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#dialysis

2 public questions tagged with this topic.

In dialysis, what happens when a hypertonic solution is used?

Dialysis demonstrations use cellophane or cellulose acetate bags with pore diameters permitting water and small molecules under few nanometers while excluding colloids like starch or proteins. When bag containing dilute salt or dye solution is immersed into beaker with concentrated solution hypertonic relative to bag contents, solute concentration inside lower than outside, water potential inside higher. Water activity gradient drives net efflux from interior to exterior attempting to equalize potentials and dilute outer compartment. Membrane remains impermeable to large solutes, so water movement dominates, volume of dialysis bag decreases, weight loss measurable, outer solution level rises. If situation reversed hypotonic outside, bag would gain water and swell possibly bursting. This behavior governed by second law favoring entropy maximizing dilution, quantified by van't Hoff osmotic pressure. Addition of hydrostatic pressure could oppose or reverse flow as in hemofiltration or reverse osmosis, but without pressure driver is osmosis. Importantly ATP hydrolysis unnecessary because passive diffusion supplies driving force. Thus hypertonic external bath causes water to leave dialysis bag.

Ref: Lodish et al., Molecular Cell Biology, Chapter: Dialysis and Osmotic Water Movement from Bags.

In dialysis, which force allows waste removal?

Artificial kidney or dialysis device replaces glomerular filtration by exploiting physical principles of diffusion across synthetic semipermeable membranes. Blood pumped through thousands of hollow fibers with wall pore size cut off around 10 kilodaltons separates from dialysate fluid flowing countercurrently. Small metabolic wastes urea 60 daltons, creatinine 113 daltons and electrolytes potassium accumulate at higher concentration in plasma than dialysate creating concentration gradient. According to Fick's first law diffusive flux proportional to concentration difference times membrane permeability and surface area divided by thickness. Consequently solutes diffuse passively from blood into dialysate without need for ATP driven pumps. Large proteins like albumin retained due to size exclusion. Countercurrent flow maintains gradient along fiber length enhancing clearance. Osmotic or hydrostatic gradients may adjust water balance but waste removal itself driven by diffusion. Active transport, endocytosis or vesicular trafficking not involved in this extracorporeal circuit. Therefore driving force allowing removal of nitrogenous waste during dialysis is passive diffusion down concentration gradient.

Ref: Guyton and Hall, Textbook of Medical Physiology, Chapter: Dialysis Principles - Diffusion of Wastes.