Hemodialysis is a life-saving treatment that filters and purifies blood when kidney function fails, typically due to conditions like diabetes or hypertension. There are different types of hemodialysis, including in-center and home options, each requiring the establishment of vascular access well in advance to ensure safe and effective treatment. While hemodialysis can improve quality of life, it only provides partial kidney function and does not cure underlying kidney disease.

1. Hemodialysis
Presentation by:
Singh Jyoti
Vaseema Rangeenwala

2. What is Dialysis?
Dialysis is a treatment that filters and purifies the blood using a machine. Thus
keeping the internal environment of body stable when kidney fails to do so.
Need?
• Kidney helps removing extra water and waste materials like urea and creatine from
body. Otherwise, its accumulation would poison the body.
• Kidney maintain blood pH and pressure.
• Kidney failure prevent these basic functions to occur.
• So, Dialysis is performed.

3. Causes:
• Diabetes
• Hypertension
• Glomerulonephritis
• Hereditary cystic and congenital renal disease
• neuroplasm

4. Indications for Dialysis
• Diabetics: Creatinine clearance is <15mg/dL
• Non-Diabetics: serum creatinine reaches 6mg/dL

5. Types of Hemodialysis
• In- center haemodialysis: You go to a hospital or a dialysis centre.
Hemodialysis usually is done 3 days a week and takes 3 to 5 hours a day.
• Home haemodialysis: After you are trained, you do your dialysis treatments
at home. Hemodialysis is usually done 3 days a week (or every other day).
Discuss with your doctor how long each session needs to be. A session could
be as long as 6 hours, which may help you feel better.
• Daily home hemodialysis: After you are trained, you do your dialysis
treatments at home. Hemodialysis is done 5 to 7 days a week. Each session
takes about 3 hours.
• Nocturnal home hemodialysis: After you are trained, you do your dialysis
treatments at home. Hemodialysis is done 3 to 7 nights a week. Each session
is done overnight (about 6 to 8 hours).

6. PREPARING FOR HEMODIALYSIS
 In case of chronic kidney disease, preparations for hemodialysis should be made at least several
months before it will be needed.
 A “Vascular Access” is to be made weeks and months before Hemodialysis.
 Vascular access/ Fistula / Shunt
• An access creates a way for blood to be removed from the body, circulate through the dialysis
machine, and then return to the body at a rate that is higher than can be achieved through a normal
vein.
• There are three major types of access: primary arteriovenous (AV) fistula, synthetic AV bridge graft,
and central venous catheter.
• The access should be created before hemodialysis begins because it needs time to heal before it can be
used.
• Having an intravenous (IV) line or frequent blood draws in the arm that will be used for access can
damage the veins, which could prevent them from being used for a hemodialysis access.
• The access is usually created in the nondominant arm; for a right-handed person this would be his or
her left arm.
 After the access is placed, it is important to monitor and care for it over time.

7.  Primary arteriovenous fistula
• A primary AV fistula is the preferred type of vascular access for most patients.
• It requires a surgical procedure that creates a direct connection between an artery
and a vein .During dialysis, two needles are inserted into the access. Blood flows out
of the body through one needle, circulates through the dialysis machine, and flows
back into the access through the other needle.
• A primary AV fistula is usually created two to four months before it will be used for
dialysis. During this time, the area can heal and fully develop or "mature.“
 Synthetic bridge graft
• Sometimes, a patient's arm veins are not suitable for creating a fistula. In these
cases, a surgeon can use a flexible, rubber-like tube to create a path between an
artery and vein.
• Grafts heal more quickly than fistulas.However, complications such as narrowing of
the blood vessels and infection are more common with grafts than with AV fistulas.
 Central venous catheter
• A central venous catheter uses a thin, flexible tube that is placed into a large vein
(usually in the neck). Catheters have the highest risk of infection and the poorest
function compared with other access types

8.  Dietary changes
• Some patients, especially those who receive dialysis in a center, will need to make
changes in their diet before and during hemodialysis treatment. These changes
ensure that you do not become overloaded with fluid and that you consume the right
balance of protein, calories, vitamins, and minerals.
• A diet that is low in sodium, potassium, and phosphorus may be recommended, and
the amount of fluids (in drinks and foods) may be limited. A dietitian can help you to
choose foods that are compatible with hemodialysis treatment.

9. Manufacturers of Dialysis Machines
• Baxter International Inc.
• Althin Healthcare, Inc.
• Gambro
• Fresenius Medical Care
• Wilmed Global – reconditioned machines
• NX Stage – home dialysis machines

10. Fresenius 2008T Hemodialyser
• Control panel

11. Parts and Function
• Control Panel

12. • Back panel

13. Module Compartment
• It comprises of:
1. Arterial drip chamber
2. Blood Pump
3. Heparin Pump
4. Level detector module
• The red line on module indicate arterial bloodline and blue line indicate venous
bloodline

18. Dialysate section
• This machine is a three stream
dialysate delivery machine.
• Dialysate from three different sources
are mixed and sent to dialyser.
• Three components of dialyser are:
Acid ,bicarbonate and purified water.
• Water is heated and degassed.
• Then mixed with concentrates and
filtered by DiaSafe filter.
• Sent through ports into dialyser

21. SIDE EFFECTS
• Most patients tolerate hemodialysis well. However, side effects of hemodialysis can
occur.
• Low blood pressure is the most common complication and can be accompanied by
light-headedness, shortness of breath, abdominal cramps, muscle cramps, nausea, or
vomiting.
• Treatments and preventive measures are available for the discomforts that can occur
during dialysis.
• Many of these side effects are related to excess salt and fluid accumulation between
dialysis treatments, which can be minimized by carefully monitoring how much salt
and fluid you consume.

22. How Well It Works
• Hemodialysis may improve your quality of life and increase your life
expectancy. But hemodialysis provides only about 10% of normal kidney
function. It does not reverse chronic kidney disease or kidney failure.
• Dialysis has not been shown to reverse or shorten the course of acute kidney
injury. But it may be used when fluid and electrolyte problems are causing
severe symptoms or other problems. Some people who develop acute kidney
injury stay dependent on hemodialysis and will go on to develop kidney
failure.

23. What To Think About
• Choosing between treatment with hemodialysis or peritoneal dialysis is
based on your lifestyle, other medical conditions, and body size and shape.
Talk to your doctor about which type would be best for you.
• If you have severe chronic kidney disease and you have not yet developed
kidney failure, talk with your doctor about which type of dialysis might work
best for you.
• People who have widely fluctuating blood pressure when they receive
hemodialysis (hemodynamic instability) may not be able to continue with
treatment. They may be switched to peritoneal dialysis.
• Many people first receive dialysis while waiting for a kidney transplant.
Some people may have to receive dialysis again if the kidney transplant
fails.

24. Reference
• Fresenius 2008T Technical Manual
• www.uptodate.com
• http://www.freseniusmedicalcare.asia/en/healthcare-
professionals/hemodialysis/machines/next-generation-4008s/