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Concurrent Control of Sodium and Bicarbonate Serum Concentrations Using a Four-Stream Hemodialysis Fluid Delivery
Deepak Malhotra1, Susie Q Lew2, Raymond E Garrett3
1Department of Medicine, University of Toledo School of Medicine, Toledo, Ohio, USA.
Hemodialysis International. International Symposium on Home Hemodialysis
|March 6, 2025
Summary
This study introduces a novel hemodialysis fluid delivery system for simultaneously correcting sodium and acid-base disorders. The system uses a four-stream approach, enabling precise control for treating complex patient conditions.
Area of Science:
- Nephrology
- Biomedical Engineering
- Clinical Chemistry
Background:
- A previously proposed four-stream dialysis fluid delivery system aimed to correct dysnatremias and metabolic acid-base disorders separately.
- This system comprised an acid concentrate, a base concentrate, a sodium chloride concentrate, and product water for hemodialysis.
Purpose of the Study:
- To describe a new method for the clinical application of a four-stream dialysis fluid delivery system.
- To enable concurrent treatment of dysnatremias and metabolic acid-base disturbances using hemodialysis.
Main Methods:
- A four-stream system with pumps controlling flow rates of product water (W), base concentrate (B), and sodium chloride concentrate (S).
- Formulas were derived to calculate pump flow rates for desired sodium and bicarbonate concentrations in the final dialysis fluid.
- The flow rate of the acid concentrate (A) and the W:S:B:A ratio remained constant.
Main Results:
- Formulas were implemented in an EXCEL spreadsheet to determine the W:S:B:A flow rate ratio for target dialysis fluid compositions.
- Calculations defined the upper and lower concentration limits for sodium and bicarbonate in the dialysis fluid.
- The system's clinical application and electrolyte measurements have not yet been performed.
Conclusions:
- The described system offers a feasible approach for treating severe dysnatremias and metabolic acid-base disorders, both individually and concurrently.
- Clinical implementation requires thorough in vitro or ex vivo studies and meticulous expert oversight for safe and reliable use.
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