Theoretical approach and clinical application of kinetic modelling in dialysis

Using kinetic modelling for shaping profile dialysis, we present a promising approach to improve the cardiovascular stability of patients during dialysis treatment. In order to obtain an insight into the physiological mechanisms of increased stability, a model considering alterations of electrolytes and water distribution and of acid-base status was developed. This algorithm was used for the evaluation of 114 dialysis sessions, which were performed with highly individualised profiles. Each profile was developed for one patient by trying empirically to prevent episodes of hypotension as well as other clinical problems throughout dialysis. The main advantage of profile dialysis compared to standard bicarbonate dialysis, for example, is a reduced water influx into the cell during the treatment. According to our clinical and theoretical results a correlation between water influx into the cell and time of occurrence of hypotensive episodes in individuals can be assumed. Hypotension usually starts after 0.5 litres of water have entered the intracellular space, regardless of the time necessary for this fluid shift.