Talk:Dialysis

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Adding more information to the Dialysis article[edit]

We would like to add more information to the introduction:

"For patients with stage 5, or End-Stage Kidney Disease (ESKD), the decline in kidney function occurred over a period of months to years until a level was reached at which treatment was needed for survival. Unlike Acute Renal Failure (ARF) (Acute Kidney Injury (AKI)), cannot be cured or reversed and long-term treatments are needed to replace the lost functions of the kidney. The treatment for ESKD that most naturally replaces lost kidney function is a kidney transplant: http://en.wikipedia.org/wiki/Kidney_transplant]. However, some patients are not good candidates for a transplant due to medical or other reasons, some cannot receive a transplant because of the short supply of donor kidneys, and others simply decide that a transplant is not the best option for them. As a result, most patients with ESKD must rely on dialysis to replace the water and waste removal functions of the healthy kidneys."

We would also like to add more clarification to the Principles section (our additions in bold): Diffusion describes a property of substances in water. Substances in water tend to move from an area where they are in a high concentration to an area of low concentration. Blood flows by one side of a semi-permeable membrane, and a dialysate, or special dialysis fluid is on the opposite side. A semipermeable membrane is a thin layer of material that contains various sized holes, 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). The two main types of dialysis, hemodialysis (HD) and peritoneal dialysis (PD), remove wastes and excess water from the blood in different ways. Hemodialysis removes wastes and water by circulating blood outside the body through an external filter, called a dialyzer, that contains a semipermeable membrane. (http://en.wikipedia.org/wiki/Hemodialysis]

And at the end of Principles section we would like to add: In peritoneal dialysis, wastes and water are removed from the blood inside the body using the peritoneal membrane 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 bloodhttp://en.wikipedia.org/wiki/Peritoneal_dialysis).

Under Hemodialysis we would like to add (our additions in bold): In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing it to a semipermeable 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 the fibers, and water and wastes move between these two solutions.

And under Dialysis we would like to add (our additions in bold): In peritoneal dialysis, a sterile solution containing minerals and glucose is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a semipermeable 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). Renaldialysis (talk) 17:39, 24 November 2009 (UTC)

Needs major rewriting[edit]

Needs major rewriting so it sounds more professional. Alex.tan 06:12, 2 Apr 2004 (UTC)

I have done some rewriting and editing, but IANARF (I am not a Renal Physician, and therefore unqualified :). In my view, this copyvio-like stepwise list of a dialysis session still needs to be rewritten, but I utterly lack the drive to wade through this waffle. JFW | T@lk 18:09, 15 Jul 2004 (UTC)
I like the current version much better than what I wrote. I will take the blame for the original (unprofessional) stepwise list - but then, I'm not a professional!  :-) I did think the article needed a little more than a dry dictionary definition "Dialysis is the process of filtering blood..." and a little more about practically how dialysis happens. No doubt it can be improved further. I was suprised to see even small remanants of my original text left! I'd like to add a list of vascular access methods, as well as a list of nominal dialysis prescriptions by nation - it varies widely, as I understand.  :KBrown 16:51, 20 Jul 2004 (UTC)

Dialysis Catheters[edit]

It would be nice to have a section on dialysis catheters. 59.92.68.53 07:30, 21 May 2007 (UTC)

Please research it and write it! Hugely appreciated. JFW | T@lk 22:02, 16 Oct 2004 (UTC)

I am currently under going this but there is a large amount of text to go thro please bare with me and i will have a draft done and dusted at some point (I am not a Renal Physician, and therefore unqualified, i am a trainee renal doctor and a renal patient for 25 years hopefully it will give you a alternative look at things.)

( this is just a rough draft of what happens )

There are a vast amount of different ways practiced with dialysis catheters and different trement all around the globe i have been witness to 20 or so persuaders all with in the UK as far as am aware most are carried out in the same way. Please edit if they are incorrect.


Usually the patient is checked over prior to the operation standard tests blood work blood pressure temaputure, once the results are in the operation can begin most of theses operation are carried out with the patient under local anstic with some mild pain killers there are varied size's and makes of dialysis catheters they can be placed in ether side of the neck Chest, or groin and in extreme cases in the back adjacent to the kidneys. the side that it gos in depends on the doctor being right or left handed or if theres a medical problem with the patient.

A small incision is made above the main artery then the catheter is entered with in the artery in the direction of the blood flow about 5 to 6 inches is place in the artery, under controlled operations very little blood is lost, and the patient should not feel any of this once in the doctor then closes the skin around the bottom of the catheter once in then it is then attached to the patients body usually with 2 or 4 stitches once the doctor is happy that it is in place and is allowing blood to flow freely the patient is then released back to the real ward for obviation for half an hour if no sine’s of pain or discomfort or apparent the patient is usually free to go. Nice to be nice 09:46, 8 Apr 2005 (UTC)

Effectiveness of Dialysis[edit]

If anyone is familiar with the subject, I would be interested as to the effectiveness of dialysis as opposed to normal kidney function, and the effectiveness in the long-term. I have no knowledge to provide, but just a suggestion if anyone is up for it! --postglock 05:43, 13 Jun 2005 (UTC)

As a former dialysis patient, I can say it's a far cry from normal kidney function. Doctors say you can live on dialysis in theory forever, but I know people who have died while on dialysis, due to loosing fistula access, and places for fistulas. I was on peritoneal dialysis, and it's better than hemo dialysis, but again, not as effective as a normal kidney. --20px Spinboy 16:52, 13 Jun 2005 (UTC)

A good conventional dose of haemodialysis could be very roughly approximated to a glomerular filtration rate of 15 ml/min. Peritoneal dialysis is worse in terms of small molecule clearance (equivalent to a GFR of around 8-10ml/min), but has the advantage of being a continuous modality. It's normally recommended that dialysis is commenced when the glomerular filtration rate of the native kidneys is <15ml/min, so its not surprising people don't feel better on dialysis, you're not greatly improving the kidney function, just mantaining a level compatible with survival. Of course if you could have daily overnight dialysis you'd achieve a respectible clearance perhaps equivalent to a GFR of around 35ml/min. Roughly "Normal" GFR >90ml/min/1.73m2 decreasing by 0.9ml/min per year after 40. John Prowle (talk · contribs).

Useful documentation for this comparison can be found on p. 1 of Gabriel Danovitch, 'Handbook of Kidney Transplantation' (Philadelphia: Lippincott, 2001), where he states that "the most efficient hemodialysis regimens currently provide only 10% tp 12% of the small solute removal achieved by two normally functioning kidneys." This comment should be updated, however, by reference to data from the new programs of short- and long-daily home hemodialysis performed six days or nights a week, which improve solute clearance, although still fall far short of achieving what normal kidneys can do. User: JP Marat —Preceding unsigned comment added by 74.198.12.3 (talk) 19:29, 28 May 2010 (UTC)

Splitting the article[edit]

I think it makes sense to split the dialysis article into 'hemodialysis' and 'peritoneal dialysis.' I think they are very different. Any thoughts? Nephron 02:43, 14 July 2005 (UTC)


I agree Dr B2 (talk) 08:24, 28 May 2009 (UTC)

Haemodialysis - Ultrafltration[edit]

There's a major error in the haemodialysis explaination, the text implies that water is removed by passage down an osmotic gradient, this is untrue for all except the earliest (post 1950s) haemodialysers.

Small molecules (Urea, etc) pass down a concentration gradient for that molecule into the dialysate. Water, however, passes down a pressure gradient form blood side to dialysate side (lower pressure) the rate of water loss is determined by alterng this trans-membrane pressure gradient. Sodium Chloride then equilbrates with the water lost. This process is termed ultrafiltration. Unlike Peritoneal Dialysis there is no osmotic gradient in conventional Haemodialysis.

  • fixedHswapnil 16:00, 3 October 2005 (UTC)

Steps of dialysis[edit]

the whole section about what happens when a patient comes for dialysis sounds out of place...should we make it a separate subheading? (rather than scrapping it altogether, i guess a patient going for the first time may find it useful)Hswapnil 19:03, 28 October 2005 (UTC)

Please edit this according to your experience. I've found it a bit dense to edit. JFW | T@lk 01:14, 30 October 2005 (UTC)
I made a start on it (sub-divided it) after splitting-out the hemodialysis section. I think it is useful... just needs a good re-work. Nephron 17:27, 17 December 2005 (UTC)

No Baxter? Over 50 dead are crying from the grave over another sign of US censorsip at wikipedia.[edit]

How come there isn't a single word about the "Baxter Althane" scandal on the entire Wikipedia, the failed CIA operation which probably tried to eliminate known kidney patient Osama bin Laden with poisoned dialysis equipment, but ended up killing about 50 people in Europe due to the two shipments being mixed up at the port?

What on earth are you talking about? Who censored what? Anyway, it sounds very fascinating but cannot be included unless you have neutral, previously published and verifiable material. If you could provide that, I see no immediate reason why the Baxter Althane issue cannot be covered. JFW | T@lk 15:18, 4 November 2005 (UTC)
Baxter Althane disaster... actually there is something on Wikipedia, nameless friend. Karmafist 04:30, 19 February 2006 (UTC)

Grafts?[edit]

Should something about grafts be mentioned under the types of access in hemodialysis? Along with fistulas and catheters, grafts are a very common method of access for hemodialysis (that's about all I know, however). -- Natalya 04:48, 21 November 2005 (UTC)

split[edit]

as Nephron suggested above, I am going to create two sub-divisions of HD and PD over the next few daysHswapnil 18:40, 12 December 2005 (UTC)

Go for it... it is something I haven't gotten around to doing. Nephron 02:57, 16 December 2005 (UTC)
i agree ... it shouldn't be merged from th beginning Dr B2 (talk) 08:26, 28 May 2009 (UTC)

Clean-up[edit]

Does anyone mind if I do a major clean-up on this article when I've finished on the PD and HD split pages? When that's done, it will make much of this page redundant, and the layout is appalling anyway. I think the focus on this page should really be about renal replacement therapy and the principles of dialysis-most of the rest of it could just be chucked. Whaddya think?Felix-felix 16:50, 30 January 2006 (UTC)

Go for it --KBrown 19:34, 31 January 2006 (UTC)

I'd turn this into a disambiguation page with links to hemodialysis, peritoneal dialysis, continuous veno-venous hemofiltration, "liver dialysis" and other possible meanings. JFW | T@lk 17:15, 1 February 2006 (UTC)

Proposed merge[edit]

I think there was sufficient agreement here for the split-- if you read the various comments here. I don’t see any compelling reason to re-open that discussion. Also, I don’t think a merge would be a good thing-- as it isn’t only hemodialysis that got split-out... there is also peritoneal dialysis. If you disagree feel free to voice your opinion here... or re-post the merge box with a link to this page (as opposed to the hemodialysis talk page). Nephron 04:35, 24 March 2006 (UTC)

Agreed, there's plenty on the HD and PD pages, this page needs stripping down, not remerging the daughter pages.Felix-felix 15:21, 26 March 2006 (UTC)

Slash and Burn[edit]

Finally done it, ditched most of the old article and added some basic explanatory stuff. I don't really think that there should be much more on this page except, perhaps links to other RRTs and extracorporeal therapies...I drank alot of coffee this morning, so let me know if I've gone over the top. CheersFelix-felix 11:41, 30 March 2006 (UTC)

Good stuff. I think the only thing-- is that it could have "main article" links, so that it is clear there are articles devoted to each HD and PD. Nephron  T|C 04:22, 31 March 2006 (UTC)
Good planFelix-felix 12:28, 31 March 2006 (UTC)

Kolff[edit]

We should really mention Willem Johan Kolff somewhere. JFW | T@lk 10:20, 17 July 2006 (UTC)

Not here.Hemodialysis, or preferably a history of dialysis article-it's a fairly big topic, Stewart Cameron has written a book about it I think.Felix-felix 13:31, 18 August 2006 (UTC)

More hack and slash[edit]

Heavy trimming on the external links, most of which were fairly good, but were not directly related to dialysis (renal diet recipes for example) most of these, if really needed should go on the chronic renal failure page. Also fixed some links in the indications section. I think this article is pretty good now...Or am I being a self deluded fool?Felix-felix 13:27, 18 August 2006 (UTC)

I think the article has improved considerably. That said, I think a few of the references got lost and I think some of the discussion about the initiation of dialysis was better in this earlier version of the article. Being a strong proponent of references, I think a few things need to be referenced. Nephron  T|C 03:24, 20 November 2006 (UTC)
No disagreement from me-all these articles need loads more refs, and 'm terrible at putting them in!Felix-felix 08:06, 20 November 2006 (UTC)

Other use of "dialize"[edit]

Another use of the term "dialize" and related terms occurs in the formulation of buffers particularly buffers for stabilizing protein solutions. I am not familiar enough with the process, but I think it should be noted and expanded upon if possible. —The preceding unsigned comment was added by Williamheyn (talkcontribs) 20:27, 21 December 2006 (UTC).

Revert to "22:50, 30 December 2006 GermanX"[edit]

I reverted to the version "22:50, 30 December 2006 GermanX". This article is not meant to be a description of hemodialysis or peritoneal dialysis-- as those already have separate articles. The discussion to split the dialysis article was made a while ago and discussion of it is found above. I will add a few comments to the article to make this clear that the sub-articles are the place to write more about hemodialysis, peritoneal dialysis et cetera. Nephron  T|C 01:35, 8 January 2007 (UTC)


Pictures[edit]

Just to add to what Nephron sais above, this page was meant to be a disambi style page leading on to the main article pages, and I know we should try and get pictures into WP articles, but these are all from the respective main articles and, to my mind, clutter up the page, which I reckon should be as clear as possible.I vote chucking them out, any thoughts?Felix-felix 15:12, 8 January 2007 (UTC)

I think the pictures can go. Also, I think the page could be trimmed-- i.e. more of the info is moved to the subarticles. Nephron  T|C 00:59, 13 January 2007 (UTC)

Bloat[edit]

This article, which was concieved mainly as a disambiguation style page, perhaps including a few other generalities (indications for dialysis, for example) is bloating rapidly. Hemodiafiltration does not need a section of it's own here (or IMO an article of it's own, unless someone wants to make a decent article, a hard task in my view.)-especially when the section, and the existing article are taken straight from the hemofiltration article. The pictures culled from theoriginal articles are bloat too. I've already deleted the 'Which is Best' section which was content free and didn't even define it's terms. Unless there are serious objections, I'm going to get out my pruning shears and trim mercilessly.Felix-felix 10:09, 18 January 2007 (UTC)

  • Oops...I may have stepped on toes, because I just added some pictures without noticing these discussions. I think that this is more than a disambiguation page, but rather an introduction to dialysis page. Hence, pictures are appropriate in my mind. Again, I didn't notice the debate on this page (now 5 months old) before making my changes.Gaff ταλκ 06:26, 4 June 2007 (UTC)

I believe Dialysis should be derived etymologically from "dia" and "lysis", not "dia" and "lusis". "Lysis" means breaking down. Regards, Anil Raj

Convection vs. Osmosis[edit]

Osmosis is the diffusion of water but in dialysis water moves from one side of the membrane to the other via convective force. From the linked reference the Kidney Atlas "Hydrostatic ultrafiltration also takes place during hemodialysis. Because the spent dialysate effluent pump (see Fig. 1-4) creates negative pressure on the dialysate compartment of the membrane unit and the blood pump creates positive pressure in the blood compartment, there is a net hydrostatic pressure gradient between the compartments. This causes a flow of water and dissolved substances from blood to the dialysate compartment. The process of solute transfer associated with this flow of water is called “convective transport.” In hemodialysis, the amount of low–molecular weight solute (eg, urea) removed by convection is negligible. In the continuous renal replacement therapies, this is a major mechanism for solute transport."BillpSea (talk) 22:22, 3 August 2008 (UTC)

AWAK merger[edit]

I think Automated wearable artificial kidney would make for a good "future technologies" section. However, we should take care include both sections on hemofiltration and peritoneal dialysis. There are a few papers out there about such attempts. I will try to list/track some down. Chaldor (talk) 06:03, 23 September 2008 (UTC)

  • Additionally, I don't think the page can stand on its own because of WP:NOTABILITY and WP:NEO issues. Thus it must either be merged under a more general context, or deleted. Chaldor (talk) 21:41, 23 September 2008 (UTC)
  • Oppose
  • I didn't quite see this article as a disambiguation page initially, but that does make sense. Here's my concern: the three articles mentioned are dealing with the same general idea, each with varying levels of spcificity. Artificial kidney is the most broad of these three. Would it make sense to move the content of the other two articles into the Artificial kidney article? You said the three are not the same thing, but they're all the same category of device. The other two are just subtypes of artificial kidney. I think they could fit neatly into a subcategory within that article. This is just an organizational issue. If you look at the way things are now, WK and AWAK have their own articles and both were created from a business-centric position to advocate a position. In my opinion, both of these fail the WP:NOTABILITY criteria for articles (not content) and also violate the WP:NEO guidelines. Chaldor (talk) 01:22, 5 October 2008 (UTC)
I think there is a distinction to be made between a mechanical/chemical device and a bio-engineered (or tissue engineered) device.
The Artificial kidney article clearly states it deals with bioengineered kidneys/bioartificial kidneys that are grown from renal cell lines/renal tissue.
I think tissue engineered vs. non-tissue engineered is a good division (though I'll concede that bioreactors could straddle the division). The articles implicitly have this (tissue engineered vs. non-tissue engineered) division. The reasons these two sets of devices do not exist are quite different. To my knowledge, the short of the long of it is that:
  • The former (non-tissue engineered -- which depend on the concept of dialysis (biochemistry)) doesn't exist as the dialysate volumes required for adequate dialysis are too large to carry around.
  • The later (tissue engineered) doesn't exist as we just don't know enough about tissue engineering-- the best, AFAIK, anyone has done is tissue engineer skin.
Nephron  T|C 19:08, 5 October 2008 (UTC)
  • I understand the distinction you are making. They are definitely separate ideas/methods/implementations, but isn't the definition you are making for artificial kidney simply arbitrary, and if used in the didactic as you are proposing, constitutes a neologism? I thought the term itself was just describing a general idea, and not a specific implementation. I didn't know that the term artificial kidney couldn't be extended to a small mechanical dialysis machine, and there are no obvious references in the article that define the usage of the term to strictly tissue-engineered organs. To me, it makes sense to have both methods of implementation under the same article as they are both different approaches for creating an artificial kidney, be it made of tissue or plastic. I'm all for explaining why neither type exists yet and the respective difficulties each implementation faces. Additionally, given how there is relatively little content across all three articles, wouldn't it make sense to synthesize the content and present one complete article that discusses all the current (and past) attempts (across all the varying approaches) at creating artificial kidneys? Chaldor (talk) 20:12, 5 October 2008 (UTC)
I merged based on what we had already agreed on -- see Talk:Wearable_artificial_kidney. We probably can merge in the other article too. Nephron  T|C 18:40, 1 November 2008 (UTC)
Hi, I would like to make some changes to the point on AWAK that cartridge replacement is not necessary. IT is necessary after the cartridge is saturated with toxins removed from the body. Limjason (talk) 06:14, 4 November 2008 (UTC)

Intestinal dialysis[edit]

I've restored the deleted intestinal dialysis section. It was deleted for an invalid reason. That it is "fringe" or represents a small percentage is not a valid wikipedia excuse for a peer review researched procedure. It may be an excuse for not having a separate article, but wikipedia articles are often more complete than mere textbooks or desk references, and qualifying material shouldn't be excluded out of mere prejudice, since most new ideas start out as fringe. Plate tectonics was fringe for several decades before it became accepted in the 1960s. One interesting thing about intestinal dialysis, is that as a non-invasive procedure, it could easily be used to supplement and perhaps improve the results of standard dialysis, or to delay the need for it.--68.35.3.66 (talk) 12:27, 15 August 2009 (UTC)

The daily metabolic load of fixed hydrogen ions[edit]

What is "the kidneys remove from the blood the daily metabolic load of fixed hydrogen ions" in the first paragraph referring to? I don't find anything about this in Kidney.--Biologos (talk) 12:16, 5 October 2009 (UTC)

In the meantime I found out that this is almost a word-by-word quote from http://www.kidneyatlas.org/book5/adk5-01.ccc.QXD.pdf (the current reference no. 1), and that it refers to the so-called fixed acids. I changed the sentence into something that is - hopefully - more understandable.--Biologos (talk) 13:55, 2 November 2009 (UTC)

The first couple of sentences should include what dialysis is![edit]

The article breaks immediately into what it is used for without saying that it is a technique to artificially replace lost kidney function—I can only assume that's what it is because the article is so unclear. I'm sure it's much more useful for a person with a medical background but to the layperson this article is useless. —Preceding unsigned comment added by 78.86.61.94 (talk) 18:07, 29 March 2011 (UTC)

PE and arterial disease[edit]

doi:10.1111/j.1538-7836.2012.04921.x - primary study in JTH showing doubled risk of pulmonary embolism with a high standardised mortality ratio. JFW | T@lk 14:28, 13 December 2012 (UTC)