Principles of Dialysis

Module 2: Principles & Prescription of Hemodialysis

Fundamentals of Solute Removal: Physiology and Clearance
- Diffusion, convection, ultrafiltration, adsorption
- Dialysis dose modeling using Urea Kinetics: Kt/V and URR calculations; limitations and alternatives
- Impact of compartmental kinetics and high-efficiency dialysis
Prescription Design & Adequacy
- Session parameters: time, blood flow, dialysate flow, surface area, duration
- Adaptations for comorbid states, residual kidney function
- Real-time adequacy tools and feedback systems (online clearance systems)
Machine & Circuit Anatomy
- Pumps, monitors, sensors, alarm hierarchies
- Anticoagulation protocols: heparin, citrate, circuit patency measures
- Safety checks: air detectors, pressure limits, venous clamp function
Dialysate Composition
- Individualized electrolyte, buffer settings (acetate vs bicarbonate), cardiac risk, and IDWG
- Intradialytic sodium modeling to reduce cramps and hypotension
- Magnesium and calcium titration based on cardiovascular risk

Dialyzer Architecture
- Membrane materials and biocompatibility
- High-flux vs low-flux; reuse protocols and controversies
- Ultrafiltration coefficient (Kuf), pore structure, surface area: how design affects performance
- Biocompatibility: complement activation and cytokine response
Water Treatment Systems
- Stages: filtration, softening, RO, ultrafiltration (carbon filters, softeners, dechlorination)
- Disinfection protocols and contaminant/microbiologic surveillance
- Troubleshooting alerts, endotoxin control, distribution loop design

Physiology of HD, Circuit anatomy, Dialyzer
Uremic and Non-uremic Clearances
Water Treatment
Dialysate solutions