Skip to main content
SpringerLink
Log in

Technical Aspects of Hemodialysis

  • Chapter
  • First Online:
Core Concepts in Dialysis and Continuous Therapies

Abstract

The invention of “dialysis” can be traced back to 1861 when Thomas Graham, Professor of chemistry at the Anderson’s University in Glasgow, first demonstrated the principles of selective transfer of molecules across a semipermeable membrane along a concentration gradient (diffusion). Willem J Kolff, the architect of the artificial kidney machine, first applied these principles in humans for blood purification, initially to treat acute renal failure in 1945. Subsequently, in an attempt to reverse uremic toxicity and restore salt and water homeostasis in chronic renal failure, diffusion was combined with convection to form the basis of current hemodialysis (HD) technology. Major advances in the design, efficiency, and safety of the technology over five decades coupled with its phenomenal global uptake since the 1980s has established HD as the dominant modality for the treatment of end-stage renal failure. This chapter reviews the main technical components of the HD system, practical concepts around treatment setup, initiation, troubleshooting, and safety, relevant to clinical practice today.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Huang Z, Gao D, Letteri JJ, Clark WR. Blood-membrane interactions during dialysis. Semin Dial. 2009;22(6):623–8. doi:10.1111/j.1525-139X.2009.00658.x.

    Article  PubMed  Google Scholar 

  2. Ledebo I. Principles and practice of hemofiltration and hemodiafiltration. Artif Organs. 1998;22(1):20–5.

    Article  CAS  PubMed  Google Scholar 

  3. Galli F. Vitamin E-derived copolymers continue the challenge to hemodialysis biomaterials. World J Nephrol. 2012;1(4):100–5. doi:10.5527/wjn.v1.i4.100.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ghezzi PM, Bonello M, Ronco C. Disinfection of dialysis monitors. Contrib Nephrol. 2007;154:39–60. doi:10.1159/000096813.

    PubMed  Google Scholar 

  5. Uda S, Mizobuchi M, Akizawa T. Biocompatible characteristics of high-performance membranes. Contrib Nephrol. 2011;173:23–9. doi:10.1159/000328941.

    Article  CAS  PubMed  Google Scholar 

  6. Misra M. The basics of hemodialysis equipment. Hemodial Int. 2005;9(1):30–6. doi:10.1111/j.1492-7535.2005.01115.x.

    Article  PubMed  Google Scholar 

  7. Kimata N, Wakayama K, Okano K, et al. Study of discrepancies between recorded and actual blood flow in hemodialysis patients. ASAIO J. 59(6):617–21. doi:10.1097/MAT.0b013e3182a708b9.

    Google Scholar 

  8. Allcock K, Jagannathan B, Hood CJ, Marshall MR. Exsanguination of a home hemodialysis patient as a result of misconnected blood-lines during the wash back procedure: a case report. BMC Nephrol. 2012;13(1):28. doi:10.1186/1471-2369-13-28.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Basile C, Ruggieri G, Vernaglione L, Montanaro A, Giordano R. A comparison of methods for the measurement of hemodialysis access recirculation. J Nephrol. 2003;16(6):908–13. http://www.ncbi.nlm.nih.gov/pubmed/14736020. Accessed 30 Mar 2015.

    PubMed  Google Scholar 

  10. Kumbar L, Karim J, Besarab A. Surveillance and monitoring of dialysis access. Int J Nephrol. 2012;2012.

    Google Scholar 

  11. Stegmayr B, Forsberg U, Jonsson P, Stegmayr C. The sensor in the venous chamber does not prevent passage of air bubbles during hemodialysis. Artif Organs. 2007;31(2):162–6. doi:10.1111/j.1525-1594.2007.00358.x.

    Article  PubMed  Google Scholar 

  12. Forsberg U, Jonsson P, Stegmayr C, Stegmayr B. Microemboli, developed during haemodialysis, pass the lung barrier and may cause ischaemic lesions in organs such as the brain. Nephrol Dial Transplant. 2010;25(8):2691–5. doi:10.1093/ndt/gfq116.

    Article  PubMed  Google Scholar 

  13. Finelli L, Miller JT, Tokars JI, Alter MJ, Arduino MJ. National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial. 18(1):52–61. doi:10.1111/j.1525-139X.2005.18108.x.

    Google Scholar 

  14. Malinauskas RA. Decreased hemodialysis circuit pressures indicating postpump tubing kinks: a retrospective investigation of hemolysis in five patients. Hemodial Int. 2008;12(3):383–93. doi:10.1111/j.1542-4758.2008.00285.x.

    Article  PubMed  Google Scholar 

  15. Raimann J, Liu L, Tyagi S, Levin NW, Kotanko P. A fresh look at dry weight. Hemodial Int. 2008;12(4):395–405. doi:10.1111/j.1542-4758.2008.00302.x.

    Article  PubMed  Google Scholar 

  16. Locatelli F, Buoncristiani U, Canaud B, Köhler H, Petitclerc T, Zucchelli P. Haemodialysis with on-line monitoring equipment: tools or toys? Nephrol Dial Transplant. 2005;20(1):22–33. doi:10.1093/ndt/gfh555.

    Article  PubMed  Google Scholar 

  17. Santoro A, Mancini E, Basile C, et al. Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial. Kidney Int. 2002;62(3):1034–45. doi:10.1046/j.1523-1755.2002.00511.x.

    Article  CAS  PubMed  Google Scholar 

  18. Clark WR, Ronco C. Determinants of haemodialyser performance and the potential effect on clinical outcome. Nephrol Dial Transplant. 2001;16(Suppl 5):56–60.

    Article  CAS  PubMed  Google Scholar 

  19. Chelamcharla M, Leypoldt JK, Cheung AK. Dialyzer membranes as determinants of the adequacy of dialysis. Semin Nephrol. 2005;25(2):81–9. http://www.ncbi.nlm.nih.gov/pubmed/15791559. Accessed 30 March 2015.

    Article  CAS  PubMed  Google Scholar 

  20. Ronco C, Brendolan A, Crepaldi C, Rodighiero M, Scabardi M. Blood and dialysate flow distributions in hollow-fiber hemodialyzers analyzed by computerized helical scanning technique. J Am Soc Nephrol. 2002;13(Suppl 1):S53–S61. http://www.ncbi.nlm.nih.gov/pubmed/11792763. Accessed 11 Jan 2015.

    CAS  PubMed  Google Scholar 

  21. Ronco C. Fluid mechanics and crossfiltration in hollow-fiber hemodialyzers. Contrib Nephrol. 2007;158:34–49. doi:10.1159/0000107233.

    Article  PubMed  Google Scholar 

  22. Ronco C, Scabardi M, Goldoni M, Brendolan A, Crepaldi C, La Greca G. Impact of spacing filaments external to hollow fibers on dialysate flow distribution and dialyzer performance. Int J Artif Organs. 1997;20(5):261–6. http://www.ncbi.nlm.nih.gov/pubmed/9209926. Accessed 11 Jan 2015.

    CAS  PubMed  Google Scholar 

  23. Boure T. Which dialyser membrane to choose? Nephrol Dial Transplant. 2004;19(2):293–6. doi:10.1093/ndt/gfg508.

    Article  CAS  PubMed  Google Scholar 

  24. Eknoyan G, Beck GJ, Cheung AK, et al. Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med. 2002;347(25):2010–9. doi:10.1056/NEJMoa021583.

    Article  PubMed  Google Scholar 

  25. Nguyen MK, Kurtz I. Physiologic interrelationships between Gibbs–Donnan equilibrium, osmolality of body fluid compartments, and plasma water sodium concentration. J Appl Physiol. 2006:1–9. doi:10.1152/japplphysiol.00505.2006.

    Google Scholar 

  26. Van Tellingen A, Grooteman MP, Bartels PC, et al. Long-term reduction of plasma homocysteine levels by super-flux dialyzers in hemodialysis patients. Kidney Int. 2001;59(1):342–7. doi:10.1046/j.1523-1755.2001.00496.x.

    Article  PubMed  Google Scholar 

  27. Santoro A, Guadagni G. Dialysis membrane: from convection to adsorption. Clin Kidney J. 2010;3(Suppl 1):i36–i9. doi:10.1093/ndtplus/sfq035.

    Article  CAS  Google Scholar 

  28. Ebo DG, Bosmans JL, Couttenye MM, Stevens WJ. Haemodialysis-associated anaphylactic and anaphylactoid reactions. Allergy. 2006;61(2):211–20. doi:10.1111/j.1398-9995.2006.00982.x.

    Article  CAS  PubMed  Google Scholar 

  29. Blossom DB, Kallen AJ, Patel PR, et al. Outbreak of adverse reactions associated with contaminated heparin. N Engl J Med. 2008;359(25):2674–84. doi:10.1056/NEJMoa0806450.

    Article  CAS  PubMed  Google Scholar 

  30. Brown C. Current opinion and controversies of dialyser reuse. Saudi J Kidney Dis Transpl. 2001;12(3):352–63. http://www.ncbi.nlm.nih.gov/pubmed/18209382. Accessed 30 March 2015.

    CAS  PubMed  Google Scholar 

  31. Lowrie EG, Li Z, Ofsthun N, Lazarus JM. Reprocessing dialysers for multiple uses: recent analysis of death risks for patients. Nephrol Dial Transplant. 2004;19(11):2823–30. doi:10.1093/ndt/gfh460.

    Article  PubMed  Google Scholar 

  32. Damasiewicz MJ, Polkinghorne KR, Kerr PG. Water quality in conventional and home haemodialysis. Nat Rev Nephrol. 2012;8(12):725–34. doi:10.1038/nrneph.2012.241.

    Article  CAS  PubMed  Google Scholar 

  33. Penne EL, Visser L, van den Dorpel MA, et al. Microbiological quality and quality control of purified water and ultrapure dialysis fluids for online hemodiafiltration in routine clinical practice. Kidney Int. 2009;76(6):665–72. doi:10.1038/ki.2009.245.

    Article  CAS  PubMed  Google Scholar 

  34. Nystrand R. Microbiology of water and fluids for hemodialysis. J Chin Med Assoc. 2008;71(5):223–9. doi:10.1016/S1726-4901(08)70110–2.

    Article  PubMed  Google Scholar 

  35. Canaud B, Lertdumrongluk P. Ultrapure dialysis fluid: a new standard for contemporary hemodialysis. Nephrourol Mon. 2012;4(3):519–23. doi:10.5812/numonthly.3060.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ledebo I. On-line preparation of solutions for dialysis: practical aspects versus safety and regulations. J Am Soc Nephrol. 2002;13(90001):78–83. http://jasn.asnjournals.org/content/13/suppl_1/S78.full. Accessed 16 Jan 2015.

    Google Scholar 

  37. Ronco C. Hemodiafiltration: evolution of a technique towards better dialysis care. Contrib Nephrol. 2011;168:19–27. doi:10.1159/000321741.

    Article  PubMed  Google Scholar 

  38. Ebah LM, Akhtar M, Wilde I, et al. Phosphate enrichment of dialysate for use in standard and extended haemodialysis. Blood Purif. 2012;34(1):28–33. doi:10.1159/000339818.

    Article  CAS  PubMed  Google Scholar 

  39. Selby NM, McIntyre CW. A systematic review of the clinical effects of reducing dialysate fluid temperature. Nephrol Dial Transplant. 2006;21(7):1883–98. doi:10.1093/ndt/gfl126.

    Article  PubMed  Google Scholar 

  40. Selby NM, Burton JO, Chesterton LJ, McIntyre CW. Dialysis-induced regional left ventricular dysfunction is ameliorated by cooling the dialysate. Clin J Am Soc Nephrol. 2006;1(6):1216–25. doi:10.2215/CJN.02010606.

    Article  PubMed  Google Scholar 

  41. Davenport A. Using dialysis machine technology to reduce intradialytic hypotension. Hemodial Int. 2011;15:S37–S42. doi:10.1111/j.1542-4758.2011.00600.x.

    Article  PubMed  Google Scholar 

  42. Oliver MJ, Edwards LJ, Churchill DN. Impact of sodium and ultrafiltration profiling on hemodialysis-related symptoms. J Am Soc Nephrol. 2001;12(1):151–6. http://jasn.asnjournals.org/content/12/1/151.full. Accessed 18 Jan 2015.

    CAS  PubMed  Google Scholar 

  43. Mercadal L, Piékarski C, Renaux J-L, Petitclerc T, Deray G. Isonatric dialysis biofeedback in hemodiafiltration with online regeneration of ultrafiltrate (HFR): rationale and study protocol for a randomized controlled study. J Nephrol. 25(6):1126–30. doi:10.5301/jn.5000084.

    Google Scholar 

  44. Agarwal R. How can we prevent intradialytic hypotension? Curr Opin Nephrol Hypertens. 2012;21(6):593–9. doi:10.1097/MNH.0b013e3283588f3c.

    Article  PubMed  Google Scholar 

  45. Rostoker G. La technique d’hémodialyse transitoire en uniponcture sur fistules natives: intérêts, limites, risques et précautions. Néphrol Thér. 2010;6(7):591–6. doi:10.1016/j.nephro.2010.05.004.

    Article  PubMed  Google Scholar 

  46. Trakarnvanich T, Chirananthavat T, Maneerat P, Chabsuwan S, Areeyakulnimit S. Is single-needle hemodialysis still a good treatment in end-stage renal disease? Blood Purif. 2007;25(5–6):490–6. doi:10.1159/000113008.

    PubMed  Google Scholar 

  47. Canaud B, Lertdumrongluk P. Ultrapure dialysis fluid: a new standard for contemporary hemodialysis. Nephrourol Mon. 2012;4(3):519–23. doi:10.5812/numonthly.3060.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ing TS. Isolated ultrafiltration: its origin and early development. Artif Organs. 2013;37(10):841–7. doi:10.1111/aor.12212.

    Article  PubMed  Google Scholar 

  49. Garrick R, Kliger A, Stefanchik B. Patient and facility safety in hemodialysis: opportunities and strategies to develop a culture of safety. Clin J Am Soc Nephrol. 2012;7:680–8. doi:10.2215/CJN.06530711.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Delfosse F, Boyer J, Lemaitre V, Inghels Y. [Disconnection of arteriovenous fistula: standardize the coverage of the hemorragic risk]. Néphrol Thér. 2012;8(1):23–34. doi:10.1016/j.nephro.2011.04.004.

    Article  PubMed  Google Scholar 

  51. Ross EA, Briz C, Sadleir RJ. Method for detecting the disconnection of an extracorporeal device using a patient’s endogenous electrical voltages. Kidney Int. 2006;69(12):2274–7. doi:10.1038/sj.ki.5001508.

    Article  CAS  PubMed  Google Scholar 

  52. Davenport A. Intradialytic complications during hemodialysis. Hemodial Int. 2006;10(2):162–7. doi:10.1111/j.1542-4758.2006.00088.x.

    Article  PubMed  Google Scholar 

  53. Hakim R, Himmelfarb J. Hemodialysis access failure: a call to action. Kidney Int. 1998;54(4):1029–40. doi:10.1046/j.1523-1755.1998.00122.x.

    Article  CAS  PubMed  Google Scholar 

  54. Ng LJ, Chen F, Pisoni RL, et al. Hospitalization risks related to vascular access type among incident US hemodialysis patients. Nephrol Dial Transplant. 2011;26(11):3659–66. doi:10.1093/ndt/gfr063.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Renal Medicine, Manchester Academic Health Science Centre, University of Manchester & Central Manchester Foundation Trust, Oxford Road, M13 9WL, Manchester, UK

    Sandip Mitra MBBS, MD, FRCP

  2. Department of Renal Medicine, University of Manchester and Devices for Dignity Healthcare Technology Co-operative, Central Manchester University Hospitals NHS Foundation Trust, Manchester, Lancashire, UK

    Nicos Mitsides MBChB, MRCP, PGCert (Dist)

Authors
  1. Sandip Mitra MBBS, MD, FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicos Mitsides MBChB, MRCP, PGCert (Dist)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sandip Mitra MBBS, MD, FRCP .

Editor information

Editors and Affiliations

  1. Department of Nephrology, Beaumont Hospital, Dublin, Dublin, Ireland

    Colm C. Magee

  2. Department of Medicine/Renal Division, Brigham and Women's Hospital, BOSTON, Massachusetts, USA

    J. Kevin Tucker

  3. Global and Continuing Education, Harvard Medical School, Boston, Massachusetts, USA

    Ajay K. Singh

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Mitra, S., Mitsides, N. (2016). Technical Aspects of Hemodialysis. In: Magee, C., Tucker, J., Singh, A. (eds) Core Concepts in Dialysis and Continuous Therapies. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7657-4_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4899-7657-4_2

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4899-7655-0

  • Online ISBN: 978-1-4899-7657-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation