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UNIT III ARTIFICIAL KIDNEY

1. INDICATIONS AND PRINCIPLES OF HAEMODIALYSIS
 Haemodialysis is a medical procedure used to filter and remove waste products and
excess fluids from the blood when the kidneys are unable to perform this function
adequately.

Fig.1. Haemodialysis Setup

Indications for Haemodialysis:
 End-Stage Renal Disease (ESRD): Patients with irreversible kidney damage and a
glomerular filtration rate (GFR) less than 15 ml/min are considered to have ESRD and
typically require haemodialysis.
 Acute Kidney Injury (AKI): Haemodialysis may be used in cases of severe and
sudden kidney damage where the kidneys are unable to filter waste and excess fluids.
 Chronic Kidney Disease (CKD): Advanced stages of CKD, where conservative
management is insufficient in controlling uremic symptoms, may necessitate
haemodialysis.
 Uremic Symptoms: Indications may include symptoms such as nausea, vomiting,
pruritus, and uncontrolled fluid overload.

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 Electrolyte Imbalance: Haemodialysis is indicated for the correction of severe

electrolyte imbalances, including hyperkalaemia.
 Toxic Ingestions: Certain toxins or drug overdoses may require haemodialysis for
rapid removal.
Principles of Haemodialysis:
1. Blood Access:
Arteriovenous (AV) Fistula:
 Preferred access for haemodialysis due to lower infection risk and longer
durability.
 Surgically created connection between an artery and a vein.
Arteriovenous (AV) Graft:
 An alternative when an AV fistula is not possible.
 Synthetic tube implanted between an artery and a vein.

Fig.2. AV Fistula Vs AV Graft

Central Venous Catheter:
 Temporary access often used in emergencies or when fistulas/grafts are not
available.
 Associated with a higher risk of infection.

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Fig.3. Central Venous Catheter

2. Haemodialysis Machine:

Fig.4. Dialyzer Machine

Dialyzer (Artificial Kidney):
 Filters blood and removes waste products.

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 Composed of hollow fibers through which blood flows and a surrounding

solution (dialysate) that helps in the exchange of solutes.
Blood Pump:
 Circulates blood through the dialyzer at the prescribed rate.
Dialysate Delivery System:
 Provides the dialysate solution with the right concentration of electrolytes and
removes waste products.
3. Haemodialysis Process:

Fig.5. Haemodialysis Process

Vascular Access Connection:
 The patient's blood is transported from the access point to the dialyzer.
Dialysis Machine Setup:
 Blood tubing is connected to the machine, and the dialysate solution is
prepared.
Filtration and Exchange:
 Blood passes through the dialyzer, where waste products and excess fluids are
removed.
Ultrafiltration:
 The removal of excess fluid from the blood.
Return to the Patient:

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 Cleaned blood is returned to the patient through the access point.

4. Monitoring and Adjustments:
Blood Pressure Monitoring:
 Regular monitoring is essential, as haemodialysis can affect blood pressure.
Electrolyte and Fluid Status Monitoring:
 Regular testing and adjustments of dialysate composition to maintain
electrolyte balance.
Heparin Administration:
 Anticoagulant to prevent clotting within the dialyzer.
Treatment Duration:
 Session duration and frequency are individualized based on patient needs.

2. MEMBRANE
A membrane is a selectively permeable barrier that separates two phases and allows
the selective passage of substances while restricting the passage of others. In
biological systems, membranes play a crucial role in maintaining cell integrity and
regulating the transport of ions and molecules.

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Fig.6.Coronavirus (SARS-CoV-2) Viral Proteins

a. Types of Membranes:
Biological Membranes:
 Cell Membrane (Plasma Membrane): Surrounds the cell, regulating the
passage of substances in and out.
 Organelle Membranes: Found in various organelles like mitochondria and
endoplasmic reticulum, providing compartmentalization.
Synthetic Membranes:
 Polymeric Membranes: Composed of polymers like cellulose acetate or
polysulfone, widely used in filtration processes.
 Composite Membranes: Combining different materials for enhanced
selectivity and durability.

Fig.7. Dialysis membranes

b. Membrane Structure:
Phospholipid Bilayer:
 Basic structural unit with hydrophilic heads facing outward and
hydrophobic tails facing inward.

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 Fluid mosaic model: Proteins embedded in the lipid bilayer confer

functionality.
Protein Channels:
 Integral membrane proteins form channels for selective transport of ions
and molecules.
 Function as carriers, receptors, and enzymes.
Membrane Fluidity:
 Influenced by lipid composition and temperature.
 Fluidity crucial for membrane flexibility and function.
Membrane Transport:
 Passive Transport (Diffusion, Osmosis): Movement along the
concentration gradient.
 Active Transport: Requires energy for movement against the gradient.
3. DIALYSATE
 Dialysate is a solution used in dialysis to remove waste products and excess fluid
from the blood. It serves as the medium for diffusion and ultrafiltration in the dialysis
process.

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(a)

(b)
Fig.8. (a) and (b) Dialysate - an overview
a. Components of Dialysate:
Electrolytes:

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 Mimics the electrolyte composition of normal plasma.

 Includes sodium, potassium, calcium, magnesium, and bicarbonate.
Buffering Agents:
 Bicarbonate or acetate buffers maintain pH within a physiological range.
Osmotic Agents:
 Glucose or mannitol may be added to the dialysate to create an osmotic
gradient.
Ultrafiltration Control:
 Determines the rate at which fluid is removed during dialysis.
 Regulated by adjusting the osmotic pressure.
b. Dialysis Process:
Haemodialysis:
 Blood flows through a dialyzer, and dialysate flows in the opposite
direction, separated by a semipermeable membrane.
 Waste products and excess fluid diffuse from blood to dialysate.
Peritoneal Dialysis:
 Dialysate is introduced into the peritoneal cavity, and waste products
diffuse across the peritoneal membrane.
 No external machine is required, making it suitable for some patients.
c. Considerations in Dialysate Composition:
Patient-Specific Requirements:
 Tailored to individual needs based on lab results and clinical condition.
Quality Control:
 Rigorous testing to ensure the sterility and purity of the dialysate.
Biocompatibility:
 Formulation aims to minimize adverse reactions and inflammation.
4. TYPES OF FILTER AND MEMBRANES
a. Purpose of Filters and Membranes
 The primary goal of haemodialysis filters and membranes is to selectively
allow the passage of certain substances while preventing the passage of
others.
 This selective permeability is vital for maintaining the balance of
electrolytes and fluids in the patient's body.

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 The filters and membranes used in haemodialysis must effectively remove

waste products, toxins, and excess fluids from the blood while retaining
essential components like red blood cells and proteins.
b. Types of Filters
i) Synthetic Filters:
 Material: These filters are made from synthetic materials such as
polysulfone, polyether sulfone, and polypropylene.
 Advantages: Synthetic filters offer high biocompatibility, reducing the risk
of adverse reactions in patients. They also provide excellent filtration
efficiency.
 Applications: Widely used in modern haemodialysis machines.
ii) Cellulose-Based Filters:
 Material: Filters made from cellulose derivatives, such as cellulose acetate.
 Advantages: Cellulose-based filters have been historically used and are
known for their good clearance of certain substances.
 Considerations: Some patients may exhibit allergic reactions to cellulose,
limiting its use in certain populations.
iii) High-Flux Filters:
 Characteristics: These filters have larger pores, allowing for higher
clearance rates of middle molecular weight substances.
 Applications: High-flux filters are particularly effective in removing larger
uremic toxins.
 Considerations: Care must be taken to avoid excessive removal of essential
proteins.
c. Types of Membranes
i) Cellulose Triacetate Membranes:
 Material: Derived from cellulose and treated with acetic acid.
 Advantages: Offers good biocompatibility and clearance of urea.
 Considerations: Prone to protein adsorption, which may impact filter
performance over time.

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Fig.9. Membrane Preparation for dialysis

ii) Polysulfone Membranes:
 Material: Synthetic membrane composed of polysulfone polymer.
 Advantages: High biocompatibility, resistance to protein adsorption, and
excellent clearance rates.
 Applications: Widely used in high-performance haemodialysis membranes.
iii) Polyethylene Membranes:
 Material: Membranes made from polyethylene polymers.
 Advantages: Known for their durability and resistance to biofouling.
 Applications: Suitable for long-term use in chronic haemodialysis.
iv) Hemophane Membranes:
 Characteristics: These membranes combine synthetic materials with cellulose.
 Advantages: Balance of biocompatibility and filtration efficiency.
 Applications: Used in haemodialysis to achieve optimal clearance rates.
d. Considerations for Membrane Selection
 Biocompatibility: The membrane should be biocompatible to minimize the risk of
inflammatory reactions and allergies.
 Permeability: The membrane should have selective permeability to ensure efficient
removal of waste products while retaining essential blood components.

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 Durability: Long-term durability is essential for membranes used in chronic

haemodialysis treatments.
 Anticoagulation: Some membranes may require specific anticoagulation strategies to
prevent clotting during the filtration process.
 Protein Adsorption: Minimizing protein adsorption is crucial for maintaining
membrane performance over time.
 Patient Factors: Individual patient characteristics, such as allergies or sensitivities,
may influence the choice of membrane material.

5. DIFFERENT TYPES OF HEMODIALYZERS

 Haemodialysis is a medical procedure used to remove waste products and
excess fluid from the blood when the kidneys are unable to perform these
functions adequately.
 Hemodialyzers, also known as dialyzers or artificial kidneys, are a crucial
component of the haemodialysis process.
 There are various types of hemodialyzers available, each with its own
characteristics and advantages.
a) Purpose of Haemodialysis:
 Remove waste products (urea, creatinine) from the blood.
 Remove excess fluids.
 Correct electrolyte imbalances.
b) Components of Haemodialysis:
 Dialyzer (Hemodialyzer): The artificial kidney that performs the actual
filtration of the blood.
 Dialysis Machine: The device that controls and monitors the dialysis process.
 Vascular Access: The entry point to the bloodstream (arteriovenous fistula,
graft, or central venous catheter).
 Dialysis Solution: A solution with a composition like plasma but without
waste products.
c) Types of Hemodialyzers:
1. High-Flux Hemodialyzers:
Characteristics:
 High permeability.

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 Allows larger molecules, including middle molecular weight toxins, to be

cleared.
 Enhanced removal of protein-bound substances.

Fig.10. Hemodialyzers Structure

Advantages:
 Better clearance of larger molecules.
 Improved removal of uremic toxins.
2. Low-Flux Hemodialyzers:
Characteristics:
 Lower permeability.
 Limited clearance of larger molecules.
Advantages:
 Suitable for patients who do not tolerate high-flux membranes.
 Cost-effective.
3. High-Efficiency Hemodialyzers:

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Fig. 11. Urea Clearance characteristics of High Efficiency Vs Low Efficiency

Characteristics:
 Efficient removal of small and middle molecular weight solutes.
 Balanced removal of water and solutes.
Advantages:
 Improved clearance without excessive removal of albumin.
4. High-Volume Hemodialyzers:
Characteristics:
 Larger surface area for increased blood flow.
 Enhanced clearance rates.
Advantages:
 Suitable for larger patients or those requiring higher blood flow rates.
5. Biosynthetic Hemodialyzers:
Characteristics:
 Made from synthetic materials (polysulfone, polyamide).
 Biocompatible.
Advantages:
 Reduced risk of allergic reactions.
 Improved long-term performance.
6. Membrane Composition:
Cellulose-Based Membranes:

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Examples: Cuprophan, cellulose acetate.

Historically used, but limited by biocompatibility issues.
Synthetic Membranes:
Examples: Polysulfone, polyamide.
Improved biocompatibility and performance.
6. MONITORING SYSTEMS
 Haemodialysis is a medical procedure that helps remove waste products and
excess fluids from the blood when the kidneys are unable to perform these
functions.
 Monitoring systems play a crucial role in ensuring the safety and effectiveness
of haemodialysis treatments
a) Blood Pressure Monitoring:
 Regular monitoring of blood pressure is essential during hemodialysis.
 Blood pressure fluctuations can occur during the procedure, and
monitoring helps in preventing complications such as hypotension or
hypertension.
 Automatic blood pressure cuffs are often used to measure blood pressure
at regular intervals throughout the session.
b) Temperature Monitoring:
 Monitoring the patient's body temperature is important to ensure that the
haemodialysis machine is effectively maintaining the desired temperature
for the dialysate.
 Abnormalities in body temperature can indicate issues with the dialysis
equipment or potential complications during the procedure.
c) Blood Flow Rate Monitoring:
 Blood flow rate through the dialyzer needs to be closely monitored.
 This ensures that an adequate amount of blood is exposed to the dialysis
membrane for effective waste removal.
 Deviations from the prescribed blood flow rate may indicate clotting,
kinking of tubing, or other issues that require prompt attention.
d) Dialysate Flow Rate Monitoring:
 Dialysate flow rate is crucial for maintaining proper concentration
gradients across the dialysis membrane.

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 Monitoring the dialysate flow rate helps in ensuring that the dialysate
composition is appropriate for efficient waste removal.
e) Ultrafiltration Monitoring:
 Ultrafiltration refers to the removal of excess fluid from the blood during
haemodialysis.
 Monitoring this process helps prevent complications such as fluid overload
or dehydration.
 The monitoring system should alert healthcare providers if there are
deviations from the prescribed ultrafiltration rate.
f) Conductivity Monitoring:
 Conductivity measures the concentration of solutes in the dialysate.
Monitoring conductivity ensures that the dialysate composition is
appropriate for maintaining electrolyte balance.
 Deviations in conductivity levels may indicate issues with the preparation
or delivery of the dialysate.
g) Alarms and Alerts:
 The monitoring system should be equipped with alarms and alerts to notify
healthcare providers of any deviations from the prescribed parameters.
 Alarms can include low or high blood pressure, temperature abnormalities,
or issues with blood or dialysate flow rates.
h) Patient Safety Monitoring:
 Monitoring systems also play a role in ensuring patient safety by tracking
vital signs and responding to any signs of distress.
 Continuous monitoring allows healthcare providers to intervene promptly
in case of emergencies.
i) Data Logging and Documentation:

 The monitoring system should have the capability to log and store data
from each haemodialysis session.
 This data can be useful for retrospective analysis, identifying trends, and
adjusting the dialysis prescription.
j) Regular Maintenance and Calibration:

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 The monitoring system and associated equipment should undergo regular

maintenance and calibration to ensure accuracy and reliability.
 Routine checks and preventive maintenance help in preventing equipment
malfunctions during haemodialysis sessions.
7. WEARABLE ARTIFICIAL KIDNEY

Fig.12. Wearable Artificial Kidney

 The Wearable Artificial Kidney (WAK) is a portable device designed to provide

continuous, ambulatory dialysis for individuals with kidney failure.
 It aims to improve the quality of life for patients by offering increased mobility and
flexibility compared to traditional dialysis methods.
a) Components and Design:
Filtration System:
 The WAK typically includes a miniaturized filtration system that mimics
the functions of the kidneys.

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 It utilizes advanced membrane technology to filter waste products and

excess fluids from the blood.
Pump Mechanism:
 A compact pump is integrated into the WAK to circulate blood through the
filtration system.
 The pump is designed to be wearable, allowing patients to move freely
while undergoing dialysis.
Power Source:
 Depending on the design, the WAK may be powered by rechargeable
batteries or other energy sources.
 Considerations for power efficiency are crucial for ensuring extended use
without frequent recharging.
Biocompatible Materials:
 The materials used in the WAK need to be biocompatible to prevent
adverse reactions when in contact with the patient's blood.
b) Advantages of WAK:
Mobility:
 Enables patients to engage in regular activities and maintain a more
normal lifestyle compared to in-center dialysis.
Continuous Treatment:
 Provides continuous and gradual dialysis, potentially offering better
outcomes compared to intermittent dialysis.
Reduced Treatment Burden:
 Decreases the burden of multiple, lengthy dialysis sessions per week,
improving adherence to treatment plans.
Improved Quality of Life:
 The convenience and flexibility of the WAK contribute to an improved
quality of life for individuals with kidney failure.
c) Challenges and Considerations:
Miniaturization and Portability:
 Engineering challenges associated with miniaturizing the components for
wearable use.
Safety and Biocompatibility:

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 Ensuring that the materials used in the device are safe for prolonged
contact with the patient's blood.
Regulatory Approval:
 The WAK must go through rigorous testing and regulatory approval
processes before it can be widely used.
Patient Education:
 Adequate patient education is essential for successful adoption, as users
need to understand how to operate and maintain the device.
8. IMPLANTING TYPE
The concept of an implantable artificial kidney is to provide a more permanent and
continuous solution for individuals with end-stage renal disease.

Fig.13. Implanting Type – Artificial Kidney

Key Considerations for Implantable Artificial Kidney:
a) Continuous Filtration:
 The goal is to develop a device that can continuously and autonomously filter
blood to mimic the natural functioning of the kidneys.
b) Biocompatible Materials:
 The materials used in the implant must be biocompatible to ensure that they do
not cause adverse reactions within the body.
c) Miniaturization:

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 Components must be miniaturized to fit within the body comfortably. This

involves advancements in microengineering and nanotechnology.
d) Power Source:
 Implantable devices require a reliable and safe power source. This could involve
innovative battery technologies or other energy sources.
e) Remote Monitoring:
 Incorporating technologies for remote monitoring allows healthcare professionals
to track the patient's kidney function and overall health.
f) Surgical Procedure:
 The implantation procedure should be minimally invasive, and the device should
integrate seamlessly with the patient's physiological systems.
g) Long-Term Safety:
 Ensuring the long-term safety and reliability of the implant is crucial for its
success.
h) Immunosuppression Considerations:
 Depending on the design, an implantable device might need to address issues
related to the body's immune response to the foreign object.

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