Individualization of Ultrafiltration in Hemodialysis

Author Department

Nephrology; Medicine

Document Type

Article, Peer-reviewed

Publication Date

12-2018

Abstract

OBJECTIVE:

There are approximately 660,000 end-stage renal disease (ESRD) patients in the USA, with hemodialysis (HD) the primary form of treatment. High ultrafiltration rates (UFRs) are associated with intradialytic hypotension, a complication associated with adverse clinical outcomes including mortality. Individualized UFR profiles could reduce the incidence of intradialytic hypotension.

METHODS:

The patient's fluid dynamics during HD is described by a nonlinear model comprising intravascular and interstitial pools, whose parameters are given by the patient's estimated nominal parameter values with uncertainty ranges; the output measurement is hematocrit. We design UFR profiles that minimize the maximal UFR needed to remove a prescribed volume of fluid within a set time, with hematocrit not exceeding a specified time-varying critical profile.

RESULTS:

We present a novel approach to designing individualized UFR profiles, and give theoretical results guaranteeing that the system remains within a pre-defined physiologically plausible region and does not exceed a specified time-invariant critical hematocrit level for all parameters in the uncertainty ranges. We test the performance of our design using a real patient data example. The designed UFR maintains the system below a time-varying critical hematocrit profile in the example.

CONCLUSION:

Theoretical results and simulations show that our designed UFR profiles can remove the target amount of fluid in a given time period while keeping the hematocrit below a specified critical profile.

SIGNIFICANCE:

Individualization of UFR profiles is now feasible using current HD technology and may reduce the incidence of intradialytic hypotension.

PMID

30530307

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