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Principles of Dialysis: Diffusion, Convection, and ...

1 Principles of Dialysis: Diffusion, Convection, and Dialysis MachinesChronic renal failure is the final common pathway of a numberof kidney diseases. The choices for a patient who reaches thepoint where renal function is insufficient to sustain life are 1) chronic dialysis treatments (either hemodialysis or peritoneal dialysis),2) renal transplantation, or 3) death. With renal failure of any cause,there are many physiologic derangements. Homeostasis of water andminerals (sodium, potassium, chloride, calcium, phosphorus, magne-sium, sulfate), and excretion of the daily metabolic load of fixedhydrogen ions is no longer possible. Toxic end-products of nitrogenmetabolism (urea, creatinine, uric acid, among others) accumulate inblood and tissue. Finally, the kidneys are no longer able to function asendocrine organs in the production of erythropoietin and 1,25-dihy-droxycholecalciferol (calcitriol). Dialysis procedures remove nitrogenous end-products of catabo-lism and begin the correction of the salt, water, and acid-base derange-ments associated with renal failure.

Colony-forming units/mL <200 <2000 FIGURE 1-7 Association for the Advancement of Medical Instrumentation (AAMI) bacteriologic standards for dialysis water and prepared dialysate. Excess bacteria in water can lead to pyrogen reactions. Treated water supply systems are designed so that there are no dead-end connections.

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