Hemodialysis: A Comprehensive Analysis of Equipment and Training

This report offers a comprehensive overview of hemodialysis, a crucial procedure for individuals with impaired kidney function. It details the workings of hemodialysis equipment, including brands like Baxter and B. Braun, and compares it with peritoneal dialysis. The report explores common complications such as fluid shifts, infections, and vitamin deficiencies, as well as the importance of dialysis technician training. It emphasizes the demand for skilled technicians and highlights the training programs available. The report concludes with a summary of the hemodialysis process and its significance in renal replacement therapy, referencing several academic sources for further information. This report is designed to provide a thorough understanding of hemodialysis, covering its various aspects from equipment and procedures to potential complications and training requirements.

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Introduction
Hemodialysis refers to the procedure of purifying the blood of an individual who
manifests signs of impairment in the functioning of the kidneys. Dialysis helps in removal of
waste materials like urea, creatinine, and free water from the circulating blood when the kidneys
demonstrate a failure to do so (1). Hemodialysis is the standard for renal replacement therapy,
and is particularly used for replacing function of the kidneys.
Working of equipment
At the beginning of the treatment, a dialysis technician or nurse inserts two needles in the
arm of the patient, both of which remain connected to a soft tissue that is attached to the dialysis
machine. This machine is responsible for pumping blood through the filter, following which the
blood is returned to the human body (2). While conducting the procedure, the machine regularly
keeps a check on the blood pressure of the patient, and also controls the speed with which blood
flow occurs through the filter and the removal of fluid from the body. Blood enters the machine
at one end and gets transferred to several hollow and thin fibers (3). Upon passing through the
hollow fiber, the dialysis solution moves in an opposite direction outside that helps in movement
of waste products from the bloodstream to the solution. The filtered blood stays in the fibre, and
is returned to the body through the other tube that is attached to the arm of the patient.

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Brands and price
Some of the most popular brands of hemodialysis equipment include Baxter, Alaris,
Hospira, B.Braun, and Sigma, all of which are commonly used across different hospitals. The
price for a B Braun Dialog plus Dialysis Machine in the USA approximately begins from
US$2,950.00. While the price for 1 unit of a Baxter 550 Dialysis machine is an estimated
US$2450 that of an Alaris Medley Infusion Pump is US$2,395.00.
Types or models
There are two to main kinds of dialysis namely, peritoneal dialysis and
hemodialysis. While hemodialysis is based on usage of equipment and a filter for removal of
water and waste products from the blood, peritoneal dialysis focuses on usage of the dialysate,
which is typically inserted in the abdominal cavity of the patient for removing excess fluids and
waste products from the body. The basic difference between the two can be accredited to the fact
that hemodialysis focuses on usage of a man made membrane for cleaning the blood, in
comparison to peritoneal dialysis that utilizes the lining of the stomach (4). Peritoneal dialysis is
a better approach since it offers flexible schedule, and also allows administration of the treatment
at home. Peritoneal dialysis is an improved procedure since it does not require as much
electricity and water quality, as hemodialysis (5). In addition, it does not impose any limitations
on independence of the patients undergoing the procedure, and is less complicated. In contrast,
hemodialysis requires adequate time for cleaning of the equipment and setup, and huge expenses
are associated with the machines.

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Common complications
Some common problems that are associated with hemodialysis are fluid
shifts, anticoagulation related, access related, first use syndrome, cardiovascular complications,
and vitamin deficiency. Hemodialysis typically encompasses removal of fluid through
ultrafiltration, since the patients suffering from renal failure pass negligible amount of
urine. However, side effects that are associated with removal of fluid include fatigue, leg cramps,
low blood pressure, headache, chest pain and nausea (6). The severity of the aforementioned
symptoms is directly related to the speed and amount of fluid removal. Taking into consideration
the fact that hemodialysis necessitates access to the cardiovascular system; the patients are often
exposed to different microbes that eventually lead to infection. This often creates an impact on
the valves of the heart, commonly known as endocarditis, or affects the bones, known as
osteomyelitis (7). There remains the risk of bleeding, and appropriate infection control practices
must be followed.
Although heparin is commonly used in the form of anticoagulant during hemodialysis,
heparin hypersensitivity is commonly reported by patients, and it results in a low platelet count.
One rare but severe anaphylactic reaction is the first use syndrome, in relation to the artificial
kidney. Common signs and symptoms include shortness of breath, sneezing, chest pain,
wheezing or sudden death (8). Not only is hemodialysis associated with neuropathy,
hemodialysis associated amyloidosis and different types of cardiac disease, but also leads to
folate deficiency amongst patients. An increase in the length and frequency of hemodialysis
treatment has been found to bring about in enhancement of fluid overload, and it also leads to
enlargement of heart. Owing to the aforementioned complications, the prevalence of alternative

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medicine and complementary medicine use it is reportedly high among individuals undergoing
hemodialysis.
Dialysis training
As per reports, dialysis technicians are in huge demand. Despite the fact that there is no
particular listing for this specific occupation in the U.S. Department of Labor’s Bureau of Labor
Statistics, an anticipated 5 million new jobs are expected to be generated by the year 2022. It has
also been reported by the National Kidney Foundation that as much is 20 million Americans
suffer from chronic renal disease, and the proportion of individuals suffering from diabetes
mellitus, which has been identified to be a risk factor for renal disease, continues to increase. A
Dialysis Technician Program is offered by the Manhattan Institute, with the aim of preparing
individuals for their employment across a range of clinical settings such as nursing
home, hospital, long-term care facilities and dialysis centers (9). This training will make the
individuals efficiently operate the equipment, while showing adherence to strict protocols,
thereby guaranteeing effective and safe health outcomes for the patients who are subject to the
hemodialysis procedure.
Conclusion
To conclude, hemodialysis refers to the treatment procedure that helps to filter excess
water and wastes from the blood of patients having renal failure. The principle of hemodialysis
equipment is based on the mechanism of counter current flow where dialysate moves in a
direction opposite, to that of the flow of blood in the extracorporeal circuit. Thus, the
hemodialysis process involves pumping of blood from the patient through the machine, which is
known as the dialyzer or an artificial kidney.

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References
1. Evangelidis, Nicole, Allison Tong, Braden Manns, Brenda Hemmelgarn, David C.
Wheeler, Peter Tugwell, Sally Crowe et al. "Developing a set of core outcomes for trials
in hemodialysis: an international Delphi survey." American Journal of Kidney
Diseases 70, no. 4 (2017): 464-475.
2. Grant, Kevin L., Michael J. Wilt, Brian D. Tracey, Brett A. Rudolf, David E. Collins,
Lisa A. Gustin, James D. Dale, and Jesse T. Bodwell. "Hemodialysis system." U.S.
Patent 9,724,458, issued August 8, 2017.
3. Mashkoor, A. (2016, May). The hemodialysis machine case study. In International
Conference on Abstract State Machines, Alloy, B, TLA, VDM, and Z (pp. 329-343).
Springer, Cham.
4. Khan, M. A., & Hussain, A. (2019). Haemodialysis Membranes: A Review. J Membr Sci
Technol, 9, 199.
5. Burbank, Jeffrey H., James M. Brugger, Dennis M. Treu, and Mark T. Wyeth.
"Peritoneal dialysis systems, devices, and methods." U.S. Patent 9,861,733, issued
January 9, 2018.
6. Zwang, Nicholas A., Sagar U. Nigwekar, and David JR Steele. "Hemodialysis
Complications." In Core Concepts in Dialysis and Continuous Therapies, pp. 39-51.
Springer, Boston, MA, 2016.
7. Sharma, A., D. Vadehra, P. Montesano, and A. Singvi. "Staphylococcus Epidermidis and
Hemodialysis: A Deadly Duo Causing Native Valve Endocarditis." In C53. CRITICAL
CARE CASE REPORTS: YOU GIVE ME (MORE) FEVER-INFECTION AND SEPSIS,
pp. A5308-A5308. American Thoracic Society, 2018.

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8. Shindo, Mitsutoshi, Susumu Ookawara, Taisuke Kitano, Hiroki Ishii, Haruhisa
Miyazawa, Kiyonori Ito, Yuichiro Ueda, Keiji Hirai, Taro Hoshino, and Yoshiyuki
Morishita. "Sustained severe intestinal edema after nafamostat mesilate-associated
anaphylactic reaction during hemodialysis." nefrologia 39, no. 2 (2019): 202-204.
9. Manhattan institute. "Dialysis Technician Training NYC - The Manhattan Institute".
2020. Manhattaninstitute.Edu. https://www.manhattaninstitute.edu/courses/dialysis-
technician.