Validation of a Two-Pool Model for the Kinetics of ß2-Microglobulin

Stiller, S.; Xu, Xiaoqi; Grüner, N.; Vienken, Joerg; Mann, H.

doi:10.1177/039139880202500511

Cited by 40 publications

(25 citation statements)

References 9 publications

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“…Some of these studies have concentrated on β2-microglobulin, which has a high molecular weight as compared to the guanidino compounds presently studied [25,26]. Other studies have concentrated on phosphate, which is known to be distributed in at least two to four different compartments [27].…”

Section: Discussionmentioning

confidence: 99%

Impact of increasing haemodialysis frequency versus haemodialysis duration on removal of urea and guanidino compounds: a kinetic analysis

Eloot

Biesen

Dhondt

et al. 2009

Nephrology Dialysis Transplantation

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Background. Patients with renal failure retain a large variety of uraemic solutes, characterized by different kinetic behaviour. It is not entirely clear what the impact is of increasing dialysis frequency and/or duration on removal efficiency, nor whether this impact is the same for all types of solutes. Methods. This study was based on two-compartmental kinetic data obtained in stable haemodialysis patients (n = 7) for urea, creatinine (CREA), guanidinosuccinic acid (GSA) and methylguanidine (MG). For each individual patient, mathematical simulations were performed for different dialysis schedules, varying in frequency, duration and intensity. For each dialysis schedule, plasmatic and extraplasmatic weekly time-averaged concentrations (TAC) were calculated, as well as their %difference to weekly TAC of the reference dialysis schedule (three times weekly 4 h). Results. Increasing dialysis duration was most beneficial for CREA and MG, which are distributed in a larger volume (54.0 ± 5.9 L and 102.6 ± 33.9 L) than urea (42.7 ± 6.0 L) [plasmatic weekly TAC decrease of 31.5 ± 3.2% and 31.8 ± 3.8% for CREA and MG with Q B of 200 mL/min, compared to 25.7 ± 3.2% for urea (P = 0.001 and P < 0.001)]. Increasing dialysis frequency resulted only in a limited increase in efficiency, most pronounced for solutes distributed in a small volume like GSA (30.6 ± 4.2 L). Increasing both duration and frequency results in weekly TAC decreases of >65% for all solutes. Comparable results were found in the extraplasmatic compartment. Conclusion. Prolonged dialysis significantly reduces solute concentration levels, especially for those solutes that are distributed in a larger volume. Increasing both dialysis frequency and duration is the superior dialysis schedule.

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Section: Discussionmentioning

confidence: 99%

Impact of increasing haemodialysis frequency versus haemodialysis duration on removal of urea and guanidino compounds: a kinetic analysis

Eloot

Biesen

Dhondt

et al. 2009

Nephrology Dialysis Transplantation

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show abstract

“…Our simulations can be considered as being performed in an ‘average patient on dialysis’ since we used kinetic models that were previously calibrated on patient’s data [5,6,7]. However, some weaknesses of the modeling approach should be highlighted.…”

Section: Discussionmentioning

confidence: 99%

“…The data of two-compartment calibrated kinetic models were taken from literature for urea and methylguanidine (MG) [5], β 2 -microglobulin (β 2 M) [6], and phosphate (P) [7] (see table 1). …”

Section: Methodsmentioning

confidence: 99%

Slow Extended Nocturnal Home Hemodialysis Shows Superior Adequacy Compared to In-Center Dialysis: A Mathematical Analysis

et al. 2012

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Extended nocturnal home hemodialysis has gained renewed interest. However, no removal data for single/double needle (lumen) (SL and DL, respectively) or for low/high blood flow in extended dialysis are available. Therefore, we studied dialysis adequacy in different nocturnal home hemodialysis strategies. Coupling a kinetic with a dialyzer model, we calculated a reduction ratio from pre- to post-dialysis (RR) and total solute removal (TSR) of urea, methylguanidine (MG), β₂-microglobulin, and phosphate. Simulations were done for dialysis with blood flow Q_b350 ml/min (DL-4h), extended DL high flow with Q_b350 (DL-HF-8h) and low flow with Q_b175 (DL-LF-8h), and SL with Q_b273 (SL-8h). Compared to DL-4h, TSR was 28–59% larger for DL-HF-8h. TSR was most increased for β₂-microglobulin (18%) with DL-LF-8h, and for MG (35%) with SL-8h. Furthermore, RRs were equal (DL-LF-8h), higher (SL-8h), and even more increased (DL-HF-8h) for all studied solutes. In the home setting, DL-LF-8h and SL-8h are safe and promising strategies.

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“…Intercompartmental clearance is more comparable to that of β 2 -microglobulin (K 12 30-80 mL/min) [14,15]. However, iodine is distributed in a much larger plasmatic volume (V 1 19.4 L, compared to 1.8 L for β 2 M) and larger total distribution volume (55% TBW, compared to 25-36% TBW for β 2 M) [15,16]. Hence, iodine plasmatic as well as extraplasmatic concentrations will decrease more slowly than those of β 2 M.…”

Section: Discussionmentioning

confidence: 99%

How to remove accumulated iodine in burn-injured patients

Eloot

Dhondt

Hoste

et al. 2009

Nephrology Dialysis Transplantation

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Background. Absorption of large quantities of iodine, as induced by the use of topical antimicrobial povidone-iodine in burn-injured patients, may cause metabolic and electrolyte abnormalities as well as renal failure. To diminish iodine levels, haemodialysis was previously reported to be a suitable therapy. We therefore studied the kinetics of iodine in order to define the most optimal dialysis strategy. Methods. Two patients with elevated iodine levels (93.6 and 81.2 mg/L) underwent continuous dialysis with blood flows Q B 150 and 120 mL/min. Blood was sampled from the inlet and outlet dialysis line at several time points during a 7-h and 39-h 10-min period, respectively. Samples were analysed for iodine with the inductively coupled plasma mass spectrometry (ICPMS) method. Kinetic analysis was performed using one and two compartmental models, deriving kinetic parameters: plasmatic volume V 1 , extraplasmatic volume V 2 and intercompartmental clearance K 12 . The calibrated kinetic model of Patient 2 was further used to simulate different dialysis strategies: 12-h per day with Q B 240, 6-h per day with Q B 480 and 240, and 12-h every 2 days with Q B 240. For each strategy, the mean average plasmatic and extraplasmatic concentration (TAC p and TAC ep ) was calculated during 48 h. Results. Iodine seemed to follow one compartmental kinetics when serum sample collections were limited to the first 7 h of dialysis (Patient 1), but iodine appeared to be distributed in two volumes (V 1 =19.4 L, V 2 =38.0 L and K 12 =55 mL/min) when a longer observation period was taken into account (Patient 2). The simulations disclosed that 12-h dialysis per day with Q B 240 or continuous dialysis with Q B 120 resulted in the lowest TAC p (18.2 and 19.0 μg/L) and TAC ep (34.4 and 36.1 μg/L). Conclusion. In patients with elevated iodine levels, especially when associated with renal failure, haemodialysis with a minimum 12-h duration with sufficient blood flow should be the first choice to remove iodine.

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Validation of a Two-Pool Model for the Kinetics of ß2-Microglobulin

Cited by 40 publications

References 9 publications

Impact of increasing haemodialysis frequency versus haemodialysis duration on removal of urea and guanidino compounds: a kinetic analysis

Impact of increasing haemodialysis frequency versus haemodialysis duration on removal of urea and guanidino compounds: a kinetic analysis

Slow Extended Nocturnal Home Hemodialysis Shows Superior Adequacy Compared to In-Center Dialysis: A Mathematical Analysis

How to remove accumulated iodine in burn-injured patients

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