Hemodialysis Case Study

Hemodialysis Case Study

A 26-year-old with diabetes mellitus has developed renal failure. While waiting for a kidney transplant, he is on maintenance hemodialysis eight to ten hours three times each week. He is on a diet restricted in sodium (500 mg/day), potassium (2.6 g/day), and protein as well as his usual diabetic diet. He has a shunt in his right wrist to allow for easy hookup to the dialysis machine.

Prior to hemodialysis, his representative blood values are the following:

Serum sodium 120 mEq/L

Serum potassium 6.4 mEq/L

Serum chloride 102 mEq/L

Serum creatinine 16 mg/dL

Hematocrit 24%

The dialysis fluid in the kidney dialysis machine contains the following:

Sodium 134 mEq/L

Potassium 2.6 mEq/L

Calcium 2.5 mEq/L

Magnesium 1.5 mEq/L

Chloride 104 mEq/L

Sodium acetate 36.6 mEq/L

Anhydrous dextrose 2 g/L

What is Dialysis?

• Dialysis: The process of separating serum substances from the blood using a permeable membrane
• Two types of dialysis:
• hemodialysis
• peritoneal dialysis
• Dialysis is needed for kidney failure treatment in order to filter waste product from the blood

Recorded Value Comparison

The Difference between hemodialysis and peritoneal dialysis

Blood Values Before Hemodialysis:

• Serum sodium 120 mEq/L
• Serum potassium 6.4 mEq/L
• Serum chloride 102 mEq/L
• Serum creatinine 16 mg/dL
• Hematocrit 24%

Dialysis Fluid Values in Dialysis Machine

• Sodium 134 mEq/L
• Potassium 2.6 mEq/L
• Calcium 2.5 mEq/L
• Magnesium 1.5 mEq/L
• Chloride 104 mEq/L
• Sodium acetate 36.6 mEq/L
• Anhydrous dextrose 2 g/L

• Hemodialysis: a machine that helps filter urea and salts from blood and helps treat people who have renal failure. It also helps control blood pressure and balances fluids and minerals such as sodium and potassium
• Peritoneal Dialysis: a filtration process that removes waste products from the blood by using a peritoneal membrane (lining of abdominal cavity) as a filter
• Most people prefer peritoneal dialysis because it can be done from the comfort of your home and can also be done multiple times a day while performing normal activities

• Serum: a protein-rich fluid that separates when blood coagulates
• Solutes move through the dialysis membrane by diffusion passing between the blood into the dialysis fluid
• Comparing blood solute concentrations before and after dialysis
• Serum sodium: Increases
• Serum potassium: Decreases
• Serum Chloride: Increases
• Serum Creatinine: Decreases
• Hematocrit: Remains the same (this is because the pores of the dialysis tubing are too small to let red blood cells through)
• Some solutes that pass from the dialysis fluid into the blood include
• water
• salts
• calcium
• acetate
• anhydrase dextrose

Hemodialysis vs Peritoneal Dialysis

Anemia and Dialysis

• Anemia can be a critical complication as a result of hemodialysis
• Anemia: a condition where the body does not have enough red blood cells for oxygen transport in the body
• This is due to a decrease in iron, vitamin B-12, and folic acid which is essential for hemoglobin formation
• hemoglobin is needed for oxygen binding to red blood cells
• Anemia can also be caused from blood loss during the connection of the body and hemodialysis machine