vitamin E-coated dialyzer effects onoxidative stress, inflammation, and vascular remodeling. Artif. Organs 35(2), E33–E39 (2011)Google Scholar
  10. 10.
    Canaud, B.: Adequacy target in hemodialysis. J. Nephrol. 17(8), S77–S86 (2004)Google Scholar
  11. 11.
    Canaud, B., Bosc, J.Y., Leray, H., Morena, M., Stec, F.: Microbiologic purity of dialysate: rationale and technical aspects. Blood Purif. 18(3), 200–213 (2000)CrossRefGoogle Scholar
  12. 12.
    Clark, W.R., Macias, W.L., Molitoris, B.A., et al.: Membrane adsorption of β-2-microglobulin: equilibrium and kinetic characterization. Kidney Int. 46(4), 1140–1146 (1994)CrossRefGoogle Scholar
  13. 13.
    Clark, W.R., Hamburger, R.J., Lysaght, M.J.: Effect Of Membrane Com-position And Structure On Solute Removal And Biocompatibility In Hemodialysis. Kidney Int. 56(6), 2005–2015 (1999)CrossRefGoogle Scholar
  14. 14.
    Curtis, J., Delaney, K., O’Kane, P., et al.: Hemodialysis Devices. In: Core Curriculum for the Dialysis Technician: A Comprehensive Review of Hemodialysis, 4th edn., pp. 88–112. Medical Education Institute, Inc., Madison (2008)Google Scholar
  15. 15.
    Davenport, A.: What are the anticoagulation options for intermittent hemodialysis? Nat. Rev. Nephrol. (2011), doi:10.1038/nrneph.2011.88; [Epub ahead of print] Google Scholar
  16. 16.
    Daugirdas, J.T.: Pathophysiology of dialysis hypotension: An update. Am. J. Kidney Dis. 38(suppl. 4), S11–S17 (2001)CrossRefGoogle Scholar
  17. 17.
    Daugirdas, J.T., Blake, P.G., Ing, T.S. (eds.): Handbook of Dialysis, 4th edn. Lippincott, Williams and Wilkins, Philadelphia (2007)Google Scholar
  18. 18.
    Deppisch, R., Gohl, H., Smeby, L.: Microdomain structure of polymeric surfaces—potential for improving blood treatment procedures. Nephrol. Dial. Transplant. 13(6), 1354–1359 (1998)CrossRefGoogle Scholar
  19. 19.
    Donauer, J., Kolblin, D., Bek, M., et al.: Ultrafiltration profiling and measurement of relative blood volume as strategies to reduce hemodialysis-related side effects. Am. J. Kidney Dis. 36(1), 115–123 (2000)CrossRefGoogle Scholar
  20. 20.
    Evenepoel, P., Dejagere, T., Verhamme, P., et al.: Heparin-coated poly-acrylonitrile membrane versus regional citrate anticoagulation: a prospective randomizedstudy of 2 anticoagulation strategies in patients at risk of bleeding. Am. J. Kidney Dis. 49(5), 642–649 (2007)CrossRefGoogle Scholar
  21. 21.
    Flanigan, M.J.: Role of sodium in hemodialysis. Kidney Int. 76, S72-S78 (2000)CrossRefGoogle Scholar
  22. 22.
    Fortner, R.W., Nowakowski, A., Carter, C.B., et al.: Death due to over-heated dialysate during dialysis. Ann. Intern. Med. 73(3), 443–444 (1970)Google Scholar
  23. 23.
    Fresenius Medical Care, Deutschland G.m.b.H., Bad Homburg, Germany, http://www.fmc-ag.com/
  24. 24.
    Gabutti, L., Ferrari, N., Giudici, G., et al.: Unexpected haemodynamic instability associated with standard bicarbonate haemodialysis. Nephrol. Dial. Transplant. 18(11), 2369–2376 (2003)CrossRefGoogle Scholar
  25. 25.
    Gastaldello, K., Melot, C., Kahn, R.J., et al.: Comparison of cellulose di-acetate and polysulfone membranes in the outcome of acute renal failure. A prospective randomized study. Nephrol. Dial. Transplant. 15(2), 224–230 (2000)CrossRefGoogle Scholar
  26. 26.
    Graham, K.A., Reaich, D., Channon, S.M., et al.: Correction of acidosis in hemodialysis decreases whole-body protein degradation. J. Am. Soc. Nephrol. 8(4), 632–637 (1997)Google Scholar
  27. 27.
    Gutch, C.F., Stoner, M.H., Corea, A.L.: Review of hemodialysis for nurses and dialysis personnel, 6th edn. Mosby, St. Louis (1999)Google Scholar
  28. 28.
    Hilderson, J., Ringoir, S., van Waeleghem, J.P., et al.: Short dialysis with a polyacrylonitrilmembrane (RP 6) without the use of a closed re-circulating dialyzate delivery system. Clin. Nephrol. 4(1), 18–22 (1975)Google Scholar
  29. 29.
    Henrich, W.L.: Principles and Practice of Dialysis, 4th edn. Lippin-cott Williams & Wilkins, USA (2009)Google Scholar
  30. 30.
    Koda, Y., Mineshima, M.: Advances and advantages in recent central dialysis fluid delivery system. Blood Purif. 27(suppl. 1), 23–27 (2009)CrossRefGoogle Scholar
  31. 31.
    Kopp, K.F., Gutch, C.F., Kolff, W.J.: Single needle dialysis. Trans. Am./ Soc. Artif. Intern. Organs 18, 75–81 (1972)CrossRefGoogle Scholar
  32. 32.
    Korwer, U., Schorn, E.B., Grassmann, A., Vienken, J.: Understanding Membranes and Dialyzers. PABST Science Publishers, Lengerich (2004)Google Scholar
  33. 33.
    Kuhlmann, U., Goldau, R., Samadi, N., et al.: Accuracy and safety of online clearance monitoring based on conductivity variation. Nephrol. Dial. Transplant. 16(5), 1053–1058 (2001)CrossRefGoogle Scholar
  34. 34.
    Kyriazis, J., Glotsos, J., Bilirakis, L., et al.: Dialysate calcium profiling during hemodialysis: use and clinical implications. Kidney Int. 61(1), 276–287 (2002)CrossRefGoogle Scholar
  35. 35.
    Lang, S., Küchle, C., Fricke, H., Schiffl, H.: Biocompatible intermittent hemodialysis. New Horiz. 3(4), 680–687 (1995)Google Scholar
  36. 36.
    Lavaud, S., Canivet, E., Wuillai, A., et al.: Optimal anticoagulation strategy in haemodialysis with heparin-coated polyacrylonitrile membrane. Nephrol. Dial. Transplant. 18(10), 2097–2104 (2003)CrossRefGoogle Scholar
  37. 37.
    Lee, F.F., Dorning, C.J., Leonard, E.F.: Urethanes as ethylene oxide res-ervoirs in hollow-fiber Dialyzers. Trans. Am. Soc. Artif. Intern. Organs 31, 526–533 (1985)Google Scholar
  38. 38.
    Leunissen, K.M., Kooman, J.P., van der Sande, F.M., van Kuijk, W.H.: Hypotension and ultrafiltration physiology in dialysis. Blood Purif. 18(4), 251–254 (2000)CrossRefGoogle Scholar
  39. 39.
    Levin, A., Goldstein, M.B.: The benefits and side effects of ramped hypertonic sodium dialysis. J. Am. Soc. Nephrol. 7(2), 242–246 (1996)Google Scholar
  40. 40.
    Lonnemann, G.: The quality of dialysate: an integrated approach. Kidney Int. Suppl. 76, S112–S119 (2000)Google Scholar
  41. 41.
    Lysaght, M.J.: Evolution of hemodialysis membranes. Contrib. Nephrol. 113, 1–10 (1995)Google Scholar
  42. 42.
    Maduell, F., Vera, M., Arias, M., et al.: Influence of the ionic dialysance monitor on Kt measurement in hemodialysis. Am. J. Kidney Dis. 52(1), 85–92 (2008)CrossRefGoogle Scholar
  43. 43.
    Mancini, E., Mambelli, E., Irpinia, M., et al.: Prevention of dialysis hypotension episodes using fuzzy logic control system. Nephrol. Dial. Transplant. 22(5), 1420–1427 (2007)CrossRefGoogle Scholar
  44. 44.
    Mancini, E., Santoro, A., Spongano, M., et al.: Effects of automatic blood volume control over intradialytic hemodynamic stability. Int. J. Artif. Organs 18(9), 495–498 (1995)Google Scholar
  45. 45.
    Masakane, I.: Review: Clinical usefulness of ultrapure dialysate - recent evidence and perspectives. Ther. Apher. Dial. 10(4), 348–354 (2006)CrossRefGoogle Scholar
  46. 46.
    Meira, F.S., Poli de Figueiredo, C.E., Figueiredo, A.E.: Influence of so-dium profile in preventing complications during hemodialysis. Hemodial. Int. 11(suppl. 3), S29–S32 (2007)CrossRefGoogle Scholar
  47. 47.
    Mercadal, L., Petitclerc, T., Jaudon, M.C., et al.: Is ionic dialysance a valid parameter for quantification of dialysis efficiency? Artif. Organs 22(12), 1005–1009 (1998)CrossRefGoogle Scholar
  48. 48.
    Mercadal, L., Du Montcel, S.T., Jaudon, M.C., et al.: Ionic dialysance vs urea clearance in the absence of cardiopulmonary recirculation. Nephrol. Dial. Transplant. 17(1), 106–111 (2002)CrossRefGoogle Scholar
  49. 49.
    Misra, M.: The basics of hemodialysis equipment. Hemodial. Int. 9(1), 30–36 (2005)CrossRefGoogle Scholar
  50. 50.
    Mitchell, S.: Estimated dry weight (EDW): aiming for accuracy. Nephrol. Nurs. J. 29(5), 421–428 (2002)Google Scholar
  51. 51.
    Monge, M., Shahapuni, I., Oprisiu, R., et al.: Reappraisal of 2003 NKF-K/DOQI guidelines for management of hyperparathyroidism in chronic kidney disease patients. Nat. Clin. Pract. Nephrol. 2(6), 326–336 (2006)CrossRefGoogle Scholar
  52. 52.
    Moret, K., Beerenhout, C.H., van den Wall Bake, A.W., et al.: Ionic dialysance and the assessment of Kt/V: the influence of different estimates of V on method agreement. Nephrol. Dial. Transplant. 22(8), 2276–2282 (2007)CrossRefGoogle Scholar
  53. 53.
    Moret, K., Aalten, J., van den Wall Bake, W., et al.: The effect of sodium profiling and feedback technologies on plasma conductivity and ionic mass balance: a study in hypotension-prone dialysis patients. Nephrol. Dial. Transplant. 21(1), 138–144 (2006)CrossRefGoogle Scholar
  54. 54.
    Morti, S.M., Zydney, A.: Protein-membrane interactions during hemo-dialysis. Effects on solute. transport. ASAIO J. 44(4), 319–326 (1998)Google Scholar
  55. 55.
    NKF-K/DOQI, Clinical practice guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. Am. J. Kidney Dis. 42(4 suppl. 3), S1–S201 (2003)Google Scholar
  56. 56.
    Nishimura, M., Nakanishi, T., Yasui, A., et al.: Serum calcium increases the incidence of arrhythmias during acetate hemodialysis. Am. J. Kidney Dis. 19(2), 149–155 (1992)Google Scholar
  57. 57.
    Oliver, M.J., Edwards, L.J., Churchill, D.N.: Impact of sodium and ul-trafiltration profiling on hemodialysis-related symptoms. J. Am. Soc. Nephrol. 12(1), 151–156 (2001)Google Scholar
  58. 58.
    Ouseph, R., Hutchison, C.A., Ward, R.A.: Differences in solute removal by two high-flux membranes of nominally similar synthetic polymers. Nephrol. Dial. Transplant. 23(5), 1704–1712 (2008)CrossRefGoogle Scholar
  59. 59.
    Palmer, B.F.: Dialysate Composition in Hemodialysis and Peritoneal Dialysis. In: Schrier, R.W. (ed.) Atlas of Diseases of the Kidney, ch. 2, vol. 5. Current Medicine, Inc., Philadelphia (1999)Google Scholar
  60. 60.
    Papadimitriou, M., Kulatilake, A.E.: Relationship between weight loss and venous and dialysate pressures during chronic intermittent haemodialysis. Med. Biol. Eng. 7(3), 317–320 (1969)CrossRefGoogle Scholar
  61. 61.
    Petitclerc, T., Goux, N., Hamani1, A., Béné, B., Jacobs, C.: Biofeed-back technique through the variations of the dialysate sodium concentration. Nefrologia XVII(1), 50–55 (1997)Google Scholar
  62. 62.
    Petitclerc, T.: Do dialysate conductivity measurements provide conductivity clearance or ionic dialysance? Kidney Int. 70(10), 1682–1686 (2005)CrossRefGoogle Scholar
  63. 63.
    Pierratos, A., Ouwendyk, M., Francoeur, R., et al.: Nocturnal hemodialysis: three-year experience. J. Am. Soc. Nephrol. 9(5), 859–868 (1998)Google Scholar
  64. 64.
    Pittard, J.D.: Safety monitors in hemodialysis. In: Nissenson, A.R., Fine, R.N. (eds.) Handbook of Dialysis Therapy, 4th edn., Philadelphia, PA, USA, pp. 188–223 (2008)Google Scholar
  65. 65.
    Polaschegg, H.: Single-needle dialysis. In: Nissenson, A.R., Fine, R.N. (eds.) Handbook of Dialysis Therapy, 4th edn., Philadelphia, PA, USA, pp. 168–187 (2008)Google Scholar
  66. 66.
    Pontoriero, G., Pozzoni, P., Andrulli, S., Locatelli, F.: The quality of dialysis water. Nephrol. Dial. Transplant. 18(suppl. 7), vii21–vii25 (2003)Google Scholar
  67. 67.
    Pozzoni, P., Di Filippo, S., Pontoriero, G., Locatelli, F.: Effectiveness of sodium and conductivity kinetic models in predicting end-dialysis plasma water sodium concentration: preliminary results of a single center experience. Hemodial. Int. 11(2), 169–177 (2007)CrossRefGoogle Scholar
  68. 68.
    Reddy, B., Cheung, A.K.H.: Hemodialysis. In: Lai, K.N. (ed.) A Practical Manual of Renal Medicine, 1st edn. World Scientific, Singapore (2009)Google Scholar
  69. 69.
    Ridel, C., Osman, D., Mercadal, L., et al.: Ionic dialysance: a new valid parameter for quantification of dialysis efficiency in acute renal failure? Intensive Care Med. 33(3), 460–465 (2007)CrossRefGoogle Scholar
  70. 70.
    Ronco, C., Crepaldi, C., Brendolan, A., et al.: Evolution of synthetic membranes for blood purification: the case of the Polyflux family. Nephrol. Dial. Transplant. 18(suppl. 7), vii10–vii20 (2003)Google Scholar
  71. 71.
    Ronco, C., Brendolan, A., Crepaldi, C., et al.: Blood and dialysate flow distributions in hollow-fiber hemodialyzers analyzed by computerized helical scanning technique. J. Am. Soc. Nephrol. 13(1), S53–S61 (2002)Google Scholar
  72. 72.
    Ronco, C., Brendolan, A., Milan, M., et al.: Impact of biofeedback-induced cardiovascular stability on hemodialysis tolerance and efficiency. Kidney Int. 58(2), 800–808 (2000)CrossRefGoogle Scholar
  73. 73.
    Rosa Diez, G.J., Bevione, P., Crucelegui, M.S., et al.: Measuring Kt by ionic dialysance is a useful tool for assessing dialysis dose in critical patients. Nefrologia 30(2), 227–231 (2010)Google Scholar
  74. 74.
    Sankaranarayanan, N., Santos, S.F., Peixoto, A.J.: Blood pressure meas-urement in dialysis patients. Adv. Chronic. Kidney Dis. 11(2), 134–142 (2004)CrossRefGoogle Scholar
  75. 75.
    Santoro, A., Mambelli, E., Canova, C., et al.: Biofeedback in dialysis. J. Nephrol. 16(suppl. 7), S48–S56 (2003)Google Scholar
  76. 76.
    Santoro, A., Mancini, E., Paolini, F., et al.: Blood volume regulation during hemodialysis. Am. J. Kidney Dis. 32(5), 739–748 (1998)CrossRefGoogle Scholar
  77. 77.
    Sargent, J., Gotch, F.: Principles and biophysics of dialysis. In: Jacobs, C., Kjellstrand, C., Koch, K., Winchester, J. (eds.) Replacement of Renal Function by Dialysis, 4th edn., pp. 34–102. Kluwer Academic Publishers, Dortdrecht (1996)CrossRefGoogle Scholar
  78. 78.
    Salai, P.B.: Hemodialysis. In: Molzahn, A.E., Butera, E. (eds.) Contemporary Nephrology Nursing: Principles and Practice, pp. 527–574. American Nephrology Nurses’ Association, Pitman (2007)Google Scholar
  79. 79.
    Sam, R., Vaseemuddin, M., Leong, W.H., et al.: Composition and clini-cal use of hemodialysates. Hemodial. Int. 10(1), 15–28 (2006)CrossRefGoogle Scholar
  80. 80.
    Schmidt, R., Roeher, O., Hickstein, H., Korth, S.: Prevention of haemo-dialysis-induced hypotension by biofeedback control of ultrafiltra-tion and infusion. Nephrol. Dial. Transplant. 16(3), 595–603 (2001a)CrossRefGoogle Scholar
  81. 81.
    Schmidt, R., Roeher, O., Hickstein, H., Korth, S.: Blood Pressure Guided Profiling of Ultrafiltration during Hemodialysis. Saudi J. Kidney Dis. Transpl. 12(3), 337–344 (2001b)Google Scholar
  82. 82.
    Schneditz, D., Ronco, C., Levin, N.: Temperature control by the blood temperature monitor. Semin. Dial. 16(6), 477–482 (2003)CrossRefGoogle Scholar
  83. 83.
    Schreiber Jr., M.J.: Clinical, dilemmas in dialysis: Managing the hypotensive patient. Setting the stage. Am. J. Kidney Dis. 38(suppl. 4), S1–S10 (2001)CrossRefGoogle Scholar
  84. 84.
    Schiffl, H., Lang, S.M., Haider, M.: Bioincompatibility of dialyzer membranes may have a negative impact on outcome of acute renal failure, independent of the dose of dialysis delivered: a retrospective multicenter analysis. ASAIO J. 44(5), M418–M422 (1998)Google Scholar
  85. 85.
    Song, J.H., Park, G.H., Lee, S.Y., et al.: Effect of sodium balance and the combination of ultrafiltration profile during sodium profiling hemodialysis on the maintenance of the quality of dialysis and sodium and fluid balances. J. Am. Soc. Nephrol. 16(1), 237–246 (2005)CrossRefGoogle Scholar
  86. 86.
    Speigel, D.M.: The role of magnesium binders in chronic kidney dis-ease. Semin. Dial. 20(4), 333–336 (2007)CrossRefGoogle Scholar
  87. 87.
    Stiller, S., Bonnie-Schorn, E., Grassmann, A., et al.: A critical review of sodium profiling for hemodialysis. Semin. Dial. 14(5), 337–347 (2001)CrossRefGoogle Scholar
  88. 88.
    Strathmann, H., Gohl, H.: Membranes for blood purification: state of the art and new developments. Contrib. Nephrol. 78, 119–141 (1990)Google Scholar
  89. 89.
    Takemoto, Y., Naganuma, T., Yoshimura, R.: Biocompatibility of the dialysis membrane. Contrib. Nephrol. 168, 139–145 (2011)CrossRefGoogle Scholar
  90. 90.
    Trakarnvanich, T., Chirananthavat, T., Ariyakulnimit, S., et al.: The efficacy of single-needle versus double-needle hemodialysis in chronic renal failure. J. Med. Assoc. Thai. 89(suppl. 2), S196–S206 (2006)Google Scholar
  91. 91.
    Twiss, E.E.: One-cannula haemodialysis. Lancet 284(7369), 1106 (1964)CrossRefGoogle Scholar
  92. 92.
    Yu, A., Ing, T., Zabineh, R., Daugirdas, J.: Effect of dialysate on central hemodynamic and urea kinetics. Kidney Int. 48(1), 237–243 (1995)CrossRefGoogle Scholar
  93. 93.
    Van der Sande, F.M., Cheriex, E.C., van Kuijk, W.H., Leunissen, K.M.: Effect of dialysate calcium concentrations on intradialytic blood pressure course in cardiac-compromised patients. Am. J. Kidney Dis. 32(1), 125–131 (1998)CrossRefGoogle Scholar
  94. 94.
    Vanholder, R., De Smet, R., Glorieux, G., et al.: Review on uremic tox-ins: classification, concentration, and interindividual variability. Kidney Int. 63(5), 1934–1943 (2003)CrossRefGoogle Scholar
  95. 95.
    Vanholder, R., Hoenich, N., Ringoir, S.: Single needle hemodialysis. In: Maher, J.F. (ed.) Replacement of Renal Function by Dialysis, 3rd edn., pp. 382–399. Kluwer Academic Publisher, Boston (1989)CrossRefGoogle Scholar
  96. 96.
    Van Stone, J.C.: Individualization of the dialysate prescription in chronic hemodialysis. Dial. Transplant. 23(11), 624–635 (1994)Google Scholar
  97. 97.
    Ward, R.A., Leypoldt, J.K., Clark, W.R., et al.: What clinically important advances in understanding and improving dialyzer function have occurred recently? Semin. Dial. 14(3), 160–174 (2001)CrossRefGoogle Scholar
  98. 98.
    Wolkotte, C., Hassell, D.R., Moret, K., et al.: Blood volume control by biofeedback and dialysis-induced symptomatology. A short term clinical study. Nephron. 92(3), 605–609 (2002)Google Scholar
  99. 99.
    Zhou, Y.L., Liu, H.L., Duan, X.F., et al.: Impact of sodium and ultrafiltration profiling on haemodialysis related hypotension. Nephrol. Dial. Transplant. 21(11), 3231–3237 (2006)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Computer and Software Engineering Department Faculty of EngineeringMisr University for Science & Technology (MUST)6th of October CityEgypt
  2. 2.Nephrology, Dialysis and Intensive Care UnitLapeyronie HospitalMontpellierFrance

Personalised recommendations