A model of vascular refilling with inflammation

Inflammation is prevalent in hemodialysis patients and is believed to significantly contribute to cardiovascular disease progression in end stage renal disease patients undergoing hemodialysis. Increased vascular permeability associated with inflammation is likely to influence the capillary wall properties, affecting vascular refilling during hemodialysis. In this paper, we present a model that incorporates inflammation into a vascular refilling model. We investigate how inflammation may affect the fluid volume and protein concentration dynamics in the plasma and interstitial spaces. In our work, we quantify inflammation by considering the concentration of the inflammatory biomarker C-reactive protein (CRP). Traditional sensitivity functions and subset selection based on asymptotic standard errors were used to aid in parameter identification. Estimates of the parameters were calculated from numerically generated measurements for fluid flux and hematocrit. Observations on the capillary wall properties, filtration and reflection coefficients, were done using data on mean CRP and serum albumin from a large population of European hemodialysis patients in their terminal two years before death and patients surviving for at least four years after dialysis initiation.