NDT Advance Access published online on February 11, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp023
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A diffusion-adjusted regional blood flow model to predict solute kinetics during haemodialysis
1 Institute of Physiology 2 Institute of Biophysics, Center for Physiological Medicine, Medical University of Graz, Austria 3 University of Illinois at Chicago, Chicago, IL, USA
Correspondence and offprint requests to: Daniel Schneditz, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21/5, 8010 Graz, Austria. Tel: +43-316-380-4269; Fax: +43-316-380-9630; E-mail: daniel.schneditz{at}medunigraz.at
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Abstract |
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Background. Sequestration of creatinine, in both erythrocytes and other cells, has complicated the widespread application of creatinine kinetics in haemodialysis. The goal of this study was to determine whether creatinine kinetics could be described using a regional blood flow (RBF) model that also incorporated diffusion between intra- and extracellular fluids.
Methods. Transport between intra- and extracellular spaces was modelled by diffusion using a specific rate constant ks for creatinine equilibration in whole blood (0.022 min–1) determined in a separate study. This ks was applied to all body spaces and to creatinine removal from blood coursing through the dialyzer. Erythrocyte and plasma creatinine and urea concentrations during haemodialysis measured and reported by others were used to test the model.
Results. The model accurately predicted the reported time course of creatinine in plasma and erythrocytes as well as the time course of urea in plasma when using the much higher ks for urea (158 min–1). However, it did not explain an increased erythrocyte to plasma urea gradient found at the end of haemodialysis.
Conclusion. The results suggest that a diffusion-adjusted regional blood flow (DA-RBF) model can be used to explain compartmentalization of creatinine or urea throughout the body during haemodialysis, although possible additional compartmentalization of urea in erythrocytes, and perhaps in the tissues, still needs to be accounted for. This new model should be applicable to modelling of other non-protein-bound candidate uraemic toxins, also.
Keywords: blood flow; creatinine kinetics; intercompartment clearance; membrane permeability; urea kinetics
Received for publication: 9.10.08
Accepted in revised form: 12. 1.09