Administration of Dialysis

The force for ultrafiltration is the hydraulic impel difference across the tissue layer. If a solute is added to a container of wet, it will serve up itself at a uniform concentration throughout the piss (diffusion). Diffusion complicates the random movement of solute molecules driven by the thermic energy of solute and water molecules. Local differences in concentration melt down as the solution reaches diffusion residual. Required time for meld depends on solute molecular size, temperature, and length of diffusion path or container size. The dialyzer can be viewed as a three-bagger laminated solution with flowing note and dialysate with stationary membrane water interposed between the two streams. In the perfect dialyzer, diffusion equilibrium would result in the blood and dialysate streams during passage through the cheat; single pass blood and dialysate flows at equal velocity, carbamide concentration equilibrium, would be reached between the blood inlet and dialysate volcano streams and all urea contained in the inflowing bloodstream would be transferred to the outflowing dialysate stream. This faculty level in not reached; efficiency is about 50 pct (5).

The artificial kidney is to provide the manageable transfer of solutes and water across a semipermeable membrane separating the flow

3. Cheung, A. K. Stages of future technological developments in haemodialysis. Nephrol. Dial Transplant 11(suppl 8):52-58; 1996.

Benefits of chronic peritoneal dialysis include " keen cardiovascular stability with continuous fluid removal, excellent blood pressure control, avoidance of cardiac arrhythmias, lack of post-haemodialysis fatigue (probably caused by rapid solute removal and resultant disequilibrium), higher hematocrit with unhorse requirement for recombinant erythropoietin, precise blood sugar control in diabetic patients with the use of intra-peritoneal insulin, improved nutrition with the contribution of calories from intraperitoneal glucose, deepen removal of beta-2 microglobulin, enhanced immune function, and maintenance of residual nephritic function" (11:369). There are also psychosocial benefits which include remediate socialization and psychological maturation in children, increased self-assertion and feelings of independence, greater mobility, and an increased quality of life (11). Complex medical regimens associated with hemodialysis impose restrictions on patients' lives which threaten a sentience of autonomy and self-control (10).

Care issues within the process include facility staffing patterns, numbers of staff physicians, facility size, treatment time, dialyzer reuse, and dialysis dose. Drop-out rates from chronic peritoneal dialysis to hemodialysis is substantial (7 percent to 14 percent per year). Peritonitis and exit site contagion are decreasing, and inadequate dialysis is gaining as a reason for proficiency failure. Technique survival is similar for hemodialysis and peritoneal dialysis (11).

10. Meers, C.; Singer, M. A.; Toffelmire, E. B.; Hopman, W.; McMurray, M.; Morton, A. R.; MacKenzie, T. A. Self-delivery of hemodialysis care: A therapy in itself. Am. J. Kid. Dis. 27(6):844-847; 1996.

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