Talk:Hemodialysis

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[edit] Step by step description of hemodialysis

Does anyone else think that this section should go?Felix-felix 18:44, 13 August 2006 (UTC)

I think it has some use. That said, I think we can throw it into a separate article: Step-by-step description of hemodialysis. Nephron  T|C 18:30, 19 August 2006 (UTC)

[edit] Principle of hemodialysis

I've edited out alot of the recent edits to this section, not because they were incorrect but because this section ought to be punchy and to the point. Nephron put some stuff related to clearance, which he clearly knows alot about, in there which clouded the point in my opinion. A section relating to dialysis adequacy after the prescription section would be good-as kt/v urr etc could all be linked to. I have to admit right now that even the thought of dialysis adequacy makes me actively suicidal..Felix-felix 11:57, 19 August 2006 (UTC)

[edit] Proposed merge

  • I vote no-in fact, I'd go further and say I think that the step-by-step guide should go altogether-it's not very encyclopedic. But having it in this article is unweildly and bloating.Felix-felix 08:35, 4 December 2006 (UTC)
  • Oppose. I second Felix-felix on the fact that it's unencyclopedic. No convincing justification was given for the merge-- by those proposing. I think the proposed merge should be removed speedily-- the split-out was discussed above. Nephron  T|C 22:04, 4 December 2006 (UTC)

[edit] Ultrafiltration and Solutes

I've added a caveat to the sentence saying that hydrostatic pressure drives water and SOME dissolved solutes. I think that the essential point to be bourne in mind is that this section should be as clear as possible to an interested lay reader-it's not a dialysis textbook for technicians and nephrologists. So whilst you are correct about the movement of Na with free water-I seriously think that this complicates the section,which should be as clear as possible. This could be dealt with later on in the text, should it be deemed necessary. However, rather than just delete, I think we should reach a consensus here first.Felix-felix 09:44, 15 January 2007 (UTC)

Felix, well, "some dissolved solutes" is OK. Practically speaking, today dialysis is done mostly with high flux membranes, so basically almost all dissolved solutes will be convected across the membrane in the course of ultrafiltration. Even with lower flux membranes, most solutes will go, since they will be small enough to pass through the membrane pores (certainly up to 1000 kD). This is I think a very important basic concept. 1) Sodium removal during ultrafiltration is the main mechanism whereby excess sodium is removed from the body by dialysis (not diffusion) 2) Solute removal by convection is the basis for the proposed advantages of hemofiltration and hemodiafiltration; the larger solutes diffuse slowly, and their removal is greatly enhanced by convective transport. 3) Very few membranes, such as RO membranes, have pores small enough to hold back dissolved solutes. So this is a concept important in water purification for dialysis, rather than for the dialysis membrane itself. 4) Convective removal of solute is also important in acid-base balance (convective removal of bicarbonate), phosphorus clearance (hemodiafiltration better than hemodialysis, and calcium (in PD) Even at the patient level, it's important that patients focus more on sodium rather than water, both in terms of taking it in, and in understanding the mechanisms for how excess sodium is removed. I have no objection to the addition of the word "some" - this is technically correct and fine. But when I read the description about movement of water only, it struck me as not completely correct. [User: jtdaugir, 26 Jan 2007].


[edit] Proposed merge with artificial kidney

Agreed-although there's nothing in that sorry little article that we'd want to import to our far superior article here, I think. But they shouldn't be separate.FelixFelix talk 10:05, 12 February 2007 (UTC)

Oppose merge + re-write. IMHO hemodialysis \ne artificial kidney. I think an article about artificial kidney would have its place and be of use. It could answer such questions as:
  1. How far are we from an artifical kidneys?
  2. What barriers are there to creating an artifical kidney?
  3. Where is the focus of current research on artifical kidneys?
  4. Are wearable kidneys going to be the future?
I think the above questions are interesting to examine, don't fit neatly into the hemodialysis article... and there is a body of literature (PubMed search: "artificial kidney" NOT hemodialysis) that looks at 'em.
  • Fissell WH. Developments towards an artificial kidney. Expert Rev Med Devices. 2006 Mar;3(2):155-65. Review. PMID 16515382
  • Saito A, Aung T, Sekiguchi K, Sato Y, Vu DM, Inagaki M, Kanai G, Tanaka R, Suzuki H, Kakuta T. Present status and perspectives of bioartificial kidneys. J Artif Organs. 2006;9(3):130-5. Review. PMID 16998696
  • Saito A, Aung T, Sekiguchi K, Sato Y. Present status and perspective of the development of a bioartificial kidney for chronic renal failure patients. Ther Apher Dial. 2006 Aug;10(4):342-7. Review. PMID 16911187
  • Gura V, Beizai M, Ezon C, Polaschegg HD. Continuous renal replacement therapy for end-stage renal disease. The wearable artificial kidney (WAK). Contrib Nephrol. 2005;149:325-33. PMID 15876856
  • Wang PC, Takezawa T. Reconstruction of renal glomerular tissue using collagen vitrigel scaffold. J Biosci Bioeng. 2005 Jun;99(6):529-40. Review. PMID 16233828
I think a total re-write of the artificial kidney article is what is necessary... not a merge. I think the first challenge of writing the "artificial kidney" article is defining the term. If it is to be merged... a merge with renal replacement therapy would, IMHO, be more appropriate than a merge with hemodialysis. Nephron  T|C 16:11, 12 February 2007 (UTC)
I have to say, I'm not very bothered about this, but a bioartificial/'wearable' kidney is no more an artificial kidney than a hemodialysis machine, except for the fact that it doesn't exist. Presumably this is also what the creators of the artificial kidney article thought too, as they seem to have written (a pretty bizarre) account of HD. Perhaps a redirect or disambiguation page called artificial kidney and a new article called bioartificial/wearable kidney (or whatever they're supposed to be called, with whatever you're supposed to say about them.)?FelixFelix talk 22:18, 12 February 2007 (UTC)

Artificial kidney is an archaic term used for a dialyzer. Despite a lot of hype about nanotechnology (which applies primarily to membrane technology and uniformity of pore size), the only really new device on the near horizon that I know of is the [David Humes' bioreactor http://www.med.umich.edu/intmed/nephrology/STAFF/humes_hd.htm] where kidney cells are grown on the membrane to replicate some of their synthetic function. But that is not an artificial kidney as most people have used this term over the past 50 or so years. It could be a historic article and stand alone that way. Presently it is factually incorrect, esp. by referring to dialysis as a "painful" process when in fact pain during the treatment is very uncommon. Right now, esp. with the picture of the dialysis machine, it is redundant with the hemodialysis page (jtdaugir).

I started a re-write of the artificial kidney article with the above in mind. I'm planning on removing the merge tag in a little while if there is no objection/no one beats me to it. Nephron  T|C 23:58, 15 February 2007 (UTC)
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