Removal of waste and water control of a Dialysis Patient

Kidney dialysis

Kidney failure has serious consequences as it means that the water and ionbalance cannot be regulated, and the levels of toxic urea build up in the body. This would ultimately be fatal if not treated.

One method of treatment is kidney dialysis. In this procedure, patients are connected to a dialysis machine which acts as an artificial kidney to remove most of the urea and restore/maintain the water and ion balance of the blood.

How dialysis works

‘Dirty’ blood (high in urea) is taken from a blood vessel in the arm, mixed with blood thinners to prevent clotting, and pumped into the machine. Inside the machine - separated by a partially permeable membrane the blood flows in the opposite direction to dialysis fluid, allowing exchange to occur between the two where a concentration gradient exists.

How dialysis works

Dialysis fluid contains:

• a glucose concentration similar to a normal level in the blood
• a concentration of ions similar to that found in normal blood plasma
• no urea

As the dialysis fluid has no urea in it, there is a large concentration gradient - meaning that urea moves across the partially permeable membrane, from the blood to the dialysis fluid, by diffusion.

As the dialysis fluid contains a glucose concentration equal to a normal blood sugar level, this prevents the net movement of glucose across the membrane as no concentration gradient exists.

And, as the dialysis fluid contains an ion concentration similar to the ideal blood plasma concentration, movement of ions across the membrane only occurs where there is an imbalance.

• If the patient’s blood is too low in ions , they will diffuse from the dialysis fluid into the blood, restoring the ideal level in the blood.
• If the patient’s blood is too high in ions , the excess ions will diffuse from the blood to the dialysis fluid.

Dialysis summary

The overall effect of this is that the blood leaving the machine and returning into the patient’s arm will have:

• greatly reduced levels of urea – it is ‘cleaned blood’
• no overall change in blood glucose levels
• the correct water and ion balance maintained or restored (with only excess ions removed)

Kidney dialysis requires highly specialised and expensive machinery. The patient must be connected to this machinery 2-3 times a week for periods (on average) of between 4-6 hours at a time.

As the filtration only works when they are connected, kidney patients must monitor their diet carefully in between dialysis sessions. They need to avoid eating foods with a high salt content or a high protein content as excess amino acids are broken down into urea.

So although dialysis is a life-saving treatment, it does have a significant effect on a person’s lifestyle. -bbc.co.uk