IN THE NAME OF GOD

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IN THE NAME OF GOD
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????? ? ??????? ???? ??

• ???? ????
• ????? 1388

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1- ??? ????

• ??? ???? ?? ????? ?????
• (Parallel Plate )
• ? ???? ????????? ??????
• ( Hollow Fiber )

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??????? ?????

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  ?? ???? ??? ?????? ?? ????? ???? ????????? ????
  ?? ????? .
• ???? ???? ??? ????????? ? ???? ??? ??????? ?
  ???? ???? ????? ??????? ???? ?? ???? ?? ???????
  ?? ??? .

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??? ???? Surface Area

• ??? ???? ????? ?????? ??? ?? ????
  ??? ?????????
• ??? ???? ????? ????? ?? ???? ???
  ????
• ???? ?? ????? ???? ????? ?? 0.4??? ???? ??
  1.3???????
• ?? ????? .
• ?? ?? ??? ???? ????? ???? ? ??? ??????? ?? ??
  ????? ??? .

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Mass Transfer coefficient

• KOA ?? ???? ??? ?????? ???? ??Mass Transfer
  coefficient ) ( ?????? ???? ???? ???? ??? ?? ??
  ???? ???? ????? ? ????? ???? ? ?????? ???? ?
  ????? ????? ??? ? ???? ?????? ???? ?? ??? .
• KOA ?? ???? ????? ??? ?? ???? ??? ??????? ??
  ???? ?? ??????? ?? ???? ?? ??? ?? ????.
• KOA ?? ??? ????? ?????? ????? ?? ????? ???? ????
  ?? ????? ???? ?? ???? ??? ?? ?? ????? ???? ?????
  ??? ? ????? ?????? ???.
• KOA ???? ???? ??????? ?? ???? ??? ?????? ??? 200
  ?? 1100 ?? ????? ????? ????.

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??? ?? ??????? ?? ( Fluid Removal )

• ??????? ???? ?? ???? ?? ?? ???? ????? ????
  ?????? ??
• ??? ?????? ?????? ???? ????
• ???? ???????? ????? ?? ???? ?????? ??

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KUF

• ???? ????? ???? ?? ??
• ??? ???? ????? ??? ?? ???? ???? ?? ???? ?? ??
  ?????
• ????? ?? ??? ?? ???? ( MM Hg ) ???? ??? ???? ????
• ???? ??????????????? ?? KUF ?????? ?? ??? .
• KUF ????? ???? ???? ????? ????? ???? ?? ??
  TMP
• KUF ???????? ???? ????? ????? ???? ?? ??
  TMP

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High-Efficiency andHigh-Flux Hemodialysis
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Definitions of flux, Permeability, and efficiency

• Flux Measure of ultrafiltration capacity
  Low and high flux are based on the
  ultrafiltration coefficient(Kuf) Low
  flux Kuf lt 10 ml/h/mmHg High flux Kuf
  lt 20 ml/h/mmHgPermeability Measure of the
  clearance of the middle molecular weight molecule
  
• (eg, ß2-microglobolin) General
  correlation between flux and Permeability
  Low Permeability ß2-microglobolin
  clearancelt10ml/h/mmHg High Permeability
  ß2-microglobolin clearancelt20ml/h/mmHgEfficiency
  Measure of urea clearance Low and
  high efficiency are based on the urea KoA value
  Low efficiency KoA lt500 ml/min
  High efficiency KoA lt500 ml/min

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Classification of High-Performance Dialysis

• High-Efficiency Low-flux hemodialysis
• High-Efficiency High-flux hemodialysis
• Low-Efficiency High-flux hemodialysis

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Characteristics ofHigh-Efficiency Dialysis

• Urea clearance rate is usually gt210 ml/min
• Urea KoA of the dialyser is usually gt600 ml/min
• Ultrafiltration coefficient of the dialyser(Kuf)
  
• maybe high or low
• Clearance of middle molecular weight molecules
• maybe high or low
• --------------------------------------
• Ko- mass transfer coefficient A- surface area

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Differences between High and Low-Efficiency
Hemodialysis
High Efficiency, ml/min Low Efficiency, ml/min
Dialyzer KoA 600 lt500
Blood flow 350 lt350
Dialysate flow 500 lt500
Bicarbonate dialysate Necessary optimal

• Ko- mass transfer coefficient A- surface area

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Causes of High-Efficiency Dialysis Failure

• Access-related Low blood flow rate
  High recirculation rate
• Time-related Patient not adherent to
  prescribed time Staff not adherent to
  prescribed time Failure to adjust time
  for conditions
• such as alarm, dialysate bypass, and
• hypotention

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Benefits High-Efficiency Dialysis

• Higher clearance of small solutes, such
• as urea, compared with conventional
  dialysis without increase in treatment
• time
• Better control of chimistery
• Potentially reduced morbidity
• Potentially higher patient survival rates

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Characteristics of High-Flux dialysis

• Dialyzer membranes are characterized by a high
• ultrafiltration coefficient(Kufgt20
  ml/h/mmHg
• High clearance of middle molecular weight
  molecules
• occurs (eg, ß2-microglobolin)
• Urea clearance can be high or low, depending on
  the
• urea KoA of the dialyzer
• High-flux dialysis requires an automated
• ultrafiltration control system

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Technical requirements for High-Flux dialysis

• High-Flux dialyzers
• Automated ultrafiltration control system

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Potential Benefits of High-Flux Dialysis

• Delayed onset and risk of dialysis-related
  amyloidosis
• because of enhanced ß2-microglobolin
  clearance
• Increased patient survival resulting from higher
  
• clearance of middle molecular weight
  molecules
• Reduced morbidity and hospital admissions
• Improved lipid profile
• Higher clearance of aluminum
• Improved nutritional status
• Reduced risk of infection
• preserved residual renal function

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Limitation of High-Flux Dialysis

• Enhanced drug clearance, requiring
• supplemental dose after dialysis
• High cost of dialyzers

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• ?????? ???? ????? ??? ?? ????? ?????? ??
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• ?? ??? ?? ????? ?? ????? ?? ????? ??????
• ????? ? ???? ??? ??? .

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???? ???????

• ?????????? 60kg ?? 160cm ?? ?? ???? .
• 1 ?????? ??? (V)? ?? ??? ??? 32 ???? ?? 32000
  ???? ????
• 2 - ?????? ???? (T) ? 4 ???? ?????? ????? ?? 240
  ?????
• 3 - ????? K.T/V ??? ? K.T/V ????? ?? ?? ????
  ??????3/1
• K.T/V 1/3
• ( K . 240) / 32000 1/3
• K ( 1/3 . 32000) / 240173
• K 173
• ??????? ???? ???? R5 ?? ???? ??? 200 ???? ???? ??
  ????? ???? 170 ???? ???? ?? ???? ?? ???? ??
  ?????? ??? ???? ? ????? ????? ??? ?????? ?? 200
  ???? ???? 250 ???? ???? ?? ????? ?? ??????? ?????
  ???? .