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Yousaf khanRenal Dialysis LecturerIPMS-KMUDialysate

DialysateRefers to the fluid and solute that have crossed a membrane

Also called bath

Composition of dialysate is nearly correspond to that of plasma water.

Composition of dialysate:Sodium chlorideSodium acetate or sodium bicarbonateCalcium chloridePotassium chlorideMagnesium chloride

Function of dialysateIt carry away the waste materials and fluid removed from the blood by dialysis.

It prevents removed of essential electrolytes.

It a avert excess water removal during dialysis.

Types of DialysateAcetate Dialysate:Acetate is physiologically compatible with blood and metabolized to bicarbonate in the liver.Mixing ratio 1: and 34 part of water

Advantages:Stable during dialysisNot prone to bacterial contaminationA wide variety of formulation are availableThe delivery system is simple and less costly

Disadvantage:Serum bicarbonate may decrease early during dialysis.

Acetate accumulation contribute to cardiovascular instability with vasodilation and hypotension, nausea, vomiting and post dialysis fatigue.

Not suited for high efficiency or high flux dialysis, serum bicarbonate is depleted and acetate level may exceed the rate at which the liver can metabolized it. Therefore cardiovascular instability may be severe and disequilibrium may occure.

Bicarbonate DialysateCalcium and magnesium will not remain in solution with bicarbonate because of low hydrogen ion content

A concentrateB concentratePurified water

A concentrate:Indicating acidified concentrate contain sodium, calcium, magnesium, potassium and chlorideTo maintain low ph enough to keep the calcium and magnesium in solution when mixed into dialysate a small amount of acetic acid is included.

B concentrate:Indicating bicarbonate concentrate contains the sodium bicarbonate.Sodium chloride may be included in some preparation to raise the total conductivity.

Two component mixed with purified water form dialysis solution before dialyzer.. During mixing CO2 will be generated as a result acid and bicarbonate reaction. CO2 will form carbonic acid which lower the PH of the final bicarbonate containing solution to 7-7.4In this PH calcium and magnesium remain in solution.

Disadvantage of bicarbonate solution:Liquid B is not stable.Dry bicarbonate may be mixedMixing process requires care to avoid much loss of CO2It must be used within 24 hrVery susceptible to bacterial contamination

Composition of dialysatecomponentNaKCaMgClHco3CH3COOConcentrate A81-900-42.5-3.50.5-0.7585-95-2-4Concentrate B40-50---20-2530-40-Total13-1450-42.5-3.50.25-0.7598-12430-402-4

Dialysate delivery systemAppropriate blending of concentrate and water for preparation of final dialysate.To monitor dialysate for temperature, composition and blood leak.To control dialysate pressure or ultrafiltration rate.To regulate the dialysate flow rate through the dialyzerDeaeration of water. Provide protective mechanisms to isolate the blood circuit and the patient from unsafe dialysis.System for disinfection and cleaning.