DIALYSIS

For the past 30 years, hemodialysis (HD) has been administered to patients with end-stage renal failure (1). Hemodialysis has evolved into a safe treatment and has been successful in preventing death in these patients (10). Peritoneal dialysis became popular as a treatment modality for end-stage renal disease (ESRD) after the development of ambulatory forms of the technique. Plastic bags of dialysis solution were introduced to the United States in 1979; this made application of the technique to the general dialysis population more feasible. By the end of 1992, approximately 70,000 people worldwide received continuous ambulatory peritoneal dialysis or continuous cycling peritoneal dialysis (chronic peritoneal dialysis). Chronic peritoneal dialysis is used less extensively worldwide than chronic hemodialysis (11).

Dialysis is defined as "the process of separating crystalloids and colloids in solution by the difference in their rates of diffusion through a semipermeable membrane: crystalloids pass through readily, colloids very slowly or not at all" (6:462). Hemodialysis is defined as "the removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane, e.g., by means of a hemodialyzer" (6:747). Peritoneal dialysis is hemodialysis through the peritoneum, the dialyzing solution is introduced into and removed from the peritoneal cavity (6). Interdialytic fluid int

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ate is dependent on the concentration and mobility of all contained ions; it reflects the concentration of sodium salts in the solution comprising the bulk of the electrolyte content. The exact relationship of conductivity to Na+ concentration varies as a function of K+, Ca2+, and Mg2+ concentrations, whether the buffer anion is acetate or bicarbonate, and as a function of the glucose concentration. Dialysate temperature is controlled to avoid blood overheating or chilling (5). Plasma complement is activated by the dialysis membrane during hemodialysis. This complement system is the primary cause of humoral immunity and its activation generates a variety of proinflammatory processes. Some consequences of hemodialysis have been attributed to membrane-induced activation of complement (4). Leukopenia due to complement activation as a result of blood/membrane interaction is reported; increased production of beta 2-microglobulin, interleukin-1, interleukin-6, tumor necrosis factor, prostacyclin, thromboxane, platelet activating factor, hydro-xyeicosatetraenoic acids are found during hemodialysis. Hemodialysis activates phospholipase A2 enzyme which releases arachidonic acid. Inflammatory cells release prostaglandins and thromb

Category: Medical - D