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class="vector-toc-link" href="#Fluid_shifts"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2.1</span> <span>Fluid shifts</span> </div> </a> <ul id="toc-Fluid_shifts-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Access-related" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Access-related"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2.2</span> <span>Access-related</span> </div> </a> <ul id="toc-Access-related-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Venous_needle_dislodgement" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Venous_needle_dislodgement"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2.3</span> <span>Venous needle dislodgement</span> </div> </a> <ul id="toc-Venous_needle_dislodgement-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Anticoagulation-related" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Anticoagulation-related"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2.4</span> <span>Anticoagulation-related</span> </div> </a> <ul id="toc-Anticoagulation-related-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-First-use_syndrome" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#First-use_syndrome"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2.5</span> <span>First-use syndrome</span> </div> </a> <ul id="toc-First-use_syndrome-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cardiovascular" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Cardiovascular"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2.6</span> <span>Cardiovascular</span> </div> </a> <ul id="toc-Cardiovascular-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Vitamin_deficiency" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Vitamin_deficiency"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2.7</span> <span>Vitamin deficiency</span> </div> </a> <ul id="toc-Vitamin_deficiency-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Electrolyte_imbalances" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Electrolyte_imbalances"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2.8</span> <span>Electrolyte imbalances</span> </div> </a> <ul id="toc-Electrolyte_imbalances-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Mechanism_and_technique" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Mechanism_and_technique"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Mechanism and technique</span> </div> </a> <button aria-controls="toc-Mechanism_and_technique-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Mechanism and technique subsection</span> </button> <ul id="toc-Mechanism_and_technique-sublist" class="vector-toc-list"> <li id="toc-Access" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Access"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Access</span> </div> </a> <ul id="toc-Access-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Types" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Types"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Types</span> </div> </a> <button aria-controls="toc-Types-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Types subsection</span> </button> <ul id="toc-Types-sublist" class="vector-toc-list"> <li id="toc-Conventional_hemodialysis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Conventional_hemodialysis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Conventional hemodialysis</span> </div> </a> <ul id="toc-Conventional_hemodialysis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Daily_hemodialysis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Daily_hemodialysis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Daily hemodialysis</span> </div> </a> <ul id="toc-Daily_hemodialysis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Nocturnal_hemodialysis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Nocturnal_hemodialysis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Nocturnal hemodialysis</span> </div> </a> <ul id="toc-Nocturnal_hemodialysis-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Equipment" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Equipment"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Equipment</span> </div> </a> <button aria-controls="toc-Equipment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Equipment subsection</span> </button> <ul id="toc-Equipment-sublist" class="vector-toc-list"> <li id="toc-Water_system" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Water_system"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Water system</span> </div> </a> <ul id="toc-Water_system-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Dialysate" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Dialysate"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Dialysate</span> </div> </a> <ul id="toc-Dialysate-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Dialyzer" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Dialyzer"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.3</span> <span>Dialyzer</span> </div> </a> <ul id="toc-Dialyzer-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Membrane_and_flux" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Membrane_and_flux"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Membrane and flux</span> </div> </a> <button aria-controls="toc-Membrane_and_flux-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Membrane and flux subsection</span> </button> <ul id="toc-Membrane_and_flux-sublist" class="vector-toc-list"> <li id="toc-Membrane_flux_and_outcome" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Membrane_flux_and_outcome"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.1</span> <span>Membrane flux and outcome</span> </div> </a> <ul id="toc-Membrane_flux_and_outcome-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Membrane_flux_and_beta-2-microglobulin_amyloidosis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Membrane_flux_and_beta-2-microglobulin_amyloidosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.2</span> <span>Membrane flux and beta-2-microglobulin amyloidosis</span> </div> </a> <ul id="toc-Membrane_flux_and_beta-2-microglobulin_amyloidosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Dialyzers_and_efficiency" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Dialyzers_and_efficiency"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.3</span> <span>Dialyzers and efficiency</span> </div> </a> <ul id="toc-Dialyzers_and_efficiency-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Reuse_of_dialyzers" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Reuse_of_dialyzers"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.4</span> <span>Reuse of dialyzers</span> </div> </a> <ul id="toc-Reuse_of_dialyzers-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>History</span> </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Hemodialysis</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 48 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-48" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">48 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%AF%D9%8A%D8%A7%D9%84_%D8%AF%D9%85%D9%88%D9%8A" title="ديال دموي – Arabic" lang="ar" hreflang="ar" data-title="ديال دموي" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Hemodializ" title="Hemodializ – Azerbaijani" lang="az" hreflang="az" data-title="Hemodializ" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target"><span>Azərbaycanca</span></a></li><li class="interlanguage-link interwiki-bn mw-list-item"><a href="https://bn.wikipedia.org/wiki/%E0%A6%B9%E0%A6%BF%E0%A6%AE%E0%A7%8B%E0%A6%A1%E0%A6%BE%E0%A6%AF%E0%A6%BC%E0%A6%BE%E0%A6%B2%E0%A6%BF%E0%A6%B8%E0%A6%BF%E0%A6%B8" title="হিমোডায়ালিসিস – Bangla" lang="bn" hreflang="bn" data-title="হিমোডায়ালিসিস" data-language-autonym="বাংলা" data-language-local-name="Bangla" class="interlanguage-link-target"><span>বাংলা</span></a></li><li class="interlanguage-link interwiki-bjn mw-list-item"><a href="https://bjn.wikipedia.org/wiki/Cuci_darah" title="Cuci darah – Banjar" lang="bjn" hreflang="bjn" data-title="Cuci darah" data-language-autonym="Banjar" data-language-local-name="Banjar" class="interlanguage-link-target"><span>Banjar</span></a></li><li class="interlanguage-link interwiki-be mw-list-item"><a href="https://be.wikipedia.org/wiki/%D0%93%D0%B5%D0%BC%D0%B0%D0%B4%D1%8B%D1%8F%D0%BB%D1%96%D0%B7" title="Гемадыяліз – Belarusian" lang="be" hreflang="be" data-title="Гемадыяліз" data-language-autonym="Беларуская" data-language-local-name="Belarusian" class="interlanguage-link-target"><span>Беларуская</span></a></li><li class="interlanguage-link interwiki-be-x-old mw-list-item"><a href="https://be-tarask.wikipedia.org/wiki/%D0%9A%D1%80%D1%8B%D0%B2%D1%8F%D1%87%D1%8B%D1%88%D1%87%D0%B0%D0%BD%D1%8C%D0%BD%D0%B5" title="Крывячышчаньне – Belarusian (Taraškievica orthography)" lang="be-tarask" hreflang="be-tarask" data-title="Крывячышчаньне" data-language-autonym="Беларуская (тарашкевіца)" data-language-local-name="Belarusian (Taraškievica orthography)" class="interlanguage-link-target"><span>Беларуская (тарашкевіца)</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%A5%D0%B5%D0%BC%D0%BE%D0%B4%D0%B8%D0%B0%D0%BB%D0%B8%D0%B7%D0%B0" title="Хемодиализа – Bulgarian" lang="bg" hreflang="bg" data-title="Хемодиализа" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Hemodijaliza" title="Hemodijaliza – Bosnian" lang="bs" hreflang="bs" data-title="Hemodijaliza" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target"><span>Bosanski</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Hemodi%C3%A0lisi" title="Hemodiàlisi – Catalan" lang="ca" hreflang="ca" data-title="Hemodiàlisi" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Hemodial%C3%BDza" title="Hemodialýza – Czech" lang="cs" hreflang="cs" data-title="Hemodialýza" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-de badge-Q70894304 mw-list-item" title=""><a href="https://de.wikipedia.org/wiki/H%C3%A4modialyse" title="Hämodialyse – German" lang="de" hreflang="de" data-title="Hämodialyse" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%91%CE%B9%CE%BC%CE%BF%CE%BA%CE%AC%CE%B8%CE%B1%CF%81%CF%83%CE%B7" title="Αιμοκάθαρση – Greek" lang="el" hreflang="el" data-title="Αιμοκάθαρση" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Hemodi%C3%A1lisis" title="Hemodiálisis – Spanish" lang="es" hreflang="es" data-title="Hemodiálisis" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%87%D9%85%D9%88%D8%AF%DB%8C%D8%A7%D9%84%DB%8C%D8%B2" title="همودیالیز – Persian" lang="fa" hreflang="fa" data-title="همودیالیز" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/H%C3%A9modialyse" title="Hémodialyse – French" lang="fr" hreflang="fr" data-title="Hémodialyse" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Haema-scagdheal%C3%BA" title="Haema-scagdhealú – Irish" lang="ga" hreflang="ga" data-title="Haema-scagdhealú" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target"><span>Gaeilge</span></a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Hemodi%C3%A1lise" title="Hemodiálise – Galician" lang="gl" hreflang="gl" data-title="Hemodiálise" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target"><span>Galego</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%ED%98%88%EC%95%A1%ED%88%AC%EC%84%9D" title="혈액투석 – Korean" lang="ko" hreflang="ko" data-title="혈액투석" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%80%D5%A5%D5%B4%D5%B8%D5%A4%D5%AB%D5%A1%D5%AC%D5%AB%D5%A6" title="Հեմոդիալիզ – Armenian" lang="hy" hreflang="hy" data-title="Հեմոդիալիզ" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%B0%E0%A4%95%E0%A5%8D%E0%A4%A4_%E0%A4%85%E0%A4%AA%E0%A5%8B%E0%A4%B9%E0%A4%A8" title="रक्त अपोहन – Hindi" lang="hi" hreflang="hi" data-title="रक्त अपोहन" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target"><span>हिन्दी</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Hemodijaliza" title="Hemodijaliza – Croatian" lang="hr" hreflang="hr" data-title="Hemodijaliza" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Hemodialisis" title="Hemodialisis – Indonesian" lang="id" hreflang="id" data-title="Hemodialisis" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/Bl%C3%B3%C3%B0skilun" title="Blóðskilun – Icelandic" lang="is" hreflang="is" data-title="Blóðskilun" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target"><span>Íslenska</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Emodialisi" title="Emodialisi – Italian" lang="it" hreflang="it" data-title="Emodialisi" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-kn mw-list-item"><a href="https://kn.wikipedia.org/wiki/%E0%B2%B9%E0%B2%BF%E0%B2%AE%E0%B3%8B%E0%B2%A1%E0%B2%AF%E0%B2%BE%E0%B2%B2%E0%B2%BF%E0%B2%B8%E0%B2%BF%E0%B2%B8%E0%B3%8D_%E0%B2%95%E0%B3%87%E0%B2%82%E0%B2%A6%E0%B3%8D%E0%B2%B0" title="ಹಿಮೋಡಯಾಲಿಸಿಸ್ ಕೇಂದ್ರ – Kannada" lang="kn" hreflang="kn" data-title="ಹಿಮೋಡಯಾಲಿಸಿಸ್ ಕೇಂದ್ರ" data-language-autonym="ಕನ್ನಡ" data-language-local-name="Kannada" class="interlanguage-link-target"><span>ಕನ್ನಡ</span></a></li><li class="interlanguage-link interwiki-kk mw-list-item"><a href="https://kk.wikipedia.org/wiki/%D0%93%D0%B5%D0%BC%D0%BE%D0%B4%D0%B8%D0%B0%D0%BB%D0%B8%D0%B7" title="Гемодиализ – Kazakh" lang="kk" hreflang="kk" data-title="Гемодиализ" data-language-autonym="Қазақша" data-language-local-name="Kazakh" class="interlanguage-link-target"><span>Қазақша</span></a></li><li class="interlanguage-link interwiki-ky mw-list-item"><a href="https://ky.wikipedia.org/wiki/%D0%93%D0%B5%D0%BC%D0%BE%D0%B4%D0%B8%D0%B0%D0%BB%D0%B8%D0%B7" title="Гемодиализ – Kyrgyz" lang="ky" hreflang="ky" data-title="Гемодиализ" data-language-autonym="Кыргызча" data-language-local-name="Kyrgyz" class="interlanguage-link-target"><span>Кыргызча</span></a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Hemodial%C4%ABze" title="Hemodialīze – Latvian" lang="lv" hreflang="lv" data-title="Hemodialīze" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target"><span>Latviešu</span></a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/Hemodializ%C4%97" title="Hemodializė – Lithuanian" lang="lt" hreflang="lt" data-title="Hemodializė" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target"><span>Lietuvių</span></a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%A5%D0%B5%D0%BC%D0%BE%D0%B4%D0%B8%D1%98%D0%B0%D0%BB%D0%B8%D0%B7%D0%B0" title="Хемодијализа – Macedonian" lang="mk" hreflang="mk" data-title="Хемодијализа" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target"><span>Македонски</span></a></li><li class="interlanguage-link interwiki-ml mw-list-item"><a href="https://ml.wikipedia.org/wiki/%E0%B4%B9%E0%B5%80%E0%B4%AE%E0%B5%8B%E0%B4%A1%E0%B4%AF%E0%B4%BE%E0%B4%B2%E0%B4%BF%E0%B4%B8%E0%B4%BF%E0%B4%B8%E0%B5%8D" title="ഹീമോഡയാലിസിസ് – Malayalam" lang="ml" hreflang="ml" data-title="ഹീമോഡയാലിസിസ്" data-language-autonym="മലയാളം" data-language-local-name="Malayalam" class="interlanguage-link-target"><span>മലയാളം</span></a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Hemodialisis" title="Hemodialisis – Malay" lang="ms" hreflang="ms" data-title="Hemodialisis" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target"><span>Bahasa Melayu</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Hemodialyse" title="Hemodialyse – Dutch" lang="nl" hreflang="nl" data-title="Hemodialyse" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E3%83%80%E3%82%A4%E3%82%A2%E3%83%A9%E3%82%A4%E3%82%B6%E3%83%BC" title="ダイアライザー – Japanese" lang="ja" hreflang="ja" data-title="ダイアライザー" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/Gemodializ" title="Gemodializ – Uzbek" lang="uz" hreflang="uz" data-title="Gemodializ" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target"><span>Oʻzbekcha / ўзбекча</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Hemodializa" title="Hemodializa – Polish" lang="pl" hreflang="pl" data-title="Hemodializa" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Hemodi%C3%A1lise" title="Hemodiálise – Portuguese" lang="pt" hreflang="pt" data-title="Hemodiálise" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Hemodializ%C4%83" title="Hemodializă – Romanian" lang="ro" hreflang="ro" data-title="Hemodializă" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target"><span>Română</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%93%D0%B5%D0%BC%D0%BE%D0%B4%D0%B8%D0%B0%D0%BB%D0%B8%D0%B7" title="Гемодиализ – Russian" lang="ru" hreflang="ru" data-title="Гемодиализ" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/Hemodial%C3%BDza" title="Hemodialýza – Slovak" lang="sk" hreflang="sk" data-title="Hemodialýza" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target"><span>Slovenčina</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%A5%D0%B5%D0%BC%D0%BE%D0%B4%D0%B8%D1%98%D0%B0%D0%BB%D0%B8%D0%B7%D0%B0" title="Хемодијализа – Serbian" lang="sr" hreflang="sr" data-title="Хемодијализа" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Hemodijaliza" title="Hemodijaliza – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Hemodijaliza" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B8%81%E0%B8%B2%E0%B8%A3%E0%B8%8A%E0%B8%B3%E0%B8%A3%E0%B8%B0%E0%B9%80%E0%B8%A5%E0%B8%B7%E0%B8%AD%E0%B8%94%E0%B8%9C%E0%B9%88%E0%B8%B2%E0%B8%99%E0%B9%80%E0%B8%A2%E0%B8%B7%E0%B9%88%E0%B8%AD" title="การชำระเลือดผ่านเยื่อ – Thai" lang="th" hreflang="th" data-title="การชำระเลือดผ่านเยื่อ" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Hemodiyaliz" title="Hemodiyaliz – Turkish" lang="tr" hreflang="tr" data-title="Hemodiyaliz" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%93%D0%B5%D0%BC%D0%BE%D0%B4%D1%96%D0%B0%D0%BB%D1%96%D0%B7" title="Гемодіаліз – Ukrainian" lang="uk" hreflang="uk" data-title="Гемодіаліз" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/Th%E1%BA%A9m_ph%C3%A2n_m%C3%A1u" title="Thẩm phân máu – Vietnamese" lang="vi" hreflang="vi" data-title="Thẩm phân máu" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target"><span>Tiếng Việt</span></a></li><li class="interlanguage-link interwiki-zh-yue mw-list-item"><a href="https://zh-yue.wikipedia.org/wiki/%E6%B4%97%E8%A1%80" title="洗血 – Cantonese" lang="yue" hreflang="yue" data-title="洗血" data-language-autonym="粵語" data-language-local-name="Cantonese" class="interlanguage-link-target"><span>粵語</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E8%A1%80%E6%B6%B2%E9%80%8F%E6%9E%90" title="血液透析 – Chinese" lang="zh" hreflang="zh" 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id="siteSub" class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical procedure for purifying blood</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical intervention</div> <style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above" style="background-color: lightblue">Hemodialysis</th></tr><tr><td colspan="2" class="infobox-image"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Hemodialysismachine.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/fc/Hemodialysismachine.jpg/280px-Hemodialysismachine.jpg" decoding="async" width="280" height="399" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/fc/Hemodialysismachine.jpg/420px-Hemodialysismachine.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/fc/Hemodialysismachine.jpg/560px-Hemodialysismachine.jpg 2x" data-file-width="1306" data-file-height="1861" /></a></span><div class="infobox-caption">Hemodialysis machine</div></td></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">kidney dialysis</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><span><span><a href="/wiki/Nephrology" title="Nephrology">Nephrology</a></span></span></td></tr><tr class="noprint"><td colspan="2" class="infobox-full-data"><div style="text-align: right;">[<a href="https://www.wikidata.org/wiki/Q391744" class="extiw" title="d:Q391744">edit on Wikidata</a>]</div></td></tr></tbody></table> <p><b>Hemodialysis</b>, <a href="/wiki/American_and_British_English_spelling_differences#ae_and_oe" title="American and British English spelling differences">also spelled</a> <b>haemodialysis</b>, or simply <b>dialysis</b>, is a process of filtering the blood of a person whose <a href="/wiki/Kidney" title="Kidney">kidneys</a> are not working normally. This type of <a href="/wiki/Kidney_dialysis" title="Kidney dialysis">dialysis</a> achieves the extracorporeal removal of waste products such as <a href="/wiki/Creatinine" title="Creatinine">creatinine</a> and <a href="/wiki/Urea" title="Urea">urea</a> and free water from the <a href="/wiki/Blood" title="Blood">blood</a> when the <a href="/wiki/Kidney" title="Kidney">kidneys</a> are in a state of <a href="/wiki/Kidney_failure" title="Kidney failure">kidney failure</a>. Hemodialysis is one of three <a href="/wiki/Renal_replacement_therapy" title="Renal replacement therapy">renal replacement therapies</a> (the other two being <a href="/wiki/Kidney_transplant" class="mw-redirect" title="Kidney transplant">kidney transplant</a> and <a href="/wiki/Peritoneal_dialysis" title="Peritoneal dialysis">peritoneal dialysis</a>). An alternative method for extracorporeal separation of blood components such as plasma or cells is <a href="/wiki/Apheresis" title="Apheresis">apheresis</a>. </p><p>Hemodialysis can be an <a href="/wiki/Outpatient" class="mw-redirect" title="Outpatient">outpatient</a> or <a href="/wiki/Inpatient" class="mw-redirect" title="Inpatient">inpatient</a> therapy. Routine hemodialysis is conducted in a dialysis outpatient facility, either a purpose-built room in a <a href="/wiki/Hospital" title="Hospital">hospital</a> or a dedicated, stand-alone clinic. Less frequently hemodialysis is done at <a href="/wiki/Home_hemodialysis" title="Home hemodialysis">home</a>. Dialysis treatments in a clinic are initiated and managed by specialized staff made up of nurses and technicians; dialysis treatments at home can be self-initiated and managed or done jointly with the assistance of a trained helper who is usually a family member.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Medical_uses">Medical uses</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=1" title="Edit section: Medical uses"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Plugged_into_dialysis.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/6/6e/Plugged_into_dialysis.jpg/220px-Plugged_into_dialysis.jpg" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/6e/Plugged_into_dialysis.jpg/330px-Plugged_into_dialysis.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/6e/Plugged_into_dialysis.jpg/440px-Plugged_into_dialysis.jpg 2x" data-file-width="1280" data-file-height="960" /></a><figcaption>Hemodialysis in progress</figcaption></figure> <p>Hemodialysis is the choice of <a href="/wiki/Kidney_dialysis" title="Kidney dialysis">renal replacement therapy</a> for patients who need dialysis acutely, and for many patients as maintenance therapy. It provides excellent, rapid clearance of solutes.<sup id="cite_ref-Daugirdas_2-0" class="reference"><a href="#cite_note-Daugirdas-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>A <a href="/wiki/Nephrologist" class="mw-redirect" title="Nephrologist">nephrologist</a> (a medical kidney specialist) decides when hemodialysis is needed and the various parameters for a dialysis treatment. These include frequency (how many treatments per week), length of each treatment, and the blood and dialysis solution flow rates, as well as the size of the dialyzer. The composition of the dialysis solution is also sometimes adjusted in terms of its sodium, potassium, and bicarbonate levels. In general, the larger the body size of an individual, the more dialysis they will need. In <a href="/wiki/North_America" title="North America">North America</a> and the <a href="/wiki/United_Kingdom" title="United Kingdom">UK</a>, 3–4 hour treatments (sometimes up to 5 hours for larger patients) given 3 times a week are typical. Twice-a-week sessions are limited to patients who have a substantial residual kidney function. Four sessions per week are often prescribed for larger patients, as well as patients who have trouble with <a href="/wiki/Fluid_overload" class="mw-redirect" title="Fluid overload">fluid overload</a>. Finally, there is growing interest in <a href="/wiki/Home_hemodialysis" title="Home hemodialysis">short daily home hemodialysis</a>, which is 1.5 – 4 hr sessions given 5–7 times per week, usually at home. There is also interest in <a href="/wiki/Nocturnal_dialysis" title="Nocturnal dialysis">nocturnal dialysis</a>, which involves dialyzing a patient, usually at home, for 8–10 hours per night, 3–6 nights per week. Nocturnal in-center dialysis, 3–4 times per week, is also offered at a handful of dialysis units in the <a href="/wiki/United_States" title="United States">United States</a>. </p> <div class="mw-heading mw-heading2"><h2 id="Adverse_effects">Adverse effects</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=2" title="Edit section: Adverse effects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Disadvantages">Disadvantages</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=3" title="Edit section: Disadvantages"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li>Restricts independence, as people undergoing this procedure cannot travel around because of supplies' availability</li> <li>Requires more supplies such as high water quality and electricity</li> <li>Requires reliable technology like dialysis machines</li> <li>The procedure is complicated and requires that care givers have more knowledge</li> <li>Requires time to set up and clean dialysis machines, and expense with machines and associated staff<sup id="cite_ref-Daugirdas_2-1" class="reference"><a href="#cite_note-Daugirdas-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Complications">Complications</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=4" title="Edit section: Complications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading4"><h4 id="Fluid_shifts">Fluid shifts</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=5" title="Edit section: Fluid shifts"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Hemodialysis often involves fluid removal (through <a href="/wiki/Ultrafiltration_(renal)" class="mw-redirect" title="Ultrafiltration (renal)">ultrafiltration</a>), because most patients with <a href="/wiki/Renal_failure" class="mw-redirect" title="Renal failure">renal failure</a> pass little or no urine. Side effects caused by removing too much fluid and/or removing fluid too rapidly include <a href="/wiki/Blood_pressure" title="Blood pressure">low blood pressure</a>, <a href="/wiki/Fatigue_(physical)" class="mw-redirect" title="Fatigue (physical)">fatigue</a>, chest pains, leg-cramps, <a href="/wiki/Nausea" title="Nausea">nausea</a> and <a href="/wiki/Headaches" class="mw-redirect" title="Headaches">headaches</a>. These symptoms can occur during the treatment and can persist post treatment; they are sometimes collectively referred to as the dialysis hangover or dialysis washout. The severity of these symptoms is usually proportionate to the amount and speed of fluid removal. However, the impact of a given amount or rate of fluid removal can vary greatly from person to person and day to day. These side effects can be avoided and/or their severity lessened by limiting fluid intake between treatments or increasing the dose of dialysis e.g. dialyzing more often or longer per treatment than the standard three times a week, 3–4 hours per treatment schedule. </p> <div class="mw-heading mw-heading4"><h4 id="Access-related">Access-related</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=6" title="Edit section: Access-related"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Since hemodialysis requires access to the circulatory system, patients undergoing hemodialysis may expose their circulatory system to <a href="/wiki/Microbes" class="mw-redirect" title="Microbes">microbes</a>, which can lead to <a href="/wiki/Bacteremia" class="mw-redirect" title="Bacteremia">bacteremia</a>, an infection affecting the heart valves (<a href="/wiki/Endocarditis" title="Endocarditis">endocarditis</a>) or an infection affecting the bones (<a href="/wiki/Osteomyelitis" title="Osteomyelitis">osteomyelitis</a>). The risk of infection varies depending on the type of access used (see below). Bleeding may also occur, again the risk varies depending on the type of access used. Infections can be minimized by strictly adhering to <a href="/wiki/Infection_control" class="mw-redirect" title="Infection control">infection control</a> best practices. </p> <div class="mw-heading mw-heading4"><h4 id="Venous_needle_dislodgement">Venous needle dislodgement</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=7" title="Edit section: Venous needle dislodgement"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Venous needle dislodgement (VND) is a fatal complication of hemodialysis where the patient experiences rapid blood loss due to a faltering attachment of the needle to the venous access point.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Anticoagulation-related">Anticoagulation-related</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=8" title="Edit section: Anticoagulation-related"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Heparin" title="Heparin">Unfractioned heparin (UHF)</a> is the most commonly used anticoagulant in hemodialysis, as it is generally well tolerated and can be quickly reversed with <a href="/wiki/Protamine_sulfate" title="Protamine sulfate">protamine sulfate</a>. <a href="/wiki/Low-molecular-weight_heparin" title="Low-molecular-weight heparin">Low-molecular weight heparin (LMWH)</a> is however, becoming increasingly popular and is now the norm in western Europe.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Compared to UHF, LMWH has the advantage of an easier mode of administration and reduced bleeding but the effect cannot be easily reversed.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Heparin can infrequently cause a low platelet count due to a reaction called <a href="/wiki/Heparin-induced_thrombocytopenia" title="Heparin-induced thrombocytopenia">heparin-induced thrombocytopenia (HIT)</a>. The risk of HIT is lower with LMWH compared to UHF. In such patients, alternative anticoagulants may be used. Even though HIT causes a low platelet count it can paradoxically predispose thrombosis.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> When comparing UHF to LMWH for the risk of adverse effects, the evidence is uncertain as to which treatment approach to thin blood has the least side effects and what is the ideal treatment strategy for preventing blood clots during hemodialysis.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> In patients at high risk of bleeding, dialysis can be done without anticoagulation.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="First-use_syndrome">First-use syndrome</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=9" title="Edit section: First-use syndrome"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>First-use syndrome is a rare but severe <a href="/wiki/Anaphylaxis" title="Anaphylaxis">anaphylactic reaction</a> to the <a href="/wiki/Artificial_kidney" title="Artificial kidney">artificial kidney</a>. Its symptoms include sneezing, wheezing, shortness of breath, back pain, chest pain, or sudden death. It can be caused by residual sterilant in the artificial kidney or the material of the membrane itself. In recent years, the incidence of first-use syndrome has decreased, due to an increased use of <a href="/wiki/Ionizing_radiation_sterilization" class="mw-redirect" title="Ionizing radiation sterilization">gamma irradiation</a>, steam sterilization, or electron-beam radiation instead of chemical sterilants, and the development of new semipermeable membranes of higher <a href="/wiki/Biocompatibility" title="Biocompatibility">biocompatibility</a>. New methods of processing previously acceptable components of dialysis must always be considered. For example, in 2008, a series of first-use type of reactions, including deaths, occurred due to heparin contaminated during the manufacturing process with oversulfated <a href="/wiki/Chondroitin_sulfate" title="Chondroitin sulfate">chondroitin sulfate</a>.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Cardiovascular">Cardiovascular</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=10" title="Edit section: Cardiovascular"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Long term complications of hemodialysis include <a href="/wiki/Hemodialysis-associated_amyloidosis" class="mw-redirect" title="Hemodialysis-associated amyloidosis">hemodialysis-associated amyloidosis</a>, <a href="/wiki/Neuropathy" class="mw-redirect" title="Neuropathy">neuropathy</a> and various forms of <a href="/wiki/Heart_disease" class="mw-redirect" title="Heart disease">heart disease</a>. Increasing the frequency and length of treatments has been shown to improve fluid overload and enlargement of the heart that is commonly seen in such patients.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Vitamin_deficiency">Vitamin deficiency</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=11" title="Edit section: Vitamin deficiency"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Folate_deficiency" title="Folate deficiency">Folate deficiency</a> can occur in some patients having hemodialysis.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Electrolyte_imbalances">Electrolyte imbalances</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=12" title="Edit section: Electrolyte imbalances"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Although a dialysate fluid, which is a solution containing diluted electrolytes, is employed for the filtration of blood, haemodialysis can cause an electrolyte imbalance. These imbalances can derive from abnormal concentrations of potassium (<a href="/wiki/Hypokalemia" title="Hypokalemia">hypokalemia</a>, <a href="/wiki/Hyperkalemia" title="Hyperkalemia">hyperkalemia</a>), and sodium (<a href="/wiki/Hyponatremia" title="Hyponatremia">hyponatremia</a>, <a href="/wiki/Hypernatremia" title="Hypernatremia">hypernatremia</a>). These electrolyte imbalances are associated with increased cardiovascular mortality.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Mechanism_and_technique">Mechanism and technique</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=13" title="Edit section: Mechanism and technique"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Semipermeable_membrane_(svg).svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/fe/Semipermeable_membrane_%28svg%29.svg/220px-Semipermeable_membrane_%28svg%29.svg.png" decoding="async" width="220" height="167" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/fe/Semipermeable_membrane_%28svg%29.svg/330px-Semipermeable_membrane_%28svg%29.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/fe/Semipermeable_membrane_%28svg%29.svg/440px-Semipermeable_membrane_%28svg%29.svg.png 2x" data-file-width="948" data-file-height="719" /></a><figcaption>Semipermeable membrane</figcaption></figure> <p>The principle of hemodialysis is the same as other methods of <a href="/wiki/Kidney_dialysis" title="Kidney dialysis">dialysis</a>; it involves <a href="/wiki/Diffusion" title="Diffusion">diffusion</a> of solutes across a semipermeable membrane. Hemodialysis utilizes <a href="/wiki/Counter-current_exchange" class="mw-redirect" title="Counter-current exchange">counter current flow</a>, where the dialysate is flowing in the opposite direction to <a href="/wiki/Blood_flow" class="mw-redirect" title="Blood flow">blood flow</a> in the <a href="/wiki/Extracorporeal" class="mw-redirect" title="Extracorporeal">extracorporeal</a> circuit. Counter-current flow maintains the concentration gradient across the membrane at a maximum and increases the efficiency of the dialysis. </p><p>Fluid removal (<a href="/wiki/Ultrafiltration_(renal)" class="mw-redirect" title="Ultrafiltration (renal)">ultrafiltration</a>) is achieved by altering the <a href="/wiki/Hydrostatic_pressure" class="mw-redirect" title="Hydrostatic pressure">hydrostatic pressure</a> of the dialysate compartment, causing free water and some dissolved solutes to move across the membrane along a created pressure gradient. </p><p>The dialysis solution that is used may be a sterilized solution of mineral ions and is called dialysate. <a href="/wiki/Urea" title="Urea">Urea</a> and other waste products including <a href="/wiki/Potassium" title="Potassium">potassium</a>, and <a href="/wiki/Phosphate" title="Phosphate">phosphate</a> diffuse into the dialysis solution. However, concentrations of <a href="/wiki/Sodium" title="Sodium">sodium</a> and chloride are similar to those of normal <a href="/wiki/Blood_plasma" title="Blood plasma">plasma</a> to prevent loss. <a href="/wiki/Sodium_bicarbonate" title="Sodium bicarbonate">Sodium bicarbonate</a> is added in a higher concentration than plasma to correct blood acidity. A small amount of glucose is also commonly used. The concentration of electrolytes in the dialysate is adjusted depending on the patient's status before the dialysis. If a high concentration of sodium is added to the dialysate, the patient can become thirsty and end up accumulating body fluids, which can lead to heart damage. On the contrary, low concentrations of sodium in the dialysate solution have been associated with a low blood pressure and intradialytic weight gain, which are markers of improved outcomes. However, the benefits of using a low concentration of sodium have not been demonstrated yet, since these patients can also develop cramps, intradialytic hypotension and low sodium in serum, which are symptoms associated with a high mortality risk.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p><p>Note that this is a different process to the related technique of <a href="/wiki/Hemofiltration" title="Hemofiltration">hemofiltration</a>. </p> <div class="mw-heading mw-heading3"><h3 id="Access">Access</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=14" title="Edit section: Access"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Vascular_access" title="Vascular access">Vascular access</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Permacath.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/20/Permacath.jpg/220px-Permacath.jpg" decoding="async" width="220" height="139" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/20/Permacath.jpg/330px-Permacath.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/20/Permacath.jpg/440px-Permacath.jpg 2x" data-file-width="1552" data-file-height="980" /></a><figcaption>Permacath for dialysis</figcaption></figure> <p>Three primary methods are used to gain access to the blood for hemodialysis: an intravenous catheter, an <a href="/wiki/Cimino_fistula" title="Cimino fistula">arteriovenous fistula</a> (AV) and a synthetic graft. The type of access is influenced by factors such as the expected time course of a patient's renal failure and the condition of their vasculature. Patients may have multiple access procedures, usually because an AV fistula or graft is maturing and a catheter is still being used. The placement of a catheter is usually done under light sedation, while fistulas and grafts require an operation. </p> <div class="mw-heading mw-heading2"><h2 id="Types">Types</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=15" title="Edit section: Types"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are three types of hemodialysis: conventional hemodialysis, daily hemodialysis, and nocturnal hemodialysis. Below is an adaptation and summary from a brochure of The Ottawa Hospital. </p> <div class="mw-heading mw-heading3"><h3 id="Conventional_hemodialysis">Conventional hemodialysis</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=16" title="Edit section: Conventional hemodialysis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size mw-halign-left" typeof="mw:File/Thumb"><a href="/wiki/File:Patient_lying_in_bed_in_intensive_care_unit_of_hospital_with_apparatuses_and_hemodialysis_machine.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/26/Patient_lying_in_bed_in_intensive_care_unit_of_hospital_with_apparatuses_and_hemodialysis_machine.jpg/220px-Patient_lying_in_bed_in_intensive_care_unit_of_hospital_with_apparatuses_and_hemodialysis_machine.jpg" decoding="async" width="220" height="173" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/26/Patient_lying_in_bed_in_intensive_care_unit_of_hospital_with_apparatuses_and_hemodialysis_machine.jpg/330px-Patient_lying_in_bed_in_intensive_care_unit_of_hospital_with_apparatuses_and_hemodialysis_machine.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/26/Patient_lying_in_bed_in_intensive_care_unit_of_hospital_with_apparatuses_and_hemodialysis_machine.jpg/440px-Patient_lying_in_bed_in_intensive_care_unit_of_hospital_with_apparatuses_and_hemodialysis_machine.jpg 2x" data-file-width="2724" data-file-height="2148" /></a><figcaption>A patient of an <a href="/wiki/Intensive_care_unit" title="Intensive care unit">intensive care unit</a> in a German hospital in 2015 who had a nearly complete disfunction of the kidneys due to a severe <a href="/wiki/Sepsis" title="Sepsis">sepsis</a>. The hemodialysis had to be carried out with a portable machine (left) on rollers near the bed, because the patient was too weak to leave the bed. Without this treatment, he would not have survived.</figcaption></figure> <p>Conventional hemodialysis is usually done three times per week, for about three to four hours for each treatment (Sometimes five hours for larger patients), during which the patient's blood is drawn out through a tube at a rate of 200–400 mL/min. The tube is connected to a 15, 16, or 17 gauge needle inserted in the dialysis fistula or graft, or connected to one port of a dialysis <a href="/wiki/Catheter" title="Catheter">catheter</a>. The blood is then pumped through the dialyzer, and then the processed blood is pumped back into the patient's bloodstream through another tube (connected to a second needle or port). During the procedure, the patient's blood pressure is closely monitored, and if it becomes low, or the patient develops any other signs of low blood volume such as nausea, the dialysis attendant can administer extra fluid through the machine. During the treatment, the patient's entire blood volume (about 5 L) circulates through the machine every 15 minutes. During this process, the dialysis patient is exposed to a week's worth of water for the average person. </p> <div class="mw-heading mw-heading3"><h3 id="Daily_hemodialysis">Daily hemodialysis</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=17" title="Edit section: Daily hemodialysis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Daily hemodialysis is typically used by those patients who do their own dialysis at home. It is less stressful (more gentle) but does require more frequent access. This is simple with catheters, but more problematic with fistulas or grafts. The "<a href="/wiki/Vascular_access#AV_fistula" title="Vascular access">buttonhole technique</a>" can be used for fistulas, but not grafts, requiring frequent access. Daily hemodialysis is usually done for 2 hours six days a week. </p> <div class="mw-heading mw-heading3"><h3 id="Nocturnal_hemodialysis">Nocturnal hemodialysis</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=18" title="Edit section: Nocturnal hemodialysis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The procedure of nocturnal hemodialysis is similar to conventional hemodialysis except it is performed three to six nights a week and between six and ten hours per session while the patient sleeps.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div style="clear:both;" class=""></div> <div class="mw-heading mw-heading2"><h2 id="Equipment">Equipment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=19" title="Edit section: Equipment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-Unreferenced_section plainlinks metadata ambox ambox-content ambox-Unreferenced" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><a href="/wiki/File:Question_book-new.svg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/50px-Question_book-new.svg.png" decoding="async" width="50" height="39" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/75px-Question_book-new.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/100px-Question_book-new.svg.png 2x" data-file-width="512" data-file-height="399" /></a></span></div></td><td class="mbox-text"><div class="mbox-text-span">This section <b>does not <a href="/wiki/Wikipedia:Citing_sources" title="Wikipedia:Citing sources">cite</a> any <a href="/wiki/Wikipedia:Verifiability" title="Wikipedia:Verifiability">sources</a></b>.<span class="hide-when-compact"> Please help <a href="/wiki/Special:EditPage/Hemodialysis" title="Special:EditPage/Hemodialysis">improve this section</a> by <a href="/wiki/Help:Referencing_for_beginners" title="Help:Referencing for beginners">adding citations to reliable sources</a>. Unsourced material may be challenged and <a href="/wiki/Wikipedia:Verifiability#Burden_of_evidence" title="Wikipedia:Verifiability">removed</a>.</span> <span class="date-container"><i>(<span class="date">November 2014</span>)</i></span><span class="hide-when-compact"><i> (<small><a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a></small>)</i></span></div></td></tr></tbody></table> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Hemodialysis-en.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/93/Hemodialysis-en.svg/220px-Hemodialysis-en.svg.png" decoding="async" width="220" height="190" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/93/Hemodialysis-en.svg/330px-Hemodialysis-en.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/93/Hemodialysis-en.svg/440px-Hemodialysis-en.svg.png 2x" data-file-width="654" data-file-height="564" /></a><figcaption>Schematic of a hemodialysis circuit</figcaption></figure> <p>The hemodialysis machine pumps the patient's blood and the dialysate through the dialyzer.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> The newest dialysis machines on the market are highly computerized and continuously monitor an array of safety-critical parameters, including blood (QB) and dialysate QD) flow rates;<sup id="cite_ref-Kashiwagi_2013_17-0" class="reference"><a href="#cite_note-Kashiwagi_2013-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> dialysis solution conductivity, temperature, and pH; and analysis of the dialysate for evidence of blood leakage or presence of air. Any reading that is out of normal range triggers an audible alarm to alert the patient-care technician who is monitoring the patient.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Manufacturers of dialysis machines include companies such as <a href="/wiki/Nipro" title="Nipro">Nipro</a>, <a href="/wiki/Fresenius_AG" class="mw-redirect" title="Fresenius AG">Fresenius</a>, <a href="/wiki/Gambro" title="Gambro">Gambro</a>, Baxter, <a href="/wiki/B._Braun" title="B. Braun">B. Braun</a>, NxStage and Bellco.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (June 2022)">citation needed</span></a></i>]</sup> QB to QD flow rates have to reach 1:2 ratio where QB is set around 250 ml/min and QD is set around 500 ml/min to ensure good dialysis efficiency.<sup id="cite_ref-Kashiwagi_2013_17-1" class="reference"><a href="#cite_note-Kashiwagi_2013-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Water_system">Water system</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=20" title="Edit section: Water system"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>An extensive <a href="/wiki/Water_purification" title="Water purification">water purification</a> system is critical for hemodialysis. Since dialysis patients are exposed to vast quantities of water, which is mixed with dialysate concentrate to form the dialysate, even trace mineral contaminants or bacterial <a href="/wiki/Endotoxins" class="mw-redirect" title="Endotoxins">endotoxins</a> can filter into the patient's blood. Because the damaged kidneys cannot perform their intended function of removing impurities, molecules introduced into the bloodstream from improperly purified water can build up to hazardous levels, causing numerous symptoms or death. <a href="/wiki/Aluminum" class="mw-redirect" title="Aluminum">Aluminum</a>, <a href="/wiki/Chlorine" title="Chlorine">chlorine</a> and or <a href="/wiki/Chloramines" title="Chloramines">chloramines</a>, <a href="/wiki/Fluoride" title="Fluoride">fluoride</a>, <a href="/wiki/Copper" title="Copper">copper</a>, and <a href="/wiki/Zinc" title="Zinc">zinc</a>, as well as bacterial fragments and <a href="/wiki/Endotoxins" class="mw-redirect" title="Endotoxins">endotoxins</a>, have all caused problems in this regard. </p><p>For this reason, water used in hemodialysis is carefully purified before use. A common water purification system includes a multi stage system. </p><p>The water is first softened. Next the water is run through a tank containing activated charcoal to <a href="/wiki/Adsorb" class="mw-redirect" title="Adsorb">adsorb</a> organic contaminants, and chlorine and chloramines. The water may then be temperature-adjusted if needed. Primary purification is then done by forcing water through a membrane with very tiny pores, a so-called <a href="/wiki/Reverse_osmosis" title="Reverse osmosis">reverse osmosis</a> membrane. This lets the water pass, but holds back even very small solutes such as electrolytes. Final removal of leftover electrolytes is done in some water systems by passing the water through an <a href="/wiki/Electrodeionization" title="Electrodeionization">electrodeionization</a> (EDI) device, which removes any leftover anions or cations and replace them with hydroxyl and hydrogen ions, respectively, leaving ultrapure water. </p><p>Even this degree of water purification may be insufficient. The trend lately is to pass this final purified water (after mixing with dialysate concentrate) through an ultrafiltration membrane or absolute filter. This provides another layer of protection by removing impurities, especially those of bacterial origin, that may have accumulated in the water after its passage through the original water purification system. </p> <div class="mw-heading mw-heading3"><h3 id="Dialysate">Dialysate</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=21" title="Edit section: Dialysate"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:CentralDialysatedelivery.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/6/64/CentralDialysatedelivery.JPG/220px-CentralDialysatedelivery.JPG" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/64/CentralDialysatedelivery.JPG/330px-CentralDialysatedelivery.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/64/CentralDialysatedelivery.JPG/440px-CentralDialysatedelivery.JPG 2x" data-file-width="900" data-file-height="675" /></a><figcaption>A hemodialysis unit's dialysate solution tanks</figcaption></figure> <p>Once purified water is mixed with dialysate (also called dialysis fluid) concentrate consisting of: <a href="/wiki/Sodium" title="Sodium">sodium</a>, <a href="/wiki/Potassium" title="Potassium">potassium</a>, <a href="/wiki/Calcium" title="Calcium">calcium</a>, <a href="/wiki/Magnesium" title="Magnesium">magnesium</a> and <a href="/wiki/Dextrose" class="mw-redirect" title="Dextrose">dextrose</a> mixed in an acid solution; this solution is mixed with the purified water and a <a href="/wiki/Chemical_buffer" class="mw-redirect" title="Chemical buffer">chemical buffer</a>. This forms the dialysate solution, which contains the basic electrolytes found in human blood. This dialysate solution contains charged ions that conducts electricity. During dialysis, the conductivity of dialysis solution is continuously monitored to ensure that the water and dialysate concentrate are being mixed in the proper proportions. Both excessively concentrated dialysis solution and excessively dilute solution can cause severe clinical problems. Chemical buffers such as bicarbonate or lactate can alternatively be added to regulate the pH of the dialysate. Both buffers can stabilize the pH of the solution at a physiological level with no negative impacts on the patient. There is some evidence of a reduction in the incidence of heart and blood problems and high blood pressure events when using bicarbonate as the pH buffer compared to lactate. However, the mortality rates after using both buffers do not show a significative difference.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Dialyzer">Dialyzer</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=22" title="Edit section: Dialyzer"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The dialyzer is the piece of equipment that filters the blood. Almost all dialyzers in use today are of the hollow-fiber variety. A cylindrical bundle of hollow fibers, whose walls are composed of semi-permeable membrane, is anchored at each end into potting compound (a sort of glue). This assembly is then put into a clear plastic cylindrical shell with four openings. One opening or blood port at each end of the cylinder communicates with each end of the bundle of hollow fibers. This forms the "blood compartment" of the dialyzer. Two other ports are cut into the side of the cylinder. These communicate with the space around the hollow fibers, the "dialysate compartment." Blood is pumped via the blood ports through this bundle of very thin <a href="/wiki/Capillary" title="Capillary">capillary</a>-like tubes, and the dialysate is pumped through the space surrounding the fibers. Pressure gradients are applied when necessary to move fluid from the blood to the dialysate compartment. </p> <div class="mw-heading mw-heading2"><h2 id="Membrane_and_flux">Membrane and flux</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=23" title="Edit section: Membrane and flux"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Dialyzer membranes come with different pore sizes. Those with smaller pore size are called "low-flux" and those with larger pore sizes are called "high-flux." Some larger molecules, such as beta-2-microglobulin, are not removed at all with low-flux dialyzers; lately, the trend has been to use high-flux dialyzers. However, such dialyzers require newer dialysis machines and high-quality dialysis solution to control the rate of fluid removal properly and to prevent backflow of dialysis solution impurities into the patient through the membrane. </p><p>Dialyzer membranes used to be made primarily of cellulose (derived from cotton linter). The surface of such membranes was not very biocompatible, because exposed hydroxyl groups would activate <a href="/wiki/Complement_system" title="Complement system">complement</a> in the blood passing by the membrane. Therefore, the basic, "unsubstituted" cellulose membrane was modified. One change was to cover these hydroxyl groups with acetate groups (cellulose acetate); another was to mix in some compounds that would inhibit complement activation at the membrane surface (modified cellulose). The original "unsubstituted cellulose" membranes are no longer in wide use, whereas cellulose acetate and modified cellulose dialyzers are still used. Cellulosic membranes can be made in either low-flux or high-flux configuration, depending on their pore size. </p><p>Another group of membranes is made from synthetic materials, using <a href="/wiki/Polymer" title="Polymer">polymers</a> such as <a href="/wiki/Polysulfone" title="Polysulfone">polyarylethersulfone</a>, <a href="/wiki/Polyamide" title="Polyamide">polyamide</a>, <a href="/wiki/Polyvinylpyrrolidone" title="Polyvinylpyrrolidone">polyvinylpyrrolidone</a>, <a href="/wiki/Polycarbonate" title="Polycarbonate">polycarbonate</a>, and <a href="/wiki/Polyacrylonitrile" title="Polyacrylonitrile">polyacrylonitrile</a>. These synthetic membranes activate complement to a lesser degree than unsubstituted cellulose membranes. However, they are in general more hydrophobic which leads to increased adsorption of proteins to the membrane surface which in turn can lead to complement system activation.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Synthetic membranes can be made in either low- or high-flux configuration, but most are high-flux. </p><p>Nanotechnology is being used in some of the most recent high-flux membranes to create a uniform pore size. The goal of high-flux membranes is to pass relatively large molecules such as beta-2-microglobulin (MW 11,600 daltons), but not to pass albumin (MW ~66,400 daltons). Every membrane has pores in a range of sizes. As pore size increases, some high-flux dialyzers begin to let albumin pass out of the blood into the dialysate. This is thought to be undesirable, although one school of thought holds that removing some albumin may be beneficial in terms of removing protein-bound uremic toxins. </p> <div class="mw-heading mw-heading3"><h3 id="Membrane_flux_and_outcome">Membrane flux and outcome</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=24" title="Edit section: Membrane flux and outcome"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Whether using a high-flux dialyzer improves patient outcomes is somewhat controversial, but several important studies have suggested that it has clinical benefits. The NIH-funded HEMO trial compared survival and hospitalizations in patients randomized to dialysis with either low-flux or high-flux membranes. Although the primary outcome (all-cause mortality) did not reach statistical significance in the group randomized to use high-flux membranes, several secondary outcomes were better in the high-flux group.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> A recent Cochrane analysis concluded that benefit of membrane choice on outcomes has not yet been demonstrated.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> A collaborative randomized trial from Europe, the MPO (Membrane Permeabilities Outcomes) study,<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> comparing mortality in patients just starting dialysis using either high-flux or low-flux membranes, found a nonsignificant trend to improved survival in those using high-flux membranes, and a survival benefit in patients with lower serum albumin levels or in diabetics. </p> <div class="mw-heading mw-heading3"><h3 id="Membrane_flux_and_beta-2-microglobulin_amyloidosis">Membrane flux and beta-2-microglobulin amyloidosis</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=25" title="Edit section: Membrane flux and beta-2-microglobulin amyloidosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Hemodialysis-associated_amyloidosis" class="mw-redirect" title="Hemodialysis-associated amyloidosis">Hemodialysis-associated amyloidosis</a></div> <p>High-flux dialysis membranes and/or intermittent internal on-line <a href="/wiki/Hemodiafiltration" class="mw-redirect" title="Hemodiafiltration">hemodiafiltration</a> (iHDF) may also be beneficial in reducing complications of beta-2-microglobulin accumulation. Because beta-2-microglobulin is a large molecule, with a molecular weight of about 11,600 daltons, it does not pass at all through low-flux dialysis membranes. Beta-2-M is removed with high-flux dialysis, but is removed even more efficiently with IHDF. After several years (usually at least 5–7), patients on hemodialysis begin to develop complications from beta-2-M accumulation, including carpal tunnel syndrome, bone cysts, and deposits of this amyloid in joints and other tissues. Beta-2-M amyloidosis can cause very serious complications, including <a href="/wiki/Spondyloarthropathy" class="mw-redirect" title="Spondyloarthropathy">spondyloarthropathy</a>, and often is associated with shoulder joint problems. Observational studies from Europe and Japan have suggested that using high-flux membranes in dialysis mode, or IHDF, reduces beta-2-M complications in comparison to regular dialysis using a low-flux membrane.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Dialyzers_and_efficiency">Dialyzers and efficiency</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=26" title="Edit section: Dialyzers and efficiency"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Dialyzers come in many different sizes. A larger dialyzer with a larger membrane area (A) will usually remove more solutes than a smaller dialyzer, especially at high blood flow rates. This also depends on the membrane permeability coefficient <i>K<sub>0</sub></i> for the solute in question. So dialyzer efficiency is usually expressed as the <i>K<sub>0</sub>A</i> – the product of permeability coefficient and area. Most dialyzers have membrane surface areas of 0.8 to 2.2 square meters, and values of <i>K<sub>0</sub>A</i> ranging from about 500 to 1500 mL/min. <i>K<sub>0</sub>A</i>, expressed in mL/min, can be thought of as the maximum clearance of a dialyzer at very high blood and dialysate flow rates. </p> <div class="mw-heading mw-heading3"><h3 id="Reuse_of_dialyzers">Reuse of dialyzers</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=27" title="Edit section: Reuse of dialyzers"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The dialyzer may either be discarded after each treatment or be reused. Reuse requires an extensive procedure of high-level disinfection. Reused dialyzers are not shared between patients. There was an initial controversy about whether reusing dialyzers worsened patient outcomes. The consensus today is that reuse of dialyzers, if done carefully and properly, produces similar outcomes to single use of dialyzers.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p><p>Dialyzer Reuse is a practice that has been around since the invention of the product. This practice includes the cleaning of a used dialyzer to be reused multiple times for the same patient. Dialysis clinics reuse dialyzers to become more economical and reduce the high costs of "single-use" dialysis which can be extremely expensive and wasteful. Single used dialyzers are initiated just once and then thrown out creating a large amount of bio-<a href="/wiki/Medical_waste" class="mw-redirect" title="Medical waste">medical waste</a> with no mercy for cost savings. If done right, dialyzer reuse can be very safe for dialysis patients. </p><p>There are two ways of reusing dialyzers, manual and automated. Manual reuse involves the cleaning of a dialyzer by hand. The dialyzer is semi-disassembled then flushed repeatedly before being rinsed with water. It is then stored with a liquid disinfectant(PAA) for 18+ hours until its next use. Although many clinics outside the USA use this method, some clinics are switching toward a more automated/streamlined process as the dialysis practice advances. The newer method of automated reuse is achieved by means of a medical device that began in the early 1980s. These devices are beneficial to dialysis clinics that practice reuse – especially for large dialysis clinical entities – because they allow for several back to back cycles per day. The dialyzer is first pre-cleaned by a technician, then automatically cleaned by machine through a step-cycles process until it is eventually filled with liquid disinfectant for storage. Although automated reuse is more effective than manual reuse, newer technology has sparked even more advancement in the process of reuse. When reused over 15 times with current methodology, the dialyzer can lose B2m, middle molecule clearance and fiber pore structure integrity, which has the potential to reduce the effectiveness of the patient's dialysis session. Currently, as of 2010, newer, more advanced reprocessing technology has proven the ability to eliminate the manual pre-cleaning process altogether and has also proven the potential to regenerate (fully restore) all functions of a dialyzer to levels that are approximately equivalent to single-use for more than 40 cycles.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> As medical reimbursement rates begin to fall even more, many dialysis clinics are continuing to operate effectively with reuse programs especially since the process is easier and more streamlined than before. </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=28" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Hemodialysis was one of the most common procedures performed in U.S. hospitals in 2011, occurring in 909,000 stays (a rate of 29 stays per 10,000 population). This was an increase of 68 percent from 1997, when there were 473,000 stays. It was the fifth most common procedure for patients aged 45–64 years.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=29" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Many have played a role in developing dialysis as a practical treatment for renal failure, starting with <a href="/wiki/Thomas_Graham_(chemist)" title="Thomas Graham (chemist)">Thomas Graham</a> of <a href="/wiki/Glasgow" title="Glasgow">Glasgow</a>, who first presented the principles of solute transport across a semipermeable membrane in 1854.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> The artificial kidney was first developed by <a href="/wiki/John_Jacob_Abel" title="John Jacob Abel">Abel</a>, Rountree, and Turner in 1913,<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> the first hemodialysis in a human being was by <a href="/wiki/Georg_Haas_(physician)" title="Georg Haas (physician)">Haas</a> (February 28, 1924)<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> and the artificial kidney was developed into a clinically useful apparatus by <a href="/wiki/Willem_Johan_Kolff" title="Willem Johan Kolff">Kolff</a> in 1943 to 1945.<sup id="cite_ref-pmid9402100_37-0" class="reference"><a href="#cite_note-pmid9402100-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> This research showed that life could be prolonged in patients dying of <a href="/wiki/Kidney_failure" title="Kidney failure">kidney failure</a>. </p><p><a href="/wiki/Willem_Kolff" class="mw-redirect" title="Willem Kolff">Willem Kolff</a> was the first to construct a working dialyzer in 1943. The first successfully treated patient was a 67-year-old woman in <a href="/wiki/Uremia" title="Uremia">uremic coma</a> who regained consciousness after 11 hours of hemodialysis with Kolff's dialyzer in 1945. At the time of its creation, Kolff's goal was to provide life support during recovery from acute renal failure. After <a href="/wiki/World_War_II" title="World War II">World War II</a> ended, Kolff donated the five dialyzers he had made to hospitals around the world, including <a href="/wiki/Mount_Sinai_Hospital,_New_York" class="mw-redirect" title="Mount Sinai Hospital, New York">Mount Sinai Hospital, New York</a>. Kolff gave a set of blueprints for his hemodialysis machine to George Thorn at the <a href="/wiki/Peter_Bent_Brigham_Hospital" class="mw-redirect" title="Peter Bent Brigham Hospital">Peter Bent Brigham Hospital</a> in <a href="/wiki/Boston" title="Boston">Boston</a>. This led to the manufacture of the next generation of Kolff's dialyzer, a <a href="/wiki/Stainless_steel" title="Stainless steel">stainless steel</a> Kolff-Brigham dialysis machine. </p><p>According to McKellar (1999), a significant contribution to renal therapies was made by Canadian surgeon <a href="/wiki/Donald_Walter_Gordon_Murray" title="Donald Walter Gordon Murray">Gordon Murray</a> with the assistance of two doctors, an undergraduate chemistry student, and research staff. Murray's work was conducted simultaneously and independently from that of Kolff. Murray's work led to the first successful artificial kidney built in North America in 1945–46, which was successfully used to treat a 26-year-old woman out of a uraemic coma in Toronto. The less-crude, more compact, second-generation "Murray-Roschlau" dialyser was invented in 1952–53, whose designs were stolen by German immigrant Erwin Halstrup, and passed off as his own (the "Halstrup–Baumann artificial kidney").<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> </p><p>By the 1950s, Willem Kolff's invention of the dialyzer was used for acute renal failure, but it was not seen as a viable treatment for patients with <a href="/wiki/Chronic_kidney_disease" title="Chronic kidney disease">stage 5 chronic kidney disease</a> (CKD). At the time, doctors believed it was impossible for patients to have dialysis indefinitely for two reasons. First, they thought no man-made device could replace the function of kidneys over the long term. In addition, a patient undergoing dialysis developed damaged veins and arteries, so that after several treatments, it became difficult to find a vessel to access the patient's blood. </p><p>The original Kolff kidney was not very useful clinically, because it did not allow for removal of excess fluid. Swedish professor <a href="/wiki/Nils_Alwall" title="Nils Alwall">Nils Alwall</a><sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> encased a modified version of this kidney inside a stainless steel canister, to which a negative pressure could be applied, in this way effecting the first truly practical application of hemodialysis, which was done in 1946 at the <a href="/wiki/University_of_Lund" class="mw-redirect" title="University of Lund">University of Lund</a>. Alwall also was arguably the inventor of the arteriovenous shunt for dialysis. He reported this first in 1948 where he used such an arteriovenous shunt in rabbits. Subsequently, he used such shunts, made of glass, as well as his canister-enclosed dialyzer, to treat 1500 patients in renal failure between 1946 and 1960, as reported to the First International Congress of Nephrology held in Evian in September 1960. Alwall was appointed to a newly created Chair of Nephrology at the University of Lund in 1957. Subsequently, he collaborated with Swedish businessman <a href="/wiki/Holger_Crafoord" title="Holger Crafoord">Holger Crafoord</a> to found one of the key companies that would manufacture dialysis equipment in the past 50 years, <a href="/wiki/Gambro" title="Gambro">Gambro</a>. The early history of dialysis has been reviewed by <a href="/wiki/Stanley_Shaldon" title="Stanley Shaldon">Stanley Shaldon</a>.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Belding_H._Scribner" class="mw-redirect" title="Belding H. Scribner">Belding H. Scribner</a>, working with the biomechanical engineer <a href="/wiki/Wayne_Quinton" title="Wayne Quinton">Wayne Quinton</a>, modified the glass shunts used by Alwall by making them from <a href="/wiki/Polytetrafluoroethylene" title="Polytetrafluoroethylene">Teflon</a>. Another key improvement was to connect them to a short piece of silicone elastomer tubing. This formed the basis of the so-called Scribner shunt, perhaps more properly called the Quinton-Scribner shunt. After treatment, the circulatory access would be kept open by connecting the two tubes outside the body using a small U-shaped Teflon tube, which would shunt the blood from the tube in the artery back to the tube in the vein.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> </p><p>In 1962, Scribner started the world's first outpatient dialysis facility, the Seattle Artificial Kidney Center, later renamed the <a href="/wiki/Northwest_Kidney_Centers" title="Northwest Kidney Centers">Northwest Kidney Centers</a>. Immediately the problem arose of who should be given dialysis, since demand far exceeded the capacity of the six dialysis machines at the center. Scribner decided that he would not make the decision about who would receive dialysis and who would not. Instead, the choices would be made by an anonymous committee, which could be viewed as one of the first <a href="/wiki/Bioethics" title="Bioethics">bioethics</a> committees. </p><p>For a detailed history of successful and unsuccessful attempts at dialysis, including pioneers such as Abel and Roundtree, Haas, and Necheles, see this review by Kjellstrand.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=30" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Aluminium_toxicity_in_people_on_dialysis" title="Aluminium toxicity in people on dialysis">Aluminium toxicity in people on dialysis</a></li> <li><a href="/wiki/Dialysis_disequilibrium_syndrome" title="Dialysis disequilibrium syndrome">Dialysis disequilibrium syndrome</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hemodialysis&action=edit&section=31" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width reflist-columns-2"> <ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" 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Archived from <a rel="nofollow" class="external text" href="http://www.uniklinikum-giessen.de/med3/history/haas/2001-Dial-Transpl.pdf">the original</a> <span class="cs1-format">(PDF)</span> on 2007-12-02.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Dialysis+and+Transplantation&rft.atitle=Georg+Haas+%281886-1971%29%3A+The+forgotten+hemodialysis+pioneer&rft.volume=30&rft.issue=12&rft.pages=828-32&rft.date=2001-12&rft.aulast=Paskalev&rft.aufirst=DN&rft_id=http%3A%2F%2Fwww.uniklinikum-giessen.de%2Fmed3%2Fhistory%2Fhaas%2F2001-Dial-Transpl.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHemodialysis" class="Z3988"></span></span> </li> <li id="cite_note-pmid9402100-37"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid9402100_37-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKolffBerkter_Wellevan_der_Ley1997" class="citation journal cs1">Kolff WJ, Berk HT, ter Welle M, van der Ley AJ, van Dijk EC, van Noordwijk J (December 1997). <a rel="nofollow" class="external text" href="http://jasn.asnjournals.org/cgi/reprint/8/12/1959">"The artificial kidney: a dialyser with a great area. 1944"</a>. <i>Journal of the American Society of Nephrology</i>. <b>8</b> (12): 1959–65. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1681%2FASN.V8121959">10.1681/ASN.V8121959</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/9402100">9402100</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+American+Society+of+Nephrology&rft.atitle=The+artificial+kidney%3A+a+dialyser+with+a+great+area.+1944&rft.volume=8&rft.issue=12&rft.pages=1959-65&rft.date=1997-12&rft_id=info%3Adoi%2F10.1681%2FASN.V8121959&rft_id=info%3Apmid%2F9402100&rft.aulast=Kolff&rft.aufirst=WJ&rft.au=Berk%2C+HT&rft.au=ter+Welle%2C+M&rft.au=van+der+Ley%2C+AJ&rft.au=van+Dijk%2C+EC&rft.au=van+Noordwijk%2C+J&rft_id=http%3A%2F%2Fjasn.asnjournals.org%2Fcgi%2Freprint%2F8%2F12%2F1959&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHemodialysis" class="Z3988"></span></span> </li> <li id="cite_note-38"><span class="mw-cite-backlink"><b><a href="#cite_ref-38">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMcKellar1999" class="citation journal cs1">McKellar S (November 1999). <a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Fndt%2F14.11.2766">"Gordon Murray and the artificial kidney in Canada"</a>. <i>Nephrology, Dialysis, Transplantation</i>. <b>14</b> (11): 2766–70. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Fndt%2F14.11.2766">10.1093/ndt/14.11.2766</a></span>. <a href="/wiki/Hdl_(identifier)" class="mw-redirect" title="Hdl (identifier)">hdl</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://hdl.handle.net/1807%2F24715">1807/24715</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/10534530">10534530</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nephrology%2C+Dialysis%2C+Transplantation&rft.atitle=Gordon+Murray+and+the+artificial+kidney+in+Canada&rft.volume=14&rft.issue=11&rft.pages=2766-70&rft.date=1999-11&rft_id=info%3Ahdl%2F1807%2F24715&rft_id=info%3Apmid%2F10534530&rft_id=info%3Adoi%2F10.1093%2Fndt%2F14.11.2766&rft.aulast=McKellar&rft.aufirst=S&rft_id=https%3A%2F%2Fdoi.org%2F10.1093%252Fndt%252F14.11.2766&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHemodialysis" class="Z3988"></span></span> </li> <li id="cite_note-39"><span class="mw-cite-backlink"><b><a href="#cite_ref-39">^</a></b></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://www.med.lu.se/english/about_the_faculty/faculty_milestones/nils_alwall">University of Lund website: Nils Alwall.</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20071001215324/http://www.med.lu.se/english/about_the_faculty/faculty_milestones/nils_alwall">Archived</a> 2007-10-01 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a></span> </li> <li id="cite_note-40"><span class="mw-cite-backlink"><b><a href="#cite_ref-40">^</a></b></span> <span class="reference-text">Shaldon S. Development of Hemodialysis, From Access to Machine (presentation given during a symposium entitled: Excellence in Dialysis: Update in Nephrology; Karachi, Pakistan. October, 2002, <a rel="nofollow" class="external text" href="http://www.hdcn.com/symp/02pak/02pak.htm">as archived on HDCN</a></span> </li> <li id="cite_note-41"><span class="mw-cite-backlink"><b><a href="#cite_ref-41">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20090113221335/http://kidney.niddk.nih.gov/about/Research_Updates/win00-01/contrib.htm">"NIDDK Contributions to Dialysis"</a>. Archived from <a rel="nofollow" class="external text" href="http://kidney.niddk.nih.gov/about/Research_Updates/win00-01/contrib.htm">the original</a> on 2009-01-13<span class="reference-accessdate">. Retrieved <span class="nowrap">2007-10-09</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=NIDDK+Contributions+to+Dialysis&rft_id=http%3A%2F%2Fkidney.niddk.nih.gov%2Fabout%2FResearch_Updates%2Fwin00-01%2Fcontrib.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHemodialysis" class="Z3988"></span></span> </li> <li id="cite_note-42"><span class="mw-cite-backlink"><b><a href="#cite_ref-42">^</a></b></span> <span class="reference-text">Kjellstrand CM. History of Dialysis, Men and Ideas. 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title="Atherectomy">Atherectomy</a></li> <li><a href="/wiki/Endarterectomy" title="Endarterectomy">Endarterectomy</a> <ul><li><a href="/wiki/Carotid_endarterectomy" title="Carotid endarterectomy">Carotid endarterectomy</a></li></ul></li> <li><a href="/wiki/Stenting" class="mw-redirect" title="Stenting">Stenting</a> <ul><li><a href="/wiki/Carotid_stenting" title="Carotid stenting">Carotid stenting</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Varicose_veins" title="Varicose veins">Venous disease</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ambulatory_phlebectomy" title="Ambulatory phlebectomy">Ambulatory phlebectomy</a></li> <li><a href="/wiki/Laser_surgery" title="Laser surgery">Laser surgery</a></li> <li><a href="/wiki/Sclerotherapy" title="Sclerotherapy">Sclerotherapy</a></li> <li><a href="/wiki/Vein_stripping" title="Vein stripping">Vein stripping</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Artery" title="Artery">Arterial</a> and <a href="/wiki/Vein" title="Vein">venous</a> access</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Venous_cutdown" title="Venous cutdown">Venous cutdown</a></li> <li><a href="/wiki/Arteriotomy" title="Arteriotomy">Arteriotomy</a></li> <li><a href="/wiki/Phlebotomy" title="Phlebotomy">Phlebotomy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Aortic_aneurysm" title="Aortic aneurysm">Aortic aneurysm</a> / <a href="/wiki/Aortic_dissection" title="Aortic dissection">dissection</a>:</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Endovascular_aneurysm_repair" title="Endovascular aneurysm repair">Endovascular aneurysm repair</a></li> <li><a href="/wiki/Open_aortic_surgery" title="Open aortic surgery">Open aortic surgery</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cardiopulmonary_bypass" title="Cardiopulmonary bypass">Cardiopulmonary bypass</a></li> <li><a href="/wiki/Cardioplegia" title="Cardioplegia">Cardioplegia</a></li> <li><a href="/wiki/Isolated_organ_perfusion_technique" title="Isolated organ perfusion technique">Isolated organ perfusion technique</a> <ul><li><a href="/wiki/Extracorporeal_membrane_oxygenation" title="Extracorporeal membrane oxygenation">Extracorporeal membrane oxygenation</a></li></ul></li> <li><a href="/wiki/Vascular_access" title="Vascular access">Vascular access</a></li> <li><a href="/wiki/Revascularization" title="Revascularization">Revascularization</a></li> <li><a href="/wiki/First_rib_resection" title="First rib resection">First rib resection</a></li> <li><a href="/wiki/Seldinger_technique" title="Seldinger technique">Seldinger technique</a></li> <li><a href="/wiki/Vascular_snare" title="Vascular snare">Vascular snare</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_imaging" title="Medical imaging">Medical imaging</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Angiography" title="Angiography">Angiography</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Digital_subtraction_angiography" title="Digital subtraction angiography">Digital subtraction angiography</a> <ul><li><a href="/wiki/Cerebral_angiography" title="Cerebral angiography">Cerebral angiography</a></li> <li><a href="/wiki/Aortography" title="Aortography">Aortography</a></li> <li><a href="/wiki/Fluorescein_angiography" title="Fluorescein angiography">Fluorescein angiography</a></li> <li><a href="/wiki/Radionuclide_angiography" title="Radionuclide angiography">Radionuclide angiography</a></li> <li><a href="/wiki/Magnetic_resonance_angiography" title="Magnetic resonance angiography">Magnetic resonance angiography</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Venography" title="Venography">Venography</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Portography" title="Portography">Portography</a></li> <li><a href="/wiki/Impedance_phlebography" class="mw-redirect" title="Impedance phlebography">Impedance phlebography</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Ultrasound</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Intravascular_ultrasound" title="Intravascular ultrasound">Intravascular ultrasound</a></li> <li><a href="/wiki/Carotid_ultrasonography" title="Carotid ultrasonography">Carotid ultrasonography</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other diagnostic</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Angioscopy" title="Angioscopy">Angioscopy</a></li> <li><a href="/wiki/Ankle%E2%80%93brachial_pressure_index" title="Ankle–brachial pressure index">Ankle–brachial pressure index</a></li> <li><a href="/wiki/Toe_pressure" title="Toe pressure">Toe pressure</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Toxicology" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Toxicology" title="Template:Toxicology"><abbr title="View this 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title="Entomotoxicology">Entomotoxicology</a></li> <li><a href="/wiki/Environmental_toxicology" title="Environmental toxicology">Environmental toxicology</a></li> <li><a href="/wiki/Forensic_toxicology" title="Forensic toxicology">Forensic toxicology</a></li> <li><a href="/wiki/Medical_toxicology" title="Medical toxicology">Medical toxicology</a></li> <li><a href="/wiki/In_vitro_toxicology" title="In vitro toxicology">In vitro toxicology</a></li> <li><a href="/wiki/Toxicogenomics" title="Toxicogenomics">Toxicogenomics</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Concepts</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Acceptable_daily_intake" title="Acceptable daily intake">Acceptable daily intake</a></li> <li><a href="/wiki/Acute_toxicity" title="Acute toxicity">Acute toxicity</a></li> <li><a href="/wiki/Bioaccumulation" title="Bioaccumulation">Bioaccumulation</a></li> <li><a href="/wiki/Biomagnification" title="Biomagnification">Biomagnification</a></li> <li><a href="/wiki/Fixed-dose_procedure" title="Fixed-dose procedure">Fixed-dose procedure</a></li> <li><a href="/wiki/Lethal_dose" title="Lethal dose">Lethal dose</a></li> <li><a href="/wiki/Poison" title="Poison">Poison</a></li> <li><a href="/wiki/Toxic_capacity" title="Toxic capacity">Toxic capacity</a></li> <li><a href="/wiki/Toxicity_class" title="Toxicity class">Toxicity class</a></li> <li><a href="/wiki/Toxin" title="Toxin">Toxin</a></li> <li><a href="/wiki/Venom" title="Venom">Venom</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Treatments</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Activated_carbon" title="Activated carbon">Activated carbon</a></li> <li><a href="/wiki/Antidote" title="Antidote">Antidote</a></li> <li><a href="/wiki/Cathartic" title="Cathartic">Cathartic</a></li> <li><a href="/wiki/Chelation_therapy" title="Chelation therapy">Chelation therapy</a></li> <li><a href="/wiki/Gastric_lavage" title="Gastric lavage">Gastric lavage</a></li> <li><a class="mw-selflink selflink">Hemodialysis</a></li> <li><a href="/wiki/Hemoperfusion" title="Hemoperfusion">Hemoperfusion</a></li> <li><a href="/wiki/Whole_bowel_irrigation" title="Whole bowel irrigation">Whole bowel irrigation</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Incidents</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/1858_Bradford_sweets_poisoning" title="1858 Bradford sweets poisoning">1858 Bradford sweets poisoning</a></li> <li><a href="/wiki/2007_pet_food_recalls" title="2007 pet food recalls">2007 pet food recalls</a></li> <li><a href="/wiki/Bhopal_disaster" title="Bhopal disaster">Bhopal disaster</a></li> <li><a href="/wiki/Minamata_disease" title="Minamata disease">Minamata disease</a></li> <li><a href="/wiki/Niigata_Minamata_disease" title="Niigata Minamata disease">Niigata Minamata disease</a></li> <li><a href="/wiki/Poisoning_of_Alexander_Litvinenko" title="Poisoning of Alexander Litvinenko">Poisoning of Alexander Litvinenko</a></li> <li><a href="/wiki/Seveso_disaster" title="Seveso disaster">Seveso disaster</a></li> <li><a href="/wiki/Consumption_of_Tide_Pods" title="Consumption of Tide Pods">Consumption of Tide Pods</a></li> <li><a href="/wiki/Visakhapatnam_gas_leak" title="Visakhapatnam gas leak">Visakhapatnam gas leak</a></li> <li><a href="/wiki/2022_Aqaba_toxic_gas_leak" title="2022 Aqaba toxic gas leak">2022 Aqaba toxic gas leak</a></li> <li><a href="/wiki/List_of_poisonings" class="mw-redirect" title="List of poisonings">List of poisonings</a></li></ul> </div></td></tr><tr><th scope="row" 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