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Therefore, during HD, urea in the plasma water leaving the dialyzer is in equilibrium with urea in the RBC water, with the ratio of these concentrations (approx. 76) being determined by the ratio of the water fractions of the aqueous and RBC compartments. On the other hand, the transcellular rate of movement for other uremic solutes, such as creatinine and phosphate, is small (or negligible) relative to the rate of dialytic removal . For a given unit volume of whole blood, an increase in Hct causes a relative increase in the distribution of solute in the RBC water, resulting in a relative sequestration of solutes with low RBC membrane diffusivity.
For a given solute, diffusive mass transfer resistance in the blood compartment of a dialyzer is the ratio of effective diffusive path length to effective solute diffusivity, both of which may be inﬂuenced by Hct . As the volume comprised by the RBC mass per unit volume of blood increases with increasing Hct, solutes diffusing to the membrane surface are relatively more likely to encounter an RBC, causing an effective lengthening of the diffusion distance. In addition, solute diffusivity may decrease as a function of increasing Hct due to the latter’s effect on viscosity, itself a determinant of mass transfer resistance.
In fact, for the same permeability coefﬁcient and the same TMP gradient, equal amounts of ultraﬁltration will be produced in all ﬁbers. However, since peripheral ﬁbers tend to have a lower blood ﬂow per ﬁber, this will result in a higher single-ﬁber ﬁltration fraction and higher hemoconcentration in the ﬁber. This in turn will result in an increase in blood viscosity and a possible increase in the resistance to ﬂow in those speciﬁc ﬁbers. This phenomenon may contribute to a further reduction in ﬂow velocity and a new steady-state proﬁle.