As far as the machines, a shift to hollow-fiber dialyzers meant more effective and better-tolerated membranes made primarily from synthetic polymers. The advent of high-flux dialyzers, with larger pore membranes that remove larger molecules of uremic toxins and fluids, has vastly improved the quality of treatment while shortening the process.

Pre-owned Equipment in Widespread Use


Hemodialysis is the first line of defense worldwide for chronic and acute kidney failure.

"Dialysis is a delivery system - the first artificial organ made by man that works," explains Shia Benhur, GIA Medical, River Hills, WI, one of the largest wholesalers of dialysis equipment, supplying the technology worldwide. "It is a very small, limited market that only a few people specialize in," he said of the equipment sales and service industry supporting dialysis.

A dialysis system is a complicated integration of electronics, mechanics and especially hydraulics. The system must purify water, add acid and bicarbonates, and control the temperature and pH balance. The patient's blood is pumped through one compartment of a dialyzer, exposing it to a semipermeable membrane; the dialysis solution is pumped through an adjacent compartment. Due to a difference in pressure, toxins from the blood are filtered to the dialysis side. The cleansed blood is then returned to the body.

In addition to filtering toxins, healthy kidneys also remove excess fluid from blood to form urine. The artificial kidney performs this function in a process called ultrafiltration in which several liters of excess salt and water are removed during a typical treatment. For this reason, the patient's blood pressure must be carefully monitored.

"Since you are removing fluid, the blood pressure tends to drop. Before treatment the BP is high because of the fluid in the system. By the time you remove the fluid and clean blood, it tends to crash because of the low blood volume. One of the main problems we experience in dialysis is low blood pressure, which can lead to cardiac arrest," explains Sudarshan Meenakshisundharam, a dialysis biomedical engineer and Director of Maple Consultants, Scarborough, Ontario.

Maintenance of dialysis equipment is also critical. The system must be cleaned, disinfected and tested between treatments. In addition, refurbishing of equipment requires changing worn parts such as gears, brushes, valves, O-rings, seals, filters and tubing, rebuilding pump motors, cosmetic reconditioning and calibration.

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