透析機

WordNet

turn, shape, mold, or otherwise finish by machinery
a device for overcoming resistance at one point by applying force at some other point (同)simple_machine
any mechanical or electrical device that transmits or modifies energy to perform or assist in the performance of human tasks
a group that controls the activities of a political party; "he was endorsed by the Democratic machine" (同)political machine
an efficient person; "the boxer was a magnificent fighting machine"
an intricate organization that accomplishes its goals efficiently; "the war machine"
make by machinery; "The Americans were machining while others still hand-made cars"
separation of substances in solution by means of their unequal diffusion through semipermeable membranes

PrepTutorEJDIC

『機械』 / 自動車,飛行機,自転車 / 加えられた力を強めたり方向を変えたりする機械(器具);てこ,滑車,くさび,斜面など / 組織,(特に)派閥 / (自主性も意欲もない)機械のような人,機械的に働く人 / …‘を'機械で作る(仕上げる);(特に)…‘に'ミシンをかける,‘を'ミシンで作る;(印刷機で)…‘を'印刷する / …‘を'きっちり計って作る《+『down』+『名,』+『名』+『down』》
透析(コロイド溶液を半透膜で分離すること)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/08/23 10:15:39」(JST)

wiki en

This article is about renal dialysis; for the laboratory technique, see dialysis (biochemistry); for treatment for liver failure, see liver dialysis.

In medicine, dialysis (from Greek dialusis,"διάλυσις", meaning dissolution, dia, meaning through, and lysis, meaning loosening or splitting) is a process for removing waste and excess water from the blood, and is used primarily to provide an artificial replacement for lost kidney function in people with renal failure.^[1] Dialysis may be used for those with an acute disturbance in kidney function (acute kidney injury, previously acute renal failure), or progressive but chronically worsening kidney function–a state known as chronic kidney disease stage 5 (previously chronic renal failure or end-stage renal disease). The latter form may develop over months or years, but in contrast to acute kidney injury is not usually reversible, and dialysis is regarded as a "holding measure" until a renal transplant can be performed, or sometimes as the only supportive measure in those for whom a transplant would be inappropriate.^[2]

The kidneys have important roles in maintaining health. When healthy, the kidneys maintain the body's internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulfate). Those acidic metabolism end-products that the body cannot get rid of via respiration are also excreted through the kidneys. The kidneys also function as a part of the endocrine system, producing erythropoietin and calcitriol. Erythropoietin is involved in the production of red blood cells and calcitriol plays a role in bone formation^[3] Dialysis is an imperfect treatment to replace kidney function because it does not correct the endocrine functions of the kidney. Dialysis treatments replace some of these functions through diffusion (waste removal) and ultrafiltration (fluid removal).^[4]

History

Arm showing tubes

Dr. Willem Kolff, a Dutch physician, constructed the first working dialyzer in 1943 during the Nazi occupation of the Netherlands.^[5] Due to the scarcity of available resources, Kolff had to improvise and build the initial machine using sausage casings, beverage cans, a washing machine, and various other items that were available at the time. Over the following two years, Kolff used his machine to treat 16 patients suffering from acute kidney failure, but the results were unsuccessful. Then, in 1945, a 67-year-old comatose woman regained consciousness following 11 hours of hemodialysis with the dialyzer, and lived for another seven years before dying of an unrelated condition. She was the first-ever patient successfully treated with dialysis.^[5]

Principle

A hemodialysis machine

Dialysis works on the principles of the diffusion of solutes and ultrafiltration of fluid across a semi-permeable membrane. Diffusion describes a property of substances in water. Substances in water tend to move from an area of high concentration to an area of low concentration.^[6] Blood flows by one side of a semi-permeable membrane, and a dialysate, or special dialysis fluid, flows by the opposite side. A semipermeable membrane is a thin layer of material that contains holes of various sizes, or pores. Smaller solutes and fluid pass through the membrane, but the membrane blocks the passage of larger substances (for example, red blood cells, large proteins). This replicates the filtering process that takes place in the kidneys, when the blood enters the kidneys and the larger substances are separated from the smaller ones in the glomerulus.^[6]

The two main types of dialysis, hemodialysis and Peritoneal dialysis, remove wastes and excess water from the blood in different ways.^[2] Hemodialysis removes wastes and water by circulating blood outside the body through an external filter, called a dialyzer, that contains a semipermeable membrane. The blood flows in one direction and the dialysate flows in the opposite. The counter-current flow of the blood and dialysate maximizes the concentration gradient of solutes between the blood and dialysate, which helps to remove more urea and creatinine from the blood. The concentrations of solutes (for example potassium, phosphorus, and urea) are undesirably high in the blood, but low or absent in the dialysis solution, and constant replacement of the dialysate ensures that the concentration of undesired solutes is kept low on this side of the membrane. The dialysis solution has levels of minerals like potassium and calcium that are similar to their natural concentration in healthy blood. For another solute, bicarbonate, dialysis solution level is set at a slightly higher level than in normal blood, to encourage diffusion of bicarbonate into the blood, to act as a pH buffer to neutralize the metabolic acidosis that is often present in these patients. The levels of the components of dialysate are typically prescribed by a nephrologist according to the needs of the individual patient.

In peritoneal dialysis, wastes and water are removed from the blood inside the body using the peritoneal membrane of the peritoneum as a natural semipermeable membrane. Wastes and excess water move from the blood, across the peritoneal membrane, and into a special dialysis solution, called dialysate, in the abdominal cavity which has a composition similar to the fluid portion of blood.

Types

There are three primary and two secondary types of dialysis: hemodialysis (primary), peritoneal dialysis (primary), hemofiltration (primary), hemodiafiltration (secondary), and intestinal dialysis (secondary).

Hemodialysis

Hemodialysis schematic

Main articles: Hemodialysis and Home hemodialysis

In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing it to a partially permeable membrane. The dialyzer is composed of thousands of tiny synthetic hollow fibers. The fiber wall acts as the semipermeable membrane. Blood flows through the fibers, dialysis solution flows around the outside of the fibers, and water and wastes move between these two solutions.^[7] The cleansed blood is then returned via the circuit back to the body. Ultrafiltration occurs by increasing the hydrostatic pressure across the dialyzer membrane. This usually is done by applying a negative pressure to the dialysate compartment of the dialyzer. This pressure gradient causes water and dissolved solutes to move from blood to dialysate, and allows the removal of several litres of excess fluid during a typical 3- to 5-hour treatment. In the US, hemodialysis treatments are typically given in a dialysis center three times per week (due in the US to Medicare reimbursement rules); however, as of 2007 over 2,500 people in the US are dialyzing at home more frequently for various treatment lengths.^[8] Studies have demonstrated the clinical benefits of dialyzing 5 to 7 times a week, for 6 to 8 hours. This type of hemodialysis is usually called "nocturnal daily hemodialysis", which a study has shown a significant improvement in both small and large molecular weight clearance and decrease the requirement of taking phosphate binders.^[9] These frequent long treatments are often done at home while sleeping, but home dialysis is a flexible modality and schedules can be changed day to day, week to week. In general, studies have shown that both increased treatment length and frequency are clinically beneficial.^[10]

Peritoneal dialysis

Schematic diagram of peritoneal dialysis

Main article: Peritoneal dialysis

In peritoneal dialysis, a sterile solution containing glucose is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a partially permeable membrane. The peritoneal membrane or peritoneum is a layer of tissue containing blood vessels that lines and surrounds the peritoneal, or abdominal, cavity and the internal abdominal organs (stomach, spleen, liver, and intestines).^[11] The dialysate is left there for a period of time to absorb waste products, and then it is drained out through the tube and discarded. This cycle or "exchange" is normally repeated 4-5 times during the day, (sometimes more often overnight with an automated system). Each time the dialysate fills and empties from the abdomen is called one exchange. A dwell time means that the time of dialysate stay in patient's abdominal cavity—wastes, chemicals and extra fluid move from patient's blood to the dialysate across the peritoneum. A drain process is the process after the dwell time, the dialysate full with waste products and extra fluid is drained out of patient's blood.^[12] Ultrafiltration occurs via osmosis; the dialysis solution used contains a high concentration of glucose, and the resulting osmotic pressure causes fluid to move from the blood into the dialysate. As a result, more fluid is drained than was instilled. Peritoneal dialysis is less efficient than hemodialysis, but because it is carried out for a longer period of time the net effect in terms of removal of waste products and of salt and water are similar to hemodialysis. Peritoneal dialysis is carried out at home by the patient. Although support is helpful, it is not essential. It does free patients from the routine of having to go to a dialysis clinic on a fixed schedule multiple times per week, and it can be done while travelling with a minimum of specialized equipment.

Hemofiltration

Main article: Hemofiltration

Hemofiltration is a similar treatment to hemodialysis, but it makes use of a different principle. The blood is pumped through a dialyzer or "hemofilter" as in dialysis, but no dialysate is used. A pressure gradient is applied; as a result, water moves across the very permeable membrane rapidly, "dragging" along with it many dissolved substances, including ones with large molecular weights, which are not cleared as well by hemodialysis. Salts and water lost from the blood during this process are replaced with a "substitution fluid" that is infused into the extracorporeal circuit during the treatment. Hemodiafiltration is a term used to describe several methods of combining hemodialysis and hemofiltration in one process.

Hemodiafiltration

Hemodialfiltration is a combination of hemodialysis and hemofiltration. In theory, this technique offers the advantages of both hemodialysis and hemofiltration.

Intestinal dialysis

In intestinal dialysis, the diet is supplemented with soluble fibres such as acacia fibre, which is digested by bacteria in the colon. This bacterial growth increases the amount of nitrogen that is eliminated in fecal waste.^[13]^[14]^[15] An alternative approach utilizes the ingestion of 1 to 1.5 liters of non-absorbable solutions of polyethylene glycol or mannitol every fourth hour.^[16]

Starting indications

The decision to initiate dialysis or hemofiltration in patients with renal failure depends on several factors. These can be divided into acute or chronic indications.

Indications for dialysis in the patient with acute kidney injury are summarized with the vowel acronym of "AEIOU":^[17]
1. Acidemia from metabolic acidosis in situations in which correction with sodium bicarbonate is impractical or may result in fluid overload
2. Electrolyte abnormality, such as severe hyperkalemia, especially when combined with AKI
3. Intoxication, that is, acute poisoning with a dialyzable substance. These substances can be represented by the mnemonic SLIME: salicylic acid, lithium, isopropanol, Magnesium-containing laxatives, and ethylene glycol
4. Overload of fluid not expected to respond to treatment with diuretics
5. Uremia complications, such as pericarditis, encephalopathy, or gastrointestinal bleeding.

Chronic indications for dialysis:
1. Symptomatic renal failure
2. Low glomerular filtration rate (GFR) (RRT often recommended to commence at a GFR of less than 10-15 mls/min/1.73m²). In diabetics, dialysis is started earlier.
3. Difficulty in medically controlling fluid overload, serum potassium, and/or serum phosphorus when the GFR is very low

References

^ "Dialysis". http://www.medicinenet.com/dialysis/article.htm#1whatis.
^ ^a ^b Pendse S, Singh A, Zawada E. Initiation of Dialysis. In: Handbook of Dialysis. 4th ed. New York, NY; 2008:14–21
^ Brundage D. Renal Disorders. St. Louis, MO: Mosby; 1992
^ "Atlas of Diseases of the Kidney, Volume 5, Principles of Dialysis: Diffusion, Convection, and Dialysis Machines" (PDF). http://www.kidneyatlas.org/book5/adk5-01.ccc.QXD.pdf. Retrieved 2011-09-02.
^ ^a ^b An online source for kidney disease and dialysis information. http://www.davita.com/dialysis/c/197; Davita: 2010
^ ^a ^b Mosby’s Dictionary of Medicine, Nursing, & Health Professions. 7th ed. St. Louis, MO; Mosby: 2006
^ Ahmad S, Misra M, Hoenich N, Daugirdas J. Hemodialysis Apparatus. In: Handbook of Dialysis. 4th ed. New York, NY; 2008:59-78.
^ "Usrds Treatment Modalities" (PDF). http://www.usrds.org/2007/pdf/04_modalities_07.pdf. Retrieved 2011-09-02.
^ Rocco MV.More frequent hemodialysis: back to the future? In: Advances in Chronic Kidney Disease. Volume 14, issue 3; 2007:e1-9.
^ Daily therapy study results compared^{[dead link]}
^ Blake P, Daugirdas J. Physiology of Peritoneal Dialysis. In: Handbook of Dialysis. 4th ed. New York, NY; 2008:323-338
^ Kallenbach J.Z. In: Review of hemodialysis for nurses and dialysis personnel. 7th ed. St. Louis, Missouri:Elsevier Mosby; 2005.
^ "Access". Medscape. http://www.medscape.com/medline/abstract/15293039. Retrieved 2011-09-02.
^ "Access". Medscape. http://www.medscape.com/medline/abstract/17517814. Retrieved 2011-09-02.
^ "Access". Medscape. http://www.medscape.com/medline/abstract/17999333. Retrieved 2011-09-02.
^ "Access". Medscape. http://www.medscape.com/medline/abstract/1904625. Retrieved 2011-09-02.
^ Irwin, Richard S.; James M. Rippe (2008). Irwin and Rippe's intensive care medicine. Lippincott Williams & Wilkins. pp. 988–999. ISBN 0-7817-9153-7, 9780781791533.

External links

Find more about Dialysis on Wikipedia's sister projects:
	Definitions and translations from Wiktionary
	Images and media from Commons
	Learning resources from Wikiversity
	News stories from Wikinews
	Quotations from Wikiquote
	Source texts from Wikisource
	Textbooks from Wikibooks

Machine Cleans Blood While You Wait—1950 article on early use of Dialysis machine at Bellevue Hospital New York City—i.e. example of how complex and large early dialysis machines were
Virtual Dialysis Museum—History and pictures of dialysis machines through time

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 血液透析装置の概要 overview of the hemodialysis apparatus
2. 夜間血液透析の技術的側面 technical aspects of nocturnal hemodialysis
3. 血液透析における緊急および長期ブラッドアクセスとしての中心静脈カテーテルの概要 overview of central catheters for acute and chronic hemodialysis access
4. 低効率性の持続または長期連日透析 sustained low efficiency or extended daily dialysis
5. 短時間連日血液透析 short daily hemodialysis

English Journal

Vascular access for hemodialysis: postoperative evaluation and function monitoring.

Leivaditis K1, Panagoutsos S, Roumeliotis A, Liakopoulos V, Vargemezis V.Author information 1Department of Nephrology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.AbstractVascular access (VA) survival is a crucial issue associated with morbidity and mortality of patients undergoing maintenance hemodialysis. The development of stenosis is the major factor that leads to VA failure. Strategies for early detection of lesions within a VA system before serious complications arise are therefore crucial. The implementation of a VA surveillance program could lead to timely detection of VA dysfunction and referral for correction, reduction in central venous catheter use and decrease in hospitalization and VA-related cost. Suggested methods for arteriovenous fistulae and grafts surveillance include blood flow measurement, static pressure evaluation and duplex ultrasonography. Physical examination is an accepted method in contrast to nonstandardized dynamic pressure measurement for grafts. Access recirculation (not urea based) and dynamic pressure measurements are accepted methods for fistulae. Decreasing URR or Kt/V (otherwise unexplained) and increased (negative) arterial pressure in the dialysis machine are methods of limited sensitivity and specificity for both fistulae and grafts. Measurement of access blood flow has been proposed as the gold standard for the screening of all types of VA. Access flow can be measured by various techniques which are direct or indirect. Several studies about VA surveillance programs have demonstrated conflicting results. Larger, randomized controlled trials need to be carried out in order to clarify whether surveillance programs are necessary and which is the best surveillance strategy for each type of VA.
International urology and nephrology.Int Urol Nephrol.2014 Feb;46(2):403-9. doi: 10.1007/s11255-013-0564-2. Epub 2013 Sep 18.
Vascular access (VA) survival is a crucial issue associated with morbidity and mortality of patients undergoing maintenance hemodialysis. The development of stenosis is the major factor that leads to VA failure. Strategies for early detection of lesions within a VA system before serious complication
PMID 24046176

Intradialytic hypotension: Frequency, sources of variation and correlation with clinical outcome.

Sands JJ1, Usvyat LA, Sullivan T, Segal JH, Zabetakis P, Kotanko P, Maddux FW, Diaz-Buxo JA.Author information 1Fresenius Medical Care North America, Waltham, Massachusetts, USA.AbstractIntradialytic hypotension (IH) is a frequent complication of hemodialysis (HD) and is associated with increased patient mortality and cardiovascular events. We studied IH to determine its variability, correlates, and clinical impact in 13 outpatient HD facilities. Blood pressure was captured by machine download. IH was defined as >30 mmHg decrease in systolic blood pressure to <90 mmHg. Risk factors were assessed by logistic regression and hospitalization by Poisson regression. Time to death and first hospitalization were assessed using Kaplan-Meier analysis in patients completing >20 HD treatments. We studied IH in 44,801 treatments (Tx) in 1137 patients. IH was frequent (17.2% of treatments) and highly variable by patient (0-100% Tx) and dialysis facility (11.1-25.8% Tx). 25.1% of patients had no IH (0% Tx) and 16.2% had IH on >35% Tx. Increased IH frequency was associated with age, female gender, diabetes, Hispanic origin, longer end stage renal disease vintage, higher body mass index, higher ultrafiltration volume, the second and third weekly Tx, lower pre-HD systolic blood pressure, higher difference between prescribed and achieved post-HD weight, and higher dialysate temperature. Dialysis facility was an independent predictor of IH frequency. Patients with >35% IH treatments had poorer survival (P = 0.036), and more frequent and longer hospitalization (P = 0.04, P = 0.002, respectively) than patients without IH. In conclusion, IH frequency was highly variable, associated with individual facilities, patient and treatment characteristics, and correlated with mortality and hospitalization. Identifying practice patterns associated with IH coupled with routine reporting of IH will facilitate medical management and may result in the prevention of IH, decreased mortality, and decreased hospitalization.
Hemodialysis international. International Symposium on Home Hemodialysis.Hemodial Int.2014 Jan 27. doi: 10.1111/hdi.12138. [Epub ahead of print]
Intradialytic hypotension (IH) is a frequent complication of hemodialysis (HD) and is associated with increased patient mortality and cardiovascular events. We studied IH to determine its variability, correlates, and clinical impact in 13 outpatient HD facilities. Blood pressure was captured by mach
PMID 24467830

Attending Rounds: A Patient with Intradialytic Hypotension.

Reilly RF.Author information Division of Nephrology, Medical Service, Veterans Affairs North Texas Health Care System, Dallas, Texas.AbstractIntradialytic hypotension is the most common adverse event that occurs during the hemodialysis procedure. Despite advances in machine technology, it remains a difficult management issue. The pathophysiology of intradialytic hypotension and measures to reduce its frequency are discussed. An accurate assessment of dry weight is crucial in all patients on dialysis and especially those patients prone to intradialytic hypotension. The presence of edema and hypertension has recently been shown to be a poor predictor of volume overload. Noninvasive methods to assess volume status, such as whole body and segmental bioimpedance, hold promise to more accurately assess fluid status. Reducing salt intake is key to limiting interdialytic weight gain. A common problem is that patients are often told to restrict fluid but not salt intake. Lowering the dialysate temperature, prohibiting food ingestion during hemodialysis, and midodrine administration are beneficial. Sodium modeling in the absence of ultrafiltration modeling should be abandoned. There is not enough data on the efficacy of l-carnitine to warrant its routine use.
Clinical journal of the American Society of Nephrology : CJASN.Clin J Am Soc Nephrol.2014 Jan 2. [Epub ahead of print]
Intradialytic hypotension is the most common adverse event that occurs during the hemodialysis procedure. Despite advances in machine technology, it remains a difficult management issue. The pathophysiology of intradialytic hypotension and measures to reduce its frequency are discussed. An accurate
PMID 24385517

Japanese Journal

腹膜透析カテーテルの超音波像に関する基礎的検討

日本透析医学会雑誌 48(2), 117-122, 2015
NAID 130004880129

腹膜透析 (PD) レジストリ2013年末調査報告

日本透析医学会雑誌 48(1), 33-44, 2015
NAID 130004880124

日機装社製透析装置DBG-03に搭載された循環血液量(BV)モニターを用いた、バスキュラーアクセス再循環スクリーニングの有用性と問題点

日本血液浄化技術学会会誌 = The journal of Japanese Society for Technology of Hemopurification 22(3), 203-213, 2014-12
NAID 40020329327

Related Pictures

★リンクテーブル★

「machine」

Dialysis
	Intervention
	; Patient receiving dialysis
ICD-9-CM	39.95
MeSH	D006435

　　[★]

n.

機械、マシーン、器械、装置

関: apparatus、device、instrument、mechanic

[0] "Dialysis". http://www.medicinenet.com/dialysis/article.htm#1whatis.

[Pendse-1] Pendse S, Singh A, Zawada E. Initiation of Dialysis. In: Handbook of Dialysis. 4th ed. New York, NY; 2008:14–21

[2] Brundage D. Renal Disorders. St. Louis, MO: Mosby; 1992

[3] "Atlas of Diseases of the Kidney, Volume 5, Principles of Dialysis: Diffusion, Convection, and Dialysis Machines" (PDF). http://www.kidneyatlas.org/book5/adk5-01.ccc.QXD.pdf. Retrieved 2011-09-02.

[Davita-4] An online source for kidney disease and dialysis information. http://www.davita.com/dialysis/c/197; Davita: 2010

[Mosby-5] Mosby’s Dictionary of Medicine, Nursing, & Health Professions. 7th ed. St. Louis, MO; Mosby: 2006

[6] Ahmad S, Misra M, Hoenich N, Daugirdas J. Hemodialysis Apparatus. In: Handbook of Dialysis. 4th ed. New York, NY; 2008:59-78.

[7] "Usrds Treatment Modalities" (PDF). http://www.usrds.org/2007/pdf/04_modalities_07.pdf. Retrieved 2011-09-02.

[8] Rocco MV.More frequent hemodialysis: back to the future? In: Advances in Chronic Kidney Disease. Volume 14, issue 3; 2007:e1-9.

[9] Daily therapy study results compared^{[dead link]}

[10] Blake P, Daugirdas J. Physiology of Peritoneal Dialysis. In: Handbook of Dialysis. 4th ed. New York, NY; 2008:323-338

[11] Kallenbach J.Z. In: Review of hemodialysis for nurses and dialysis personnel. 7th ed. St. Louis, Missouri:Elsevier Mosby; 2005.

[12] "Access". Medscape. http://www.medscape.com/medline/abstract/15293039. Retrieved 2011-09-02.

[13] "Access". Medscape. http://www.medscape.com/medline/abstract/17517814. Retrieved 2011-09-02.

[14] "Access". Medscape. http://www.medscape.com/medline/abstract/17999333. Retrieved 2011-09-02.

[15] "Access". Medscape. http://www.medscape.com/medline/abstract/1904625. Retrieved 2011-09-02.

[irwin-16] Irwin, Richard S.; James M. Rippe (2008). Irwin and Rippe's intensive care medicine. Lippincott Williams & Wilkins. pp. 988–999. ISBN 0-7817-9153-7, 9780781791533.

匿名

検索

案内

案内

dialysis machine