Talk:Hemodialysis

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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)

the picture of the hemodialysis circuit should be looked at again due to venous and arterial have been swtched around falsifying how dialysis is done...thanks you...dialysis tech — Preceding unsigned comment added by 98.192.209.226 (talk) 15:51, 15 September 2011 (UTC)

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)

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)

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].

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.  Felix Felix 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:
 * How far are we from an artifical kidneys?
 * What barriers are there to creating an artifical kidney?
 * Where is the focus of current research on artifical kidneys?
 * 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.
 * 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.
 * 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.
 * 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.
 * Wang PC, Takezawa T. Reconstruction of renal glomerular tissue using collagen vitrigel scaffold. J Biosci Bioeng. 2005 Jun;99(6):529-40. Review.
 * 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.)?  Felix Felix 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)
 * I support you on that. JuJube 07:26, 10 May 2007 (UTC)


 * I agree totally with Nephron. With breakthrough discoveries on the horizon, this article could really take off.  To my mind, the most important distinction between HD and "artificial kidney" is portability and continuous duty, neither of which presently exist.
 * Badly Bradley 23:40, 26 May 2007 (UTC)

Article order
This article is getting better, mainly due to input from User:jtdaugir. The article as a whole reads quite badly, I think, the order of the sections is counterintuitive, perhaps principle first, then history, then prescription, then access ,then side effects and then equipment? Could we do with more references? How about more or better pictures (especially a better semi-permeable membrane one!)? It would be nice to work towards GA or even FA, what do we think?  Felix Felix talk 16:46, 24 April 2007 (UTC)

Nocturnal HD
(Culleton et al, JAMA 2007) is likely to cause a stir. JFW | T@lk  07:32, 23 September 2007 (UTC)
 * It isn't really that much of a surprise -- if you read the home hemodialysis article which is referenced out the wazhoo. There is a nocturnal hemodialysis article already-- it redirects to HHD. :-)  There is a good deal of observational data to suggest NHHD is better than CHD. The naysayers want a study... so it is happening. I ref'ed the pilot study (of the JAMA article) in the HHD article-- see ref 14. Nephron  T|C 22:05, 23 September 2007 (UTC)

A cannulation section?
Obviously if you have a graft or fistula hemodialysis will require cannulation - there are good citations available cannulation camp from a renal network could be the basis for a section. BillpSea 04:55, 27 September 2007 (UTC)
 * I think this is a bit off the beaten path for the hemodialysis article. Perhaps it is time to split-out vascular access / link with Main article --see dialysis if you don't know what I mean by this-- and create a template to link together the vascular access related articles (Cimino fistula, dialysis catheter, vascular access steal syndrome...).  I think cannulation camp might fit into an article like that; the hemodialysis article, IMHO, ought not go to that level of detail. Nephron  T|C 07:33, 27 September 2007 (UTC)

A self-care section?
There was just a nice outline of incenter self-care and its clinical advantages in Nephrology News & Issues as an insert from the non-profit Medical Education Institute Incontrol focus on self-care. And here is an article announcing a tenth self-care unit in CA so self-care is a current practice.BillpSea 04:55, 27 September 2007 (UTC)
 * Speaking again to what I wrote above-- a section probably is a bit much for the purpose of the hemodialysis article. That said, I think the fact that self-canulation ought to be encouraged is worth mentioning--along with the advantages/reasons self-canulation is encouraged. Nephron  T|C 07:40, 27 September 2007 (UTC)

profiling on a hemodialysis
Somebody can tell about profiling on a hemodialysis? —Preceding unsigned comment added by 92.39.65.81 (talk) 20:47, 18 November 2008 (UTC)
 * Sodium profiling? A setting on the newer hemodialysis machines? I think what is needed is a discussion of the three fluid compartments in the body - the problem with hemodialysis is that it only cleans/treats the blood compartment leaving 6/7 of the fluid in the body untreated. Sodium modeling fits in here because it can allow higher rates of fluid withdrawal by increasing transport between the fluid spaces. It would be hard to discuss the specific features of a specific machine but I do think the concept of sodium modeling could find a place in a thorough explanation of the body's fluid structure - what dialysis is tryig to do vs. what the kidneys can manage.BillpSea (talk) 06:32, 19 November 2008 (UTC)

achilles tendon removed
I have removed the line, "Access is the achilles tendon for hemodialysis patients, since failure & complications of acess contribute to a majority of deaths in patients on hemodialysis." I fail to see how this makes any sense." How exactly does one canulate a tendon?173.171.151.171 (talk) 15:10, 10 February 2011 (UTC)


 * The fact that you can die from the needle falling out is a big deal (this is what an Achilles heel is, a weakness). I work on home hemodialysis systems which have Access Disconnect shut down, warning systems as well as many other safety features. When I read of folks bleeding out I thought this was all in the early years of hemodialysis. Should we, can we say that this is no longer a concern? Jeffhemm (talk) 19:44, 23 March 2023 (UTC)
 * no longer a frequent occurrence. I'm still concerned. Jeffhemm (talk) 19:50, 23 March 2023 (UTC)

This doesn't make sense to me
The dialysis solution that is used may be a sterilized solution of mineral ions or comply with British Pharmacopoeia. Doesn't make sense. I&#39;m wild (talk) 12:20, 11 May 2014 (UTC)

Emergencies
When stuff goes wrong: 10.2215/CJN.05260516 JFW &#124; T@lk  13:55, 8 February 2017 (UTC)

Reorg sections per MEDMOS
I'm doing a little reorg today to fit more with the MEDMOS. HD seems to sort of fit under procedures but also under treatments. BakerStMD 14:47, 17 March 2017 (UTC)

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Hyperthermia
Can we say something about use as emergency treatment for severe/atypical cases of hyperthermia? The hyperthermia article alludes to this in passing, links to this page, and this page makes so mention whatsoever. If the hyperthermia page is wrong, someone better educated than I should go verify it, or at least change the referral to this page as though it contained a more complete explanation of hemodialysis treatment for hyperthermia.

2600:8800:7D88:4150:B1FB:D206:A73B:7ADB (talk) 07:04, 23 November 2017 (UTC)

External links modified (January 2018)
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Two "Types" Sections?
Isn't this a bit odd? Perhaps one should be merged with the other or renamed. Evil Narwhal (talk) 23:56, 14 July 2021 (UTC)
 * Nice catch! The second one was added in this edit. I'm not sure why I didn't notice it at the time but I removed it. The IP that added the redundant heading did the same thing at the [[Dialysis catheter article, which I've also fixed. Graham 87 07:05, 15 July 2021 (UTC)