AN INTEGRATED MODEL TO IMPROVE DIALYSIS THERAPY PLANNING - Oral presentations and posters of the XL Annual ESAO Congress - 11-14 September 2013, Glasgow, Scotland (UK)

Objectives: Dialysis treatment is still associated with a non-negligible rate of morbidity. A better outcome could be gained by tailoring the treatment on the single patient. Many mathematical models have been developed to describe body fluid and solute kinetics during Standard Hemo-Dialysis (SHD), while Online Hemo-Dia-Filtration (HDF) and Acetate Free-Biofiltration (AFB) have been poorly investigated so far. This work aims to provide a tool to compare the effects of different therapy settings or dialysis techniques on the patients, to supply each patient with the more suitable treatment. Methods & Materials: The data from 338 dialysis sessions (13 patients), recorded at IRCCS Policlinico San Donato, San Donato M.se, Italy, were used to develop and validate the mathematical models simulating each of the different dialysis techniques. The diffusive and convective interactions occurring among the patient, the dialysate and, where appropriate, the substitution fluid, were considered. Three parameters, related to mass transfer efficiency at the cell membrane, at the dialyser and at the capillary wall, were used to tune the model. The effects of the different settings on each patient were investigated. Results: The simulated electrolyte concentrations deviated from clinical measurements less than 5% in the 97% of the sessions, exception made for potassium which deviated less than 10%. Blood volume deviated less than 5% in the 80% of the HD and HDF sessions and less than 10% in the 75% of AFB sessions. The effects of different settings on each technique were highlighted in terms of molecules removal efficiency. Conclusions: The developed integrated model allows the description of electrolytes and compartmental fluid transfer in the dialysis patient and the evaluation of the effects of different settings. These results will be beneficial to dialysis therapy planning and quality of life of the patients.