an additional 1.50 lakh new patients of end-stage chronic
kidney disease requiring dialysis or kidney transplant are
added to the existing lot in the country. And of these
only a measly 5 to 7 per cent are able to get some form of
treatment, while the rest die without getting any definite
healthcare intervention, a study conducted by All-India
Institute of Medical Sciences and funded by the Indian
Council of Medical Research has found.
The study revealed that the high cost of treatment and
non-availability of donors were the major limitation for
successful treatment of chronic kidney disease, which also
forced people to resort to all sorts of “legal and
illegal” methods to get a kidney transplant.
In India one in ten people has some form of chronic kidney
disease. Diabetes and hypertension are responsible for
more than 60 per cent cases of chronic kidney disease.
Fifteen per cent of adults in urban areas are diabetic and
40 per cent of these are likely to develop kidney disease.
About 20-30 per cent of the adults are hypertensive and
many of them will develop chronic kidney disease. Many
patients of chronic kidney disease die of cardiovascular
have functions like they remove waste products from the
blood and also remove excess fluid. They do this by acting
as a filter, thus producing urine. They also help control
our blood pressure, the level of minerals in our bones and
the production of red blood cells. When the kidney fails
to perform its routine function the patients has to
undergo dialysis. Kidney disease leading to ESRD has many
causes and some are like diabetes, high blood pressure,
infection to urinary tract which can reach to kidney, etc
and the prevalence varies by country, region, ethnicity,
gender, and age.
The emergence of new therapeutic interventions has created
opportunities in India to manage the progression of renal
diseases. For those who need renal replacement therapy,
services like Hemodialysis, Chronic Ambulatory Peritoneal
Dialysis (CAPD) and Transplantation and in addition to the
basic hemodialysis facilities, the patients' requirements
for other modalities of treatment such as Continuous
Arterio-Venous Haemofilteration (CAVH), Continuous Veno-Venous
Haemofilteration (CVVH), Continuous Cycler-Assisted
Peritioneal Dialysis (CCPD) are also available.
Haemodialysis is a process by which the blood is cleansed
by an artificial kidney, a machine that removes the wastes
by diffusion. An ESRD patient usually undergoes it thrice
a week. Dialysis entails a high recurring expenditure.
years, an excellent but expensive option has become
available: Continuous Ambulatory Peritoneal Dialysis (CAPD).
CAPD is done inside the patient's body, using his or her
own peritoneal membrane (which lines the peritoneal
cavity) as a blood filter. A catheter is inserted into the
patient's abdominal cavity and is connected to sterilize
plastic bags containing the dialysis solution. Through a
process of diffusion and osmosis, waste products in the
blood are transferred across the membrane into the bag.
Typically, this exchange of fluids across the membrane is
done three or four times during the day. The CAPD method
is a refinement of the peritoneal dialysis technique.
Under CAPD, patients are on non-stop dialysis.
Equipment And Supplies
The various products required for
the Dialysis Procedures as mentioned are :
• Blood Lines
• Fistula Needles
• Adopters (Different Type)
• Extension Lines
• Introducer Needle
• Femoral Catheter
• Teflon Coated guide wire
• Vascular Access Catheters [Hemodialysis /
• Dual Lumen Catheters with curved extension
• Dual Lumen Catheters Jugular Catheters
• Flexxicon Catheters
• CAPD Related Product
• Peritoneal Dialysis (PD) Sets
• Peritoneal Dialysis (PD) Catheters
Some of the important products
frequently used are described at length below :
Function: Hemodialysis uses a special filter called a
dialyzer that functions as an artificial kidney to
clean the blood. The dialyzer is a canister connected
to the hemodialysis machine. During treatment, the
patient’s blood travels through tubes into the
dialyzer, this filters out wastes, extra salt, and
extra water. Then the cleaned blood flows through
another set of tubes back into the patient’s body. The
hemodialysis machine monitors blood flow and removes
wastes from the dialyzer. It is designed to provide
controllable transfer of solutes and water across a
semi permeable membrane separating flowing blood and
dialysate streams. The transfer processes are
diffusion (dialysis) and convection (ultrafiltration).
There are three basic dialyzer designs: coil, parallel
plate, and hollow fiber configurations. Hollow Fiber
Dialyzer is the most effective design for providing
low-volume high efficiency devices with low resistance
Inside the dialyzer, a porous
artificial semi-permeable membrane separates the blood
from a fluid (the dialysate). Fluid, waste products,
and electrolytes in the blood filter through the
semi-permeable membrane into the dialysate. Blood
cells and large proteins are unable to filter through
the small pores of the membrane and so remain in the
blood. The dialyzed (purified) blood is then returned
to the person's body.
Materials: The fibers are
made from such biocompatible materials as cellulose
acetate or polysulfone. The fibers have a microporous
structure that permit the diffusion of small molecular
weight species from the blood to the dialysate.
2). Blood Lines: Arterial &
This tubing set consist of two parts, viz. arterial
and venous, which are used during dialysis and are
attached with fistula and dialyzer. These tubing sets
are designed for the patient to connect external
system which extracts patient's blood to the dialyzer.
The design of blood lines should be such that they are
biocompatible and prevent blood turbulence and
Components of Blood Lines:
1). Dialyzer Connector
2. Blood Chamber
3) Top Cover at end of bloodchamber
5). Luer Lock
6). Pump Segment
7). Luer Lock Connector
8). Injection Site
9). Blood Catcher
10). Priming recirculating Connector
The history of dialysis
Life, death and a “washing machine”
Although experiments with dialysis
are said to have occurred thousands of years ago,
dialysis as we know it has its roots in the 20th
The 1940s: Inspiration, war and
Dr. Willem Kolff is considered the
father of dialysis. This young Dutch physician
constructed the first dialyzer (artificial kidney) in
The road to Kolff’s creation of an
artificial kidney began in the late 1930s when he was
working in a small ward at the University of Groningen
Hospital in the Netherlands. There, Kolff watched
helplessly as a young man died slowly of kidney
failure. Kolff decided to find a way to make a machine
that would do the work of the kidneys. The young
doctor searched the university library for information
on removing toxins from blood and stumbled across an
article about hemodialysis with animals published in
1913 by John Abel, a renowned pharmacologist at Johns
Hopkins University. Abel’s writing inspired Kolff, and
he became committed to the development of an
At about the same time that Kolff
began his research, World War II erupted. Once the
Nazis overtook the Netherlands, Kolff was sent to work
in a remote Dutch hospital.
Despite challenging conditions, the
young physician pressed on. Although materials were
scarce, Kolff possessed the resourceful spirit of the
true inventor and improvised, using sausage skins,
orange juice cans, a washing machine and other common
items to make a device that could clear the blood of
toxins. Amazingly, he carried on his experiment under
Nazi scrutiny, risking his own life by forging
documents so that he could continue his work. Kolff
was able to get his wife and colleagues to help, even
though it meant they too were putting themselves in
In 1943, Kolff’s invention,
although crude, was completed. During the course of
the next two years, he treated 16 patients with acute
kidney failure but had little success. All that
changed in 1945, when a 67-year-old woman in uremic
coma regained consciousness after 11 hours of
hemodialysis with Kolff’s dialyzer.
Kolff’s machine is considered the
first modern drum dialyzer, and it remained the
standard for the next decade. At the time of its
creation, Kolff’s goal was to help kidneys recover.
The brave doctor had no way of knowing that his
invention was one of the foremost life-saving
developments in the history of modern medicine.
After World War II ended, Kolff donated the five
artificial kidneys he’d made to hospitals around the
world, including Mt. Sinai Hospital in New York.
Because of this unselfish act, doctors in many
countries were able to learn about the practice of
In the late 40s, Kolff came to the US, where he
continued his research. At the time, many people in
the medical field were scandalized by kidney dialysis,
calling it “an abomination.” Kolff and others like him
who worked with dialysis were frequently ridiculed.
But Kolff didn’t give up.
At Mt. Sinai Hospital, he instructed other doctors in
the use of his artificial kidney, but the hospital’s
administrators were opposed to this type of therapy.
Therefore, Kolff and his colleagues were forced to
perform dialysis in a surgical suite after hours.
Spectators crowded the gallery to watch the “rogues”