Figure 69

Delivering an adequate dose of dialysis in hemodialysis. Providing an adequate amount of dialysis is an important part of the dialysis prescription. During the dialytic procedure a sharp decrease in the concentration of urea occurs followed by a gradual increase during the interdialytic period. The decrease in urea during dialysis is determined by three main parameters: dialyzer urea clearance rate (K), dialysis treatment time (t), and the volume of urea distribution (V). The dialyzer urea clearance rate (K) is influenced by the characteristics of the dialysis membrane (KoA), blood flow rate, dialysate flow rate, and convective urea flux that occurs with ultrafiltration. The gradual increase in urea during the interdialytic period depends on the rate of urea generation that, in an otherwise stable patient, reflects the dietary protein intake, distribution volume of urea, and presence or absence of residual renal function.

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