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Mohammed Abdel Gawad MD/PhD Neph, ESENeph
Nephrology Unit, School of Medicine, NewGiza University
Nephrology Consultant, Alexandria
Founder of NephroTube.com
Chair of AFRAN Web/Media Committee
ISN Education SoMe Team Member
Chapter 4
Dialysate Circuit
You can get this book free from www.NephroTube.com
Watch the video recording of this lecture
on NephroTube YouTube channel
www.YouTube.com/NephroTube
Visit
www.NephroTube.com
to get more Nephrology lectures
(pdf and video recordings)
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Dialysate
circuit
components
Concentrates
(concentrated
dialysate)
Dialysate
delivery
system
Talk Outline: Chapter 4
Dialysate Circuit
• Concentrates (concentrated dialysate)
• Types of dialysate delivery system
• Single-patient dialysate delivery system (SPDDS) components:
• I. Preparation of “pure” dialysate by SPDDS
• II. Preparation of “ultrapure” dialysate by SPDDS
• CO2 production during hemodialysis and Dialysate-related acidosis
• Dialysate circuit-related alarms:
• I. Conductivity monitor
• II. Temperature monitor
• III. Blood leak detector
• IV. pH sensors
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Talk Outline: Chapter 4
Dialysate Circuit
• Concentrates (concentrated dialysate)
• Types of dialysate delivery system
• Single-patient dialysate delivery system (SPDDS) components:
• I. Preparation of “pure” dialysate by SPDDS
• II. Preparation of “ultrapure” dialysate by SPDDS
• CO2 production during hemodialysis and Dialysate-related acidosis
• Dialysate circuit-related alarms:
• I. Conductivity monitor
• II. Temperature monitor
• III. Blood leak detector
• IV. pH sensors
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Why is concentrated NaHCO3 (B-concentrate) separated from A-concentrate?
To avoid the precipitation of CaCO3 and MgCO3.
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Buffers rather than bicarbonate:
• Lactate-containing dialysate: The NxStage machine, used by some home
dialysis patients.
• Acetate-containing dialysate:
• It was previously used instead of bicarbonate.
• The liver and skeletal muscles metabolize acetate to form bicarbonate.
• Headache and hypotension.
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Why is acid added to the A-concentrate?
To avoid the precipitation of CaCO3 and MgCO3 through formation of H2CO3
(pH of the final pure dialysate 7.0–7.4)
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Talk Outline: Chapter 4
Dialysate Circuit
• Concentrates (concentrated dialysate)
• Types of dialysate delivery system
• Single-patient dialysate delivery system (SPDDS) components:
• I. Preparation of “pure” dialysate by SPDDS
• II. Preparation of “ultrapure” dialysate by SPDDS
• CO2 production during hemodialysis and Dialysate-related acidosis
• Dialysate circuit-related alarms:
• I. Conductivity monitor
• II. Temperature monitor
• III. Blood leak detector
• IV. pH sensors
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Single central
location mix
treated
water with
A- and B-
concentrate
to prepare
final diluted
dialysate
Treated pure
water from
water unit
Treated pure
water from
water unit
Central dialysate delivery system
(CDDS)
A B
A B
A B
Prepared
final
diluted
dialysate
to
machines
Hemodialysis machines
mix treated water with
A- and B- concentrate
to prepare final diluted
dialysate
Single-patient dialysate delivery system
(SPDDS)
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Talk Outline: Chapter 4
Dialysate Circuit
• Concentrates (concentrated dialysate)
• Types of dialysate delivery system
• Single-patient dialysate delivery system (SPDDS) components:
• I. Preparation of “pure” dialysate by SPDDS
• II. Preparation of “ultrapure” dialysate by SPDDS
• CO2 production during hemodialysis and Dialysate-related acidosis
• Dialysate circuit-related alarms:
• I. Conductivity monitor
• II. Temperature monitor
• III. Blood leak detector
• IV. pH sensors
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Talk Outline: Chapter 4
Dialysate Circuit
• Concentrates (concentrated dialysate)
• Types of dialysate delivery system
• Single-patient dialysate delivery system (SPDDS) components:
• I. Preparation of “pure” dialysate by SPDDS
• II. Preparation of “ultrapure” dialysate by SPDDS
• CO2 production during hemodialysis and Dialysate-related acidosis
• Dialysate circuit-related alarms:
• I. Conductivity monitor
• II. Temperature monitor
• III. Blood leak detector
• IV. pH sensors
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
• Water preparation system
• Proportioning system
• Volumetric control system
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
A B
Water preparation system
Heater
Dialyzer
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
A B
Water preparation system
Heater
Dialyzer
Examples of proportionate ratios:
A-concentrate: B-concentrate: water
• 1:1.72:42.28 (45x)
• 1:1.83:34 (36.83x)
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
A B
Water preparation system
Heater
Dialyzer
Examples of proportionate ratios:
A-concentrate: B-concentrate: water
• 1:1.72:42.28 (45x)
• 1:1.83:34 (36.83x)
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
A B
Water preparation system
Heater
Dialyzer
Examples of proportionate ratios:
A-concentrate: B-concentrate: water
• 1:1.72:42.28 (45x)
• 1:1.83:34 (36.83x)
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
A B
Water preparation system
Heater
Dialyzer
Examples of proportionate ratios:
A-concentrate: B-concentrate: water
• 1:1.72:42.28 (45x)
• 1:1.83:34 (36.83x)
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
A B
Water preparation system
Heater
Dialyzer
Examples of proportionate ratios:
A-concentrate: B-concentrate: water
• 1:1.72:42.28 (45x)
• 1:1.83:34 (36.83x)
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
“Pure” dialysate
A B
Water preparation system
Heater
Dialyzer
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
“Pure” dialysate
A B
Water preparation system
Heater
Dialyzer
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
A B
+ - Conductivity
monitor
Temperature
monitor
Dialysate outflow
Drain
Blood leak
detector
Balancing chamber
(Part of volumetric control system.
See Fig. 4.3 for more details of
other parts of this system)
Bypass
valve
“Pure” dialysate
Bypass
circuit
Dialyzer
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
“Pure” dialysate
A B
Water preparation system
Heater
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
A B
+ - Conductivity
monitor
Temperature
monitor
Dialysate outflow
Drain
Blood leak
detector
Balancing chamber
(Part of volumetric control system.
See Fig. 4.3 for more details of
other parts of this system)
Bypass
valve
“Pure” dialysate
Bypass
circuit
Dialyzer
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
“Pure” dialysate
A B
Water preparation system
Heater
Central computer
unit (control UF)
Post-pump arterial pressure
Venous pressure
Dialysate inlet
pressure
Dialysate outlet
pressure Ultrafiltration
pump
Ultrafiltrate
Balancing chamber
Flexible
membrane
Drain
Water preparation
and proportionating
systems
(See Figure 4.2)
Dialysate inflow
Dialysate outflow
One-way
valve
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Talk Outline: Chapter 4
Dialysate Circuit
• Concentrates (concentrated dialysate)
• Types of dialysate delivery system
• Single-patient dialysate delivery system (SPDDS) components:
• I. Preparation of “pure” dialysate by SPDDS
• II. Preparation of “ultrapure” dialysate by SPDDS
• CO2 production during hemodialysis and Dialysate-related acidosis
• Dialysate circuit-related alarms:
• I. Conductivity monitor
• II. Temperature monitor
• III. Blood leak detector
• IV. pH sensors
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Drain
Balancing
chamber
“Ultrapure”
dialysate
Bacterial- and
endotoxin-retentive
ultrafilter
“Pure”
dialysate
Water preparation
and proportionating
systems
(See Figure 4.2)
Dialyzer
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
“Ultrapure” dialysate:
Decreased C-reactive protein and interleukin-6 plasma levels.
Improved response of anemia to erythropoietin therapy.
Better nutritional status.
Reduced plasma levels of β2-microglobulin.
Residual renal function loss is slower.
Cardiovascular morbidity is lower.
“Ultrapure” dialysate formation is now highly desirable for hemodialysis, especially when
using high permeable high-flux dialyzers
Talk Outline: Chapter 4
Dialysate Circuit
• Concentrates (concentrated dialysate)
• Types of dialysate delivery system
• Single-patient dialysate delivery system (SPDDS) components:
• I. Preparation of “pure” dialysate by SPDDS
• II. Preparation of “ultrapure” dialysate by SPDDS
• CO2 production during hemodialysis and Dialysate-related acidosis
• Dialysate circuit-related alarms:
• I. Conductivity monitor
• II. Temperature monitor
• III. Blood leak detector
• IV. pH sensors
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
A B
CO2
CO2
CO2
HCO3
−
+
H
+
→
H
2
CO
3
→
CO
2
+
H
2
O
HCO3−
(A) Patients with
no respiratory problem
CO2
HCO3− + H+ → H2CO3 → CO2 + H2O
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
A B
CO2
CO2
CO2
HCO3
−
+
H
+
→
H
2
CO
3
→
CO
2
+
H
2
O
HCO3−
(A) Patients with
no respiratory problem
(B) Patients with
respiratory problem
CO2
A B
CO2
CO2
CO2
HCO3
−
+
H
+
→
H
2
CO
3
→
CO
2
+
H
2
O
HCO3−
CO2
CO2
HCO3− + H+ → H2CO3 → CO2 + H2O
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
A B
CO2
CO2
CO2
HCO3
−
+
H
+
→
H
2
CO
3
→
CO
2
+
H
2
O
HCO3−
(A) Patients with
no respiratory problem
(B) Patients with
respiratory problem
CO2
A B
CO2
CO2
CO2
HCO3
−
+
H
+
→
H
2
CO
3
→
CO
2
+
H
2
O
HCO3−
CO2
CO2
HCO3− + H+ → H2CO3 → CO2 + H2O
It is advised in these patients to avoid
using high dialysate HCO3− and to
avoid rapid correction of acidosis to
decrease the load of CO2 production.
Talk Outline: Chapter 4
Dialysate Circuit
• Concentrates (concentrated dialysate)
• Types of dialysate delivery system
• Single-patient dialysate delivery system (SPDDS) components:
• I. Preparation of “pure” dialysate by SPDDS
• II. Preparation of “ultrapure” dialysate by SPDDS
• CO2 production during hemodialysis and Dialysate-related acidosis
• Dialysate circuit-related alarms:
• I. Conductivity monitor
• II. Temperature monitor
• III. Blood leak detector
• IV. pH sensors
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
A B
+ - Conductivity
monitor
Temperature
monitor
Dialysate outflow
Drain
Blood leak
detector
Balancing chamber
(Part of volumetric control system.
See Fig. 4.3 for more details of
other parts of this system)
Bypass
valve
“Pure” dialysate
Bypass
circuit
Dialyzer
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
“Pure” dialysate
A B
Water preparation system
Heater
Acceptable range
12 to 16 mS/cm
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
A B
+ - Conductivity
monitor
Dialysate outflow
Drain
Bypass
valve
“Pure” dialysate
Bypass
circuit
Dialyzer
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
“Pure” dialysate
A B
Water preparation system
Heater
Acceptable range
12 to 16 mS/cm
Talk Outline: Chapter 4
Dialysate Circuit
• Concentrates (concentrated dialysate)
• Types of dialysate delivery system
• Single-patient dialysate delivery system (SPDDS) components:
• I. Preparation of “pure” dialysate by SPDDS
• II. Preparation of “ultrapure” dialysate by SPDDS
• CO2 production during hemodialysis and Dialysate-related acidosis
• Dialysate circuit-related alarms:
• I. Conductivity monitor
• II. Temperature monitor
• III. Blood leak detector
• IV. pH sensors
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
A B
+ - Conductivity
monitor
Temperature
monitor
Dialysate outflow
Drain
Blood leak
detector
Balancing chamber
(Part of volumetric control system.
See Fig. 4.3 for more details of
other parts of this system)
Bypass
valve
“Pure” dialysate
Bypass
circuit
Dialyzer
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
“Pure” dialysate
A B
Water preparation system
Heater
Acceptable range
35–38°C
Talk Outline: Chapter 4
Dialysate Circuit
• Concentrates (concentrated dialysate)
• Types of dialysate delivery system
• Single-patient dialysate delivery system (SPDDS) components:
• I. Preparation of “pure” dialysate by SPDDS
• II. Preparation of “ultrapure” dialysate by SPDDS
• CO2 production during hemodialysis and Dialysate-related acidosis
• Dialysate circuit-related alarms:
• I. Conductivity monitor
• II. Temperature monitor
• III. Blood leak detector
• IV. pH sensors
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
A B
+ - Conductivity
monitor
Temperature
monitor
Dialysate outflow
Drain
Blood leak
detector
Balancing chamber
(Part of volumetric control system.
See Fig. 4.3 for more details of
other parts of this system)
Bypass
valve
“Pure” dialysate
Bypass
circuit
Dialyzer
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
“Pure” dialysate
A B
Water preparation system
Heater
Ruptured
dialyzer
fibers
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
A B
+ - Conductivity
monitor
Temperature
monitor
Dialysate outflow
Drain
Blood leak
detector
Balancing chamber
(Part of volumetric control system.
See Fig. 4.3 for more details of
other parts of this system)
Bypass
valve
“Pure” dialysate
Bypass
circuit
Dialyzer
Pure water
from water
unit
A B
Deaeration
Proportionating
system
Concentrates
“Pure” dialysate
A B
Water preparation system
Heater
Ruptured
dialyzer
fibers
False blood leak alarm:
• It occurs if there are air bubbles in the dialysate, deposits of grease or scale on
the blood detector sensor lens, or in patients who received hydroxocobalamin
infusion.
• To diagnose false alarms, Hemastix® strips can be dipped in the outflow
dialysate
Talk Outline: Chapter 4
Dialysate Circuit
• Concentrates (concentrated dialysate)
• Types of dialysate delivery system
• Single-patient dialysate delivery system (SPDDS) components:
• I. Preparation of “pure” dialysate by SPDDS
• II. Preparation of “ultrapure” dialysate by SPDDS
• CO2 production during hemodialysis and Dialysate-related acidosis
• Dialysate circuit-related alarms:
• I. Conductivity monitor
• II. Temperature monitor
• III. Blood leak detector
• IV. pH sensors
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
pH sensors
• The pH of the final diluted pure dialysate is approximately 7.0–7.4.
• The primary purpose of this pH electrode is to ensure that the correct
concentrates are connected to the machine by identifying any
abnormalities in the dialysate pH.
NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024
You can get this book free from www.NephroTube.com
Thank You

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  • 1. Mohammed Abdel Gawad MD/PhD Neph, ESENeph Nephrology Unit, School of Medicine, NewGiza University Nephrology Consultant, Alexandria Founder of NephroTube.com Chair of AFRAN Web/Media Committee ISN Education SoMe Team Member Chapter 4 Dialysate Circuit You can get this book free from www.NephroTube.com
  • 2. Watch the video recording of this lecture on NephroTube YouTube channel www.YouTube.com/NephroTube
  • 3. Visit www.NephroTube.com to get more Nephrology lectures (pdf and video recordings)
  • 4. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Dialysate circuit components Concentrates (concentrated dialysate) Dialysate delivery system
  • 5. Talk Outline: Chapter 4 Dialysate Circuit • Concentrates (concentrated dialysate) • Types of dialysate delivery system • Single-patient dialysate delivery system (SPDDS) components: • I. Preparation of “pure” dialysate by SPDDS • II. Preparation of “ultrapure” dialysate by SPDDS • CO2 production during hemodialysis and Dialysate-related acidosis • Dialysate circuit-related alarms: • I. Conductivity monitor • II. Temperature monitor • III. Blood leak detector • IV. pH sensors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 6. Talk Outline: Chapter 4 Dialysate Circuit • Concentrates (concentrated dialysate) • Types of dialysate delivery system • Single-patient dialysate delivery system (SPDDS) components: • I. Preparation of “pure” dialysate by SPDDS • II. Preparation of “ultrapure” dialysate by SPDDS • CO2 production during hemodialysis and Dialysate-related acidosis • Dialysate circuit-related alarms: • I. Conductivity monitor • II. Temperature monitor • III. Blood leak detector • IV. pH sensors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 7. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 8. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 9. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Why is concentrated NaHCO3 (B-concentrate) separated from A-concentrate? To avoid the precipitation of CaCO3 and MgCO3.
  • 10. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Buffers rather than bicarbonate: • Lactate-containing dialysate: The NxStage machine, used by some home dialysis patients. • Acetate-containing dialysate: • It was previously used instead of bicarbonate. • The liver and skeletal muscles metabolize acetate to form bicarbonate. • Headache and hypotension.
  • 11. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Why is acid added to the A-concentrate? To avoid the precipitation of CaCO3 and MgCO3 through formation of H2CO3 (pH of the final pure dialysate 7.0–7.4)
  • 12. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 13. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 14. Talk Outline: Chapter 4 Dialysate Circuit • Concentrates (concentrated dialysate) • Types of dialysate delivery system • Single-patient dialysate delivery system (SPDDS) components: • I. Preparation of “pure” dialysate by SPDDS • II. Preparation of “ultrapure” dialysate by SPDDS • CO2 production during hemodialysis and Dialysate-related acidosis • Dialysate circuit-related alarms: • I. Conductivity monitor • II. Temperature monitor • III. Blood leak detector • IV. pH sensors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 15. Single central location mix treated water with A- and B- concentrate to prepare final diluted dialysate Treated pure water from water unit Treated pure water from water unit Central dialysate delivery system (CDDS) A B A B A B Prepared final diluted dialysate to machines Hemodialysis machines mix treated water with A- and B- concentrate to prepare final diluted dialysate Single-patient dialysate delivery system (SPDDS) NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 16. Talk Outline: Chapter 4 Dialysate Circuit • Concentrates (concentrated dialysate) • Types of dialysate delivery system • Single-patient dialysate delivery system (SPDDS) components: • I. Preparation of “pure” dialysate by SPDDS • II. Preparation of “ultrapure” dialysate by SPDDS • CO2 production during hemodialysis and Dialysate-related acidosis • Dialysate circuit-related alarms: • I. Conductivity monitor • II. Temperature monitor • III. Blood leak detector • IV. pH sensors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 17. Talk Outline: Chapter 4 Dialysate Circuit • Concentrates (concentrated dialysate) • Types of dialysate delivery system • Single-patient dialysate delivery system (SPDDS) components: • I. Preparation of “pure” dialysate by SPDDS • II. Preparation of “ultrapure” dialysate by SPDDS • CO2 production during hemodialysis and Dialysate-related acidosis • Dialysate circuit-related alarms: • I. Conductivity monitor • II. Temperature monitor • III. Blood leak detector • IV. pH sensors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com • Water preparation system • Proportioning system • Volumetric control system
  • 18. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Pure water from water unit A B Deaeration Proportionating system Concentrates A B Water preparation system Heater Dialyzer
  • 19. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Pure water from water unit A B Deaeration Proportionating system Concentrates A B Water preparation system Heater Dialyzer Examples of proportionate ratios: A-concentrate: B-concentrate: water • 1:1.72:42.28 (45x) • 1:1.83:34 (36.83x)
  • 20. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Pure water from water unit A B Deaeration Proportionating system Concentrates A B Water preparation system Heater Dialyzer Examples of proportionate ratios: A-concentrate: B-concentrate: water • 1:1.72:42.28 (45x) • 1:1.83:34 (36.83x)
  • 21. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Pure water from water unit A B Deaeration Proportionating system Concentrates A B Water preparation system Heater Dialyzer Examples of proportionate ratios: A-concentrate: B-concentrate: water • 1:1.72:42.28 (45x) • 1:1.83:34 (36.83x)
  • 22. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Pure water from water unit A B Deaeration Proportionating system Concentrates A B Water preparation system Heater Dialyzer Examples of proportionate ratios: A-concentrate: B-concentrate: water • 1:1.72:42.28 (45x) • 1:1.83:34 (36.83x)
  • 23. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Pure water from water unit A B Deaeration Proportionating system Concentrates A B Water preparation system Heater Dialyzer Examples of proportionate ratios: A-concentrate: B-concentrate: water • 1:1.72:42.28 (45x) • 1:1.83:34 (36.83x)
  • 24. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Pure water from water unit A B Deaeration Proportionating system Concentrates “Pure” dialysate A B Water preparation system Heater Dialyzer
  • 25. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Pure water from water unit A B Deaeration Proportionating system Concentrates “Pure” dialysate A B Water preparation system Heater Dialyzer
  • 26. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com A B + - Conductivity monitor Temperature monitor Dialysate outflow Drain Blood leak detector Balancing chamber (Part of volumetric control system. See Fig. 4.3 for more details of other parts of this system) Bypass valve “Pure” dialysate Bypass circuit Dialyzer Pure water from water unit A B Deaeration Proportionating system Concentrates “Pure” dialysate A B Water preparation system Heater
  • 27. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com A B + - Conductivity monitor Temperature monitor Dialysate outflow Drain Blood leak detector Balancing chamber (Part of volumetric control system. See Fig. 4.3 for more details of other parts of this system) Bypass valve “Pure” dialysate Bypass circuit Dialyzer Pure water from water unit A B Deaeration Proportionating system Concentrates “Pure” dialysate A B Water preparation system Heater
  • 28. Central computer unit (control UF) Post-pump arterial pressure Venous pressure Dialysate inlet pressure Dialysate outlet pressure Ultrafiltration pump Ultrafiltrate Balancing chamber Flexible membrane Drain Water preparation and proportionating systems (See Figure 4.2) Dialysate inflow Dialysate outflow One-way valve NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 29. Talk Outline: Chapter 4 Dialysate Circuit • Concentrates (concentrated dialysate) • Types of dialysate delivery system • Single-patient dialysate delivery system (SPDDS) components: • I. Preparation of “pure” dialysate by SPDDS • II. Preparation of “ultrapure” dialysate by SPDDS • CO2 production during hemodialysis and Dialysate-related acidosis • Dialysate circuit-related alarms: • I. Conductivity monitor • II. Temperature monitor • III. Blood leak detector • IV. pH sensors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 30. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com Drain Balancing chamber “Ultrapure” dialysate Bacterial- and endotoxin-retentive ultrafilter “Pure” dialysate Water preparation and proportionating systems (See Figure 4.2) Dialyzer
  • 31. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com “Ultrapure” dialysate: Decreased C-reactive protein and interleukin-6 plasma levels. Improved response of anemia to erythropoietin therapy. Better nutritional status. Reduced plasma levels of β2-microglobulin. Residual renal function loss is slower. Cardiovascular morbidity is lower. “Ultrapure” dialysate formation is now highly desirable for hemodialysis, especially when using high permeable high-flux dialyzers
  • 32. Talk Outline: Chapter 4 Dialysate Circuit • Concentrates (concentrated dialysate) • Types of dialysate delivery system • Single-patient dialysate delivery system (SPDDS) components: • I. Preparation of “pure” dialysate by SPDDS • II. Preparation of “ultrapure” dialysate by SPDDS • CO2 production during hemodialysis and Dialysate-related acidosis • Dialysate circuit-related alarms: • I. Conductivity monitor • II. Temperature monitor • III. Blood leak detector • IV. pH sensors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 33. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com A B CO2 CO2 CO2 HCO3 − + H + → H 2 CO 3 → CO 2 + H 2 O HCO3− (A) Patients with no respiratory problem CO2 HCO3− + H+ → H2CO3 → CO2 + H2O
  • 34. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com A B CO2 CO2 CO2 HCO3 − + H + → H 2 CO 3 → CO 2 + H 2 O HCO3− (A) Patients with no respiratory problem (B) Patients with respiratory problem CO2 A B CO2 CO2 CO2 HCO3 − + H + → H 2 CO 3 → CO 2 + H 2 O HCO3− CO2 CO2 HCO3− + H+ → H2CO3 → CO2 + H2O
  • 35. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com A B CO2 CO2 CO2 HCO3 − + H + → H 2 CO 3 → CO 2 + H 2 O HCO3− (A) Patients with no respiratory problem (B) Patients with respiratory problem CO2 A B CO2 CO2 CO2 HCO3 − + H + → H 2 CO 3 → CO 2 + H 2 O HCO3− CO2 CO2 HCO3− + H+ → H2CO3 → CO2 + H2O It is advised in these patients to avoid using high dialysate HCO3− and to avoid rapid correction of acidosis to decrease the load of CO2 production.
  • 36. Talk Outline: Chapter 4 Dialysate Circuit • Concentrates (concentrated dialysate) • Types of dialysate delivery system • Single-patient dialysate delivery system (SPDDS) components: • I. Preparation of “pure” dialysate by SPDDS • II. Preparation of “ultrapure” dialysate by SPDDS • CO2 production during hemodialysis and Dialysate-related acidosis • Dialysate circuit-related alarms: • I. Conductivity monitor • II. Temperature monitor • III. Blood leak detector • IV. pH sensors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 37. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com A B + - Conductivity monitor Temperature monitor Dialysate outflow Drain Blood leak detector Balancing chamber (Part of volumetric control system. See Fig. 4.3 for more details of other parts of this system) Bypass valve “Pure” dialysate Bypass circuit Dialyzer Pure water from water unit A B Deaeration Proportionating system Concentrates “Pure” dialysate A B Water preparation system Heater Acceptable range 12 to 16 mS/cm
  • 38. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com A B + - Conductivity monitor Dialysate outflow Drain Bypass valve “Pure” dialysate Bypass circuit Dialyzer Pure water from water unit A B Deaeration Proportionating system Concentrates “Pure” dialysate A B Water preparation system Heater Acceptable range 12 to 16 mS/cm
  • 39. Talk Outline: Chapter 4 Dialysate Circuit • Concentrates (concentrated dialysate) • Types of dialysate delivery system • Single-patient dialysate delivery system (SPDDS) components: • I. Preparation of “pure” dialysate by SPDDS • II. Preparation of “ultrapure” dialysate by SPDDS • CO2 production during hemodialysis and Dialysate-related acidosis • Dialysate circuit-related alarms: • I. Conductivity monitor • II. Temperature monitor • III. Blood leak detector • IV. pH sensors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 40. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com A B + - Conductivity monitor Temperature monitor Dialysate outflow Drain Blood leak detector Balancing chamber (Part of volumetric control system. See Fig. 4.3 for more details of other parts of this system) Bypass valve “Pure” dialysate Bypass circuit Dialyzer Pure water from water unit A B Deaeration Proportionating system Concentrates “Pure” dialysate A B Water preparation system Heater Acceptable range 35–38°C
  • 41. Talk Outline: Chapter 4 Dialysate Circuit • Concentrates (concentrated dialysate) • Types of dialysate delivery system • Single-patient dialysate delivery system (SPDDS) components: • I. Preparation of “pure” dialysate by SPDDS • II. Preparation of “ultrapure” dialysate by SPDDS • CO2 production during hemodialysis and Dialysate-related acidosis • Dialysate circuit-related alarms: • I. Conductivity monitor • II. Temperature monitor • III. Blood leak detector • IV. pH sensors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 42. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com A B + - Conductivity monitor Temperature monitor Dialysate outflow Drain Blood leak detector Balancing chamber (Part of volumetric control system. See Fig. 4.3 for more details of other parts of this system) Bypass valve “Pure” dialysate Bypass circuit Dialyzer Pure water from water unit A B Deaeration Proportionating system Concentrates “Pure” dialysate A B Water preparation system Heater Ruptured dialyzer fibers
  • 43. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com A B + - Conductivity monitor Temperature monitor Dialysate outflow Drain Blood leak detector Balancing chamber (Part of volumetric control system. See Fig. 4.3 for more details of other parts of this system) Bypass valve “Pure” dialysate Bypass circuit Dialyzer Pure water from water unit A B Deaeration Proportionating system Concentrates “Pure” dialysate A B Water preparation system Heater Ruptured dialyzer fibers False blood leak alarm: • It occurs if there are air bubbles in the dialysate, deposits of grease or scale on the blood detector sensor lens, or in patients who received hydroxocobalamin infusion. • To diagnose false alarms, Hemastix® strips can be dipped in the outflow dialysate
  • 44. Talk Outline: Chapter 4 Dialysate Circuit • Concentrates (concentrated dialysate) • Types of dialysate delivery system • Single-patient dialysate delivery system (SPDDS) components: • I. Preparation of “pure” dialysate by SPDDS • II. Preparation of “ultrapure” dialysate by SPDDS • CO2 production during hemodialysis and Dialysate-related acidosis • Dialysate circuit-related alarms: • I. Conductivity monitor • II. Temperature monitor • III. Blood leak detector • IV. pH sensors NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com
  • 45. pH sensors • The pH of the final diluted pure dialysate is approximately 7.0–7.4. • The primary purpose of this pH electrode is to ensure that the correct concentrates are connected to the machine by identifying any abnormalities in the dialysate pH. NephroTube Synopsis of Conventional Hemodialysis, First Edition, 2024 You can get this book free from www.NephroTube.com