9846

Hemodialysis

This Demonstration uses the pharmacokinetic one- and two-compartment models to simulate hemodialysis.

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In the one-compartment model, the patient's body fluid is considered as one unit; toxins, here represented by creatinine, are removed to the dialyzer by diffusion. The two-compartment model assumes the body fluids are divided into two compartments, one directly accessible to the dialyzer (extracellular) and the other indirectly accessible (intracellular); creatinine is generated in the extracellular compartment [1]. Assuming constant volume and no residual kidney function, the one-compartment model is described by an ordinary differential equation:
and the two-compartment model by a pair of coupled ordinary differential equations:
and
.
Here , , and are the creatinine concentrations in the total, extracellular, and intracellular compartments; is the mass transfer coefficient; is the dialyzer clearance; and , , and are the total, extracellular, and intracellular volumes. Total body volume in liters is taken as 57% of body weight in kilograms, and the intracellular and extracellular volumes as 2/3 and 1/3 of total body volume [2]. is the rate of creatinine generation and is time. The initial condition for the dialysis time period is , a constant, in the recovery period (no dialysis) , and the initial values of , , and are equal to the values of , , and at the end of dialysis. These equations are solved using Mathematica's built-in function NDSolve. The solution to the two-compartment model exhibits the phenomena of post-dialysis rebound, the observed fast increase in creatinine concentration after dialysis caused by disequilibrium between the compartments.
References
[1] J. Waniewski, "Mathematical Modeling of Fluid and Solute Transport in Hemodialysis and Peritoneal Dialysis," Journal of Membrane Science, 274(1–2), 2006 pp. 24–37. doi:10.1016/j.memsci.2005.11.038.
[2] K. B. G. Sprenger, W. Kratz, A. E. Lewis, and U. Stadtmüller, "Kinetic Modeling of Hemodialysis, Hemofiltration, and Hemodiafiltration," Kidney International, 24, 1983 pp. 143–151. doi:10.1038/ki.1983.138.
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