An in silico method to predict net calcium transfer during hemodialysis

Maheshwari, Vaibhav; Cherif, Alhaji; Fuertinger, Doris; Schappacher‐Tilp, Gudrun; Preciado, Priscila; Thijssen, Stephan; Bushinsky, David A.; Kotanko, Peter

doi:10.1109/embc.2017.8037424

Cited by 4 publications

(5 citation statements)

References 6 publications

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“…Ideally, a model that gives information on the CaMB during dialysis would be of great help in preventing side effects of both a positive and/or negative CaMB. Recently, a two-compartmental patient model, taking into account the Ca-albumin binding and varying protein concentration (Gibbs-Donnan effect) and spatiotemporal representation of dialyzer model, was developed to investigate and quantify the CaMB during dialysis [48]. The simulations made by the model suggest that with a DCa of 1.25 mmol/L, patients may also be loaded with Ca during dialysis.…”

Section: Does An Optimal Dca Exist?mentioning

confidence: 99%

Dialysate Calcium Levels: Do They Matter?

et al. 2018

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Background: Calcium (Ca) is an essential element that plays a critical role in many biological processes. In dialysis patients, the regulation of Ca balance is highly complex, given the absence of kidney function, endocrine disturbances and the use of drugs such as phosphate binders, vitamin D analogues, and calcimimetics. Also, the use of different dialysate Ca (DCa) baths has profound effect on Ca balance, which depends both on the difference between the Ca concentration in the bath and the serum of the patients, as on the ultrafiltration volume. Summary: The choice of DCa may have important short- and long-term consequences. While lower DCa (especially < 2.5 mEq/L) concentrations have been associated with an increased risk of sudden cardiac death in observational studies, DCa in the higher ranges (3.0 mEq/L and above) may contribute to vascular pathology. Intra-dialytic hemodynamics may also be affected by the choice of DCa. In general, lower DCa concentrations are associated with an increase, and higher DCa concentrations with a decrease in parathyroid hormone (PTH) levels. Preliminary data has suggested that a DCa of 2.75 mEq/L may help in obtaining a net zero intradialytic Ca balance in individual patients, but clinical experience is still limited. Key Message: The optimal Ca balance depends on multiple parameters including blood Ca levels, PTH and the use of phosphate binders and vitamin D analogues, as well as on the risk of hemodynamic stability and cardiac arrhythmias. Therefore, DCa prescription should be individualised. A DCa of 2.75 mEq/L may be useful adjunct for dialysis providers.

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Section: Does An Optimal Dca Exist?mentioning

confidence: 99%

Dialysate Calcium Levels: Do They Matter?

et al. 2018

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“…The following supporting information can be downloaded at: https: //www.mdpi.com/article/10.3390/toxins16070292/s1, Figure S1: Effects of 2 L Hartmann solution infusion; Figure S2: Effect of 240 mL of 30% urea infusion in a patient with SIADH; Table S1: Nomenclature table for urea dynamics; Table S2: Additional model variables and parameters for Acid-base dynamics (reference [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] are cited in the Supplementary Materials).…”

Section: Supplementary Materialsmentioning

confidence: 99%

Allo-Hemodialysis, a Novel Dialytic Treatment Option for Patients with Kidney Failure: Outcomes of Mathematical Modelling, Prototyping, and Ex Vivo Testing

Maheshwari,

Grobe,

Wang

et al. 2024

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It has been estimated that in 2010, over two million patients with end-stage kidney disease may have faced premature death due to a lack of access to affordable renal replacement therapy, mostly dialysis. To address this shortfall in dialytic kidney replacement therapy, we propose a novel, cost-effective, and low-complexity hemodialysis method called allo-hemodialysis (alloHD). With alloHD, instead of conventional hemodialysis, the blood of a patient with kidney failure flows through the dialyzer’s dialysate compartment counter-currently to the blood of a healthy subject (referred to as a “buddy”) flowing through the blood compartment. Along the concentration and hydrostatic pressure gradients, uremic solutes and excess fluid are transferred from the patient to the buddy and subsequently excreted by the healthy kidneys of the buddy. We developed a mathematical model of alloHD to systematically explore dialysis adequacy in terms of weekly standard urea Kt/V. We showed that in the case of an anuric child (20 kg), four 4 h alloHD sessions are sufficient to attain a weekly standard Kt/V of >2.0. In the case of an anuric adult patient (70 kg), six 4 h alloHD sessions are necessary. As a next step, we designed and built an alloHD machine prototype that comprises off-the-shelf components. We then used this prototype to perform ex vivo experiments to investigate the transport of solutes, including urea, creatinine, and protein-bound uremic retention products, and to quantitate the accuracy and precision of the machine’s ultrafiltration control. These experiments showed that alloHD performed as expected, encouraging future in vivo studies in animals with and without kidney failure.

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“…Furthermore, when considering calcium clearance during extracorporeal therapies, changes in serum bicarbonate, pH, and magnesium homeostasis have to be considered. Recently proposed novel calcium kinetic models might prove to be helpful toward a more accurate assessment of calcium balance on HD …”

Section: The Choice Of Dca In Conventional Hdmentioning

confidence: 99%

“…Recently proposed novel calcium kinetic models might prove to be helpful toward a more accurate assessment of calcium balance on HD. [13][14][15] Compelling evidence suggests that calcium mass balance is always positive with a DCa 3.5 mEq/L, negative or neutral with the use of mildly positive calcium balance while maintains optimal serum calcium and PTH levels. 26 Variable calcium balances with the same DCa that have been reported in different studies obviously are accounted for by the variability in baseline serum ionized calcium concentration and the ultrafiltrate volume, but probably also by differences in population characteristics as well.…”

Section: The Choi Ce Of D C a In Conventional Hdmentioning

confidence: 99%

Calcium balance in hemodialysis: More uncertainty than certainty

Kirmizis

Basile

2020

Seminars in Dialysis

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There is controversy about the choice of dialysate calcium concentration (DCa), with strong arguments both in favor of and against the use of a low or high DCa, as they can both be potentially harmful. Evidence suggests that calcium mass balance is positive with a DCa 3.5 mEq/L, negative or neutral with the use of DCa 2.5 mEq/L, whereas both positive and negative balances have been observed with the use of DCa 3.0 mEq/L. Overall, the use of DCa >2.5 mEq/L is usually associated with an increase in serum calcium level and a decrease in serum PTH level and use of lower vitamin D analogue dose, with the opposite effects usually observed with the use of lower DCa. Most of the available evidence is from small‐sized and crossover studies; hence, evidence should be regarded with caution and applied in a patient‐specific manner. As there are a lot of significant unanswered questions regarding calcium balance and the optimal DCa in hemodialysis patients, further high‐quality research is needed to clarify many still unclear aspects of calcium homeostasis and balance in these patients. In conclusion, with the existing evidence the choice of DCa needs to be individualized and contextualized in the setting of each patient's calcium balance needs and homeostatic response, taking also into account oral calcium intake (dietary and medicinal), any other relevant therapy administered, such as vitamin D analogues, the type of renal mineral bone disorder, and associated cardiovascular comorbidity.

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An in silico method to predict net calcium transfer during hemodialysis

Cited by 4 publications

References 6 publications

Dialysate Calcium Levels: Do They Matter?

Dialysate Calcium Levels: Do They Matter?

Allo-Hemodialysis, a Novel Dialytic Treatment Option for Patients with Kidney Failure: Outcomes of Mathematical Modelling, Prototyping, and Ex Vivo Testing

Calcium balance in hemodialysis: More uncertainty than certainty

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