Dialysis Techniques by Neelam verma

31/03/2025

Continuous Renal Replacement Therapy (CRRT) with hemoperfusion is a specialized blood purification technique used in critically ill patients, especially those with sepsis, multi-organ failure, or severe drug/toxin overdoses. It combines CRRT, which provides slow and continuous removal of solutes and fluids, with hemoperfusion, which helps remove inflammatory mediators, toxins, or endotoxins using adsorption filters.

Key Components of CRRT with Hemoperfusion:
1. CRRT (Continuous Renal Replacement Therapy)
• Modes: CVVH (convection), CVVHD (diffusion), CVVHDF (both convection & diffusion)
• Removes fluids and small-to-medium molecules (e.g., urea, creatinine, electrolytes)
2. Hemoperfusion
• Uses an adsorptive cartridge (e.g., polymyxin B, CytoSorb) to remove specific toxins or inflammatory mediators
• Targets cytokines (IL-6, IL-1, TNF-α) in septic patients
• Effective for drug overdoses (e.g., barbiturates, theophylline, paraquat poisoning)

Indications
• Sepsis with cytokine storm
• Acute poisoning (certain drugs or toxins)
• Severe inflammatory response syndrome (SIRS)
• Liver failure with hepatic encephalopathy
• Multi-organ dysfunction syndrome (MODS)

Benefits
• Enhances clearance of inflammatory mediators
• Improves hemodynamic stability in septic patients
• Potentially reduces vasopressor dependency

Would you like specific details on setup, filter types, or clinical protocols?

04/11/2024

Key Aspects of Sodium Profiling in the 4008S:

1. Purpose of Sodium Profiling:
• Helps prevent intradialytic hypotension (low blood pressure during dialysis) by modifying the sodium level in the dialysate, which can assist with osmotic stability.
• Reduces cramps, dizziness, and nausea by managing fluid shifts more smoothly.
2. Adjustable Sodium Levels:
• Allows the clinician to set a sodium profile, typically starting with a higher concentration and gradually lowering it throughout the session.
• For example, the sodium level may start around 145-155 mEq/L and gradually decrease to a standard level, often around 135-140 mEq/L.
3. Profile Options:
• Linear Profile: Sodium concentration decreases in a steady, linear manner throughout the session.
• Stepwise Profile: Sodium levels are adjusted in specific steps, allowing for more flexibility in tailoring the concentration at different points in the session.
• Individualized Profiles: Custom profiles can be set based on patient needs, such as high initial sodium for patients with frequent hypotension issues, followed by a gradual decrease.
4. Benefits of Sodium Profiling:
• Improved Patient Tolerance: Sodium profiling can make fluid removal more tolerable, especially in patients prone to hypotension.
• Enhanced Fluid Balance: Helps in maintaining osmotic balance, which reduces the risk of rapid fluid shifts that can lead to discomfort.
• Reduced Recovery Time: Patients may experience less post-dialysis fatigue or “dialysis hangover” due to improved fluid and electrolyte balance.
5. Monitoring and Safety:
• Sodium profiling must be used carefully, as excessive sodium levels can lead to sodium loading, which may increase thirst and result in higher interdialytic weight gain.
• Clinicians monitor patient response to sodium profiling closely to adjust for optimal

04/11/2024

Ultraflux EMiC 2 for the removal of middle molecules
In addition to the conventional goals of CKRT, such as the control of the fluid status and the correction of electrolyte abnormalities, an enhanced reduction of IL-6, IL-8, and myoglobin has been demonstrated using EMiC 211 in comparison to Ultraflux AV 1000

The high‑permeability hemofilter Ultraflux EMiC 2 is used in Ci‑Ca CVVHD treatments.

It can improve the removal of middle molecules exceeding the molecular weight of commonly known small-sized uremic toxins such as urea and creatinine, while retaining albumin.1‑5
Ultraflux EMiC 2 at a glance:
Clearance of middle molecules such as myoglobin or interleukin-62 Clearance has been demonstrated throughout citrate-anticoagulated CKRT for up to 72 hours

22/12/2023

Support your patients’ mental health

Depression is the most common psychiatric illness in people who are on dialysis and can affect health, as well as overall well-being.
End-stage renal disease (ESRD) has a significant impact upon the lives of sufferers.
The experience of multiple losses, including kidney function, family role, work role, sexual function, time and mobility, impact significantly on the lives of patients .
Further stressors, including medication effects , dietary constraints, fear of death and dependency upon treatment may affect quality of life and exacerbate feelings of a loss of control.
The consequences of missing depression among dialysis patients may be considerable. Comorbid depressive illnesses amplify the impact of chronic illnesses, and increase functional disability and the use of health care services
Going to dialysis three times a week and constantly having to visit different doctors often brings on a flood of anxiety and feelings of depression. This disease has a way of taking over your life.
Having kidney failure changes a lot of things, and that can contribute to feelings of depression and isolation
# What can be Causes of anxiety in dialysis patients #
Several factors seem to trigger anxiety and depression in hemodialysis patients such as co-morbidities, frequent hospitalizations chronic pain, sleep disturbances ,chronic inflammation, increased fatigue, decreased sexual functioning ,uremia ,failure of family support restrictions in daily life.

The feelings of mounting restlessness from the hours already spent tethered to the dialysis machine, in combination with the anticipation of these physiologic symptoms
dialysis technician- how can you help to patients:-
Encouraging and supporting patients' autonomy is central to the Self-Determination Theory. In practice it can take many forms. Encouraging patients to take on as much self-care as possible is one, and dialysis staff should be working to help patients care for themselves.
How is depression treated?
Depression is typically treated in one or a combination of two ways: with medications and/or with psychotherapy, also known as “talk therapy.”
Medications can only be prescribed by a qualified doctor or nurse practitioner. Psychiatrists are physicians who have specialized knowledge and training in the use of medications to affect what is going on in the brain to cause depression. It is always best to check with your nephrologist before seeing a psychiatrist, as many medicines used to treat depression require dosage adjustments for those who are at end stage renal disease.
Depression is a very treatable disease. Just like you get medical treatment for your renal disease there are treatments available for depression. Don’t let depression rob you of your happiness.

Warm Regards
Neelam Verma
Sr. Dialysis Faculty

16/12/2023

Do you know?

Each year, more than half a million people go to emergency rooms for kidney stone problems. It is estimated that one in ten people will have a kidney stone at some time in their lives

kidney stone is a hard object that is made from chemicals in the urine. There are four types of kidney stones: calcium oxalate, uric acid, struvite, and cystine.
A kidney stone may be treated with shockwave lithotripsy, uteroscopy, percutaneous nephrolithomy or nephrolithotripsy.

Common symptoms include -

severe pain on either side of your lower back
more vague pain or stomach ache that doesn't go away
blood in the urine
nausea or vomiting
fever and chills
urine that smells bad or looks cloudy

There are several risk factors for developing kidney stones. These include:

Not drinking enough liquids.
Having a diet that includes the substances that form the stones (phosphate, for example, is in meat, fish, beans and other protein-rich foods).
Having a family history of kidney stones.
Having a blockage in your urinary tract

How to prevent kidney stones

Proper hydration is a key preventive measure. It’s recommended to drink enough fluid to pass at least 2.5 litersTrusted Source of urine each day. Increasing the amount of urine you pass helps flush the kidneys.

You can substitute ginger ale, lemon-lime soda, and fruit juice for water to help you increase your fluid intake. If the stones are related to low citrate levels, citrate juices could help prevent the formation of stones.

Eating oxalate-rich foods in moderation and reducing your intake of salt and animal proteins can also lower your risk of kidney stones.

In fact, there are many medications and procedures that can help manage symptoms and promote the passage of kidney stones.

Additionally, staying well-hydrated and making changes to your diet can prevent kidney stones from forming in the long

27/05/2023

18/03/2023

Dialysis conference at Delhi

09/03/2023

This 09 March 2023, choose right for your kidneys. Having a balance diet can keep your kidneys healthy & happy.

Warm wishes on World Kidney Day to everyone.”

08/03/2023

05/02/2023

Q-Dialysis in children 👶

Dialysis is a life-saving medical procedure used by kidney specialists to treat children whose kidneys have failed.

Adult dialysis facilities are not equipped for kids’ needs. At the Kidney Center, we make every effort to meet your child’s needs and ensure that they are receiving care in the most comfortable environment possible.

Kidney failure — or end-stage renal disease (ESRD) — means that the kidneys have stopped working and a child needs dialysis or a kidney transplant to survive.

# Nearly 10,000 children and adolescents have end-stage renal disease.

Dialysis is usually needed when a child loses 85 to 90% of their kidney function, which is called kidney failure. This means the kidneys are damaged and can’t do their important jobs well enough.

Kidney failure in children can be caused by conditions such as birth defects, infections, kidney injuries, and hereditary diseases — such as polycystic kidney disease — that may be passed from parents to children.

Q-Which dialysis is better for children?

PD also tends to be better for young children and infants, who may not be able to tolerate hemodialysis due to their small size. All children on dialysis have to follow a special kidney diet, but the diet is less strict with PD compared to hemodialysis

Q-How long does dialysis take for a child?

Each dialysis session takes 3-4 hours, and is done three or more times a week. Haemodialysis usually takes place in the hospital, but some children are able to receive haemodialysis at home. Peritoneal dialysis (PD) – using the peritoneum, which is the lining of the abdomen (tummy).

Q- How can the parents suspect that the child’s kidney has failed or is failing?

The easiest sign to recognize is a decrease in the quantity of urine that the child passes. Normally, a child will pass urine 5 to 8 times in the day. If the child is passing less than 5 times it is a cause for concern.
Swelling over the eyelids giving a puffy appearance. This is seen when fluid accumulates in the body.
Loss of appetite, nausea, and vomiting.
Generalized weakness and loss of energy. The child may prefer to sit in one place or lie down and may have no interest in playing.
The child may become anemic and may look pale.
There may be breathing difficulty and cough because of the accumulation of water in the lungs. The child may become breathless on walking or may not be able to lie down flat and maybe comfortable only if propped up with a pillow.
The blood pressure may increase and if this is severe it can cause convulsions and unconsciousness.

Q - Which dialyzer is appropriate for pediatric hemodialysis?

The 6H poly flux dialyzer(0.6 surface area )enables high flux dialysis for small patients including pediatric indications.

03/02/2023

Sustained low efficiency dialysis (SLED)

SLED, is a recent hybrid dialysis methodology, which is increasingly used for patients with renal failure in the intensive care unit.

Hemodialysis (HD) for critically ill patients with acute renal failure has been provided as intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT). IHD is often complicated by hypotension and inadequate fluid removal, and CRRT by high cost of solutions and problems with anticoagulation. Sustained low-efficiency daily dialysis (SLED) has been suggested as an alternative treatment.

Advantages:

# Efficient clearance of small solutes
# Good hemodynamic tolerability
# smallFlexible treatment schedules
fluid removal with solute control
# cost efficient with decreased workload

This form of treatment is a more viable alternative to CRRT or traditional methods, in the case of critically ill patients.

Hybrid therapies are also known as PIRRT, sustained low-efficiency dialysis (SLED), and extended daily dialysis (EDD). These therapies use conventional hemodialysis machines with lower blood-pump speeds and dialysate flow rates to provide solute and fluid removal slower than IHD but faster than conventional CRRT.

Typically, they use low blood-pump speeds of 200 mL/min
# dialysate flow rates of 300 mL/min
# timing 6 to 12 hours daily.
PIRRT combines the advantages of CRRT and IHD. They allow for improved hemodynamic stability through gradual solute and volume removal as in CRRT.

27/01/2023

ADEQUACY OF DIALYSIS

Adequacy of dialysis refers to how we remove toxins and waste products from the patients blood, and has a major impact on their well being.

How do we know if a patient is adequately dialyzed ?

solute clearance ( urea kinetic modelling- UKM)
/V
reduction ratio (URR)

What is Kt/V ?

K = Urea clearance of dialyser (ml/min or L/hr )
*pore size & specification
*The surface area of dialyser

T = time of dialysis ( minutes )

V = Volume of dissolved urea in the body.

*Urea is equally distributed in all body compartments.
*Water is also equally distributed in all body compartment.
*Volume of urea almost equal total body water.

How to calculate Kt/V ?

If dialyser clearance K = 300ml/min
Time= 3 hrs
Patient weight = 70 kg

Answer : -
K = 300ml and
t = 3 hrs , 60 X 3 = 180 min
Kt = 300 X 180 = 54,000ml =54 liters
Kt = 54 liters

*The body is about 60 percent water by weight
* Patient weight = 70 kg
70 X60/100 = 42 liters
V = 42 liters
Kt / V = 54/42 = 1.3 ( good dialysis)
Measures of adequacy ,Standard kt/v should be 1.2 or more .

reduction ratio (URR)

It is calculated as follows

URR = Pre HD Urea -Post HD Urea /Pre HD Urea X 100
If Pre HD urea = 100 mg/dl
Post HD urea = 40 mg /dl
URR = 100 – 40 X 100
100
URR = 0.6 X 100 = 60 %( better dialysis URR should be more then 60 %)

What affects dialysis adequacy?

There are many factors that can affect dialysis adequacy;

The most frequently detected factors in the individual patient are poor vascular access, recirculation, decreases in dialyzer ,dose,performance and insufficient anticoagulation.