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The Evolution of Dialysis Concentrates
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Dialysis concentrates are essential for removing waste from the blood of patients undergoing hemodialysis. These concentrates typically contain water, electrolytes, and salts like bicarbonate and sodium. The first dialysis concentrate was invented in 1943 by Willem Kolff, who used a sausage casing membrane wrapped around a drum.
Dialysis concentrates have come a long way since then, evolving into cost-effective and safe treatments for kidney failure patients. They are available in both liquid and powder forms and can be quickly mixed and administered during treatment.
The Origins of Dialysis Concentrates
The origins of dialysis concentrates can be traced back to the 1960s when the Scribner Shunt, a device that allowed patients to undergo dialysis without an incision, was developed. This system was based on a Japanese invention, which consisted of a series of small tubing tubes connected to one another in a central area. Each tube was a bundle of thin capillary-like fibres with walls covered in semipermeable membranes. Blood was pumped through one end of the bundle, and dialysate was pumped through the space surrounding the fibres.
Today, the most widely used dialysis devices are hollow-fibre dialyzers. They consist of a bundle of very thin fibres anchored to the outside of a plastic cylindrical shell by a potting compound.
Acid Concentrates
Acid concentrates are another essential component of dialysis treatment. These concentrates are prepared by mixing a liquid or powdered substance with water. The pH of the slurry is typically different from that of the dialysis fluid to ensure long-term stability. The acid concentrate is a mixture of electrolytes, glucose, and 2-8 mEq/L of acetate, which is metabolized into bicarbonate in the liver, to prevent calcium precipitation. Alternatively, citric acid can be used instead of acetate.
Patients with chronic kidney disease receive maintenance hemodialysis to reduce the number of uremic waste products in their blood and correct metabolic acid-base abnormalities. Metabolic acidosis is associated with poor outcomes in HD patients, including increased mortality and cardiovascular complications. A recent study analyzed the association between dialysate bicarbonate concentration and outcomes in 17031 HD patients from 11 DOPPS countries. Results showed that higher dialysate bicarbonate concentration was associated with all-cause and cause-specific mortality in non-individualized facilities, whereas individualized facilities did not have a significant association.
Bicarbonate Concentrates
Bicarbonate concentrates are necessary for correcting the metabolic acidosis that regularly occurs with renal failure. These buffers neutralize the acids formed during protein catabolism and replenish the body’s bicarbonate stores. The concentration of bicarbonate in dialysate concentrate is a critical factor in the pH of the final dialysis fluid, as it determines how much of the buffering power is delivered to the patient. A higher bicarbonate concentration, such as 35 to 42 mEq/L, has been linked to positive clinical outcomes such as improved protein turnover, triceps fold thickness, and serum branched-chain amino acid levels.
Some modern dialysis machines use a lower concentration of bicarbonate in the acid concentrate and a higher concentration of bicarbonate in the bicarbonate concentrate. This approach decreases the total amount of bicarbonate delivered to the final dialysis solution while also reducing the total concentration of sodium in the dialysis fluid. This strategy is designed to minimize the impact of the acid concentration on the buffer base and the bicarbonate concentration on the final dialysis fluid pH.
Dialysis concentrates are used in a variety of dialysis treatment applications, providing a safe, effective, and convenient way to treat patients with kidney failure. The main component of a dialysis concentrate is water, which is treated to remove any harmful contaminants that could harm the patient. The water is then combined with a variety of solutes.
