Objectives: Although diabetes is the leading cause of end-stage renal dis- ease in many countries, data about its impact on patient-specific reaction to haemodialysis (HD) is scarce. Models that allow identifying and pre- dicting patient-specific response to HD are in development and their improvement is encouraged by clinicians to obtain suitable decision sup- port systems (DSS). Here, possible correlations between diabetes and alterations in the patient-specific parameters identified by a multi-pool, multi-solute model, developed in our laboratory, are investigated. Methods: Data acquired during the ‘DialysIS’ Interreg Project (141 patients, 4 centres, 1276 HD) have been used. For each patient, a set of specific parameters was identified: one modulates the permeability at the capillary wall (ρ), the others account for altered transport of catabo- lites and electrolytes at the cellular wall (ki) and at the dialyser mem- brane (ηi), where ‘i’ indicates different solutes. Patients have been classified as diabetic (D) or not (ND) and among Ds, as insulin-dependent (D_ID) or not (D_NID). Initial glucose concentrations and identified val- ues of ρ, ki, ηi in the different groups have been compared using proper statistical tests (p<0.01). Results: There were were 37 (26,4%) D patients and 16 of them were D_ID (43,2%). Initial plasma glucose concentration statistically differs both between D and ND and between D_ID and D_NID patients. Among the patient-specific parameters ρ, and KNa, KMg, KCreatinine and KBicarbonate results were different between D and ND. The values of ηNa, ηMg, ηCa, ηUrea and ηCreatinine, instead, significantly differ between D_ID and D_NID. Discussion: Diabetes-induced autonomic and peripheral neuropathies can justify the finding of altered capillary wall permeability in D; moreo- ver the use of insulin, protein based, seems to impact on the mass trans- port through the dialyzer membrane. The proposed approach allows adding a new tile to the studies on how the diabetic pathology affects the response to the HD treatment.

DIALYSIS AND DIABETES: WHAT A MATHEMATICAL MODEL CAN TELL US?

G. Casagrande;ML. Costantino
2019-01-01

Abstract

Objectives: Although diabetes is the leading cause of end-stage renal dis- ease in many countries, data about its impact on patient-specific reaction to haemodialysis (HD) is scarce. Models that allow identifying and pre- dicting patient-specific response to HD are in development and their improvement is encouraged by clinicians to obtain suitable decision sup- port systems (DSS). Here, possible correlations between diabetes and alterations in the patient-specific parameters identified by a multi-pool, multi-solute model, developed in our laboratory, are investigated. Methods: Data acquired during the ‘DialysIS’ Interreg Project (141 patients, 4 centres, 1276 HD) have been used. For each patient, a set of specific parameters was identified: one modulates the permeability at the capillary wall (ρ), the others account for altered transport of catabo- lites and electrolytes at the cellular wall (ki) and at the dialyser mem- brane (ηi), where ‘i’ indicates different solutes. Patients have been classified as diabetic (D) or not (ND) and among Ds, as insulin-dependent (D_ID) or not (D_NID). Initial glucose concentrations and identified val- ues of ρ, ki, ηi in the different groups have been compared using proper statistical tests (p<0.01). Results: There were were 37 (26,4%) D patients and 16 of them were D_ID (43,2%). Initial plasma glucose concentration statistically differs both between D and ND and between D_ID and D_NID patients. Among the patient-specific parameters ρ, and KNa, KMg, KCreatinine and KBicarbonate results were different between D and ND. The values of ηNa, ηMg, ηCa, ηUrea and ηCreatinine, instead, significantly differ between D_ID and D_NID. Discussion: Diabetes-induced autonomic and peripheral neuropathies can justify the finding of altered capillary wall permeability in D; moreo- ver the use of insulin, protein based, seems to impact on the mass trans- port through the dialyzer membrane. The proposed approach allows adding a new tile to the studies on how the diabetic pathology affects the response to the HD treatment.
2019
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11311/1120976
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