Maheshwari Vaibhav, Cherif Alhaji, Fuertinger Doris, Schappacher-Tilp Gudrun, Preciado Priscila, Thijssen Stephan, Bushinsky David A, Kotanko Peter
Annu Int Conf IEEE Eng Med Biol Soc. 2017 Jul;2017:2740-2743. doi: 10.1109/EMBC.2017.8037424.
International guidelines for chronic hemodialysis patients suggest a dialysate calcium concentration between 1.25 and 1.5 mmol/L. However, it is not certain if these dialysate calcium levels result in net calcium transfer into the patient. With ubiquitous prevalence of vascular calcification in hemodialysis patients, it is pertinent to model the mass balance of calcium during dialysis. To this end, we developed a two compartmental patient model and spatiotemporal representation of dialyzer model to investigate and quantify the calcium mass balance during dialysis. The model accounts for calcium-albumin binding and varying protein concentration; the latter accounts for the Gibbs-Donnan effect. The model simulations suggest that despite a lower dialysate calcium concentration of 1.25 mmol/L, some of our patients may be loaded with calcium during dialysis. This net calcium flux from dialysate to blood side may be a potential contributor to vascular calcification, a primary cause of cardiovascular mortality in hemodialysis patients.
慢性血液透析患者的国际指南建议透析液钙浓度在1.25至1.5 mmol/L之间。然而，目前尚不确定这些透析液钙水平是否会导致钙净转移至患者体内。鉴于血液透析患者血管钙化普遍存在，建立透析过程中钙的质量平衡模型很有必要。为此，我们开发了一个双室患者模型和透析器模型的时空表示，以研究和量化透析过程中的钙质量平衡。该模型考虑了钙与白蛋白的结合以及不同的蛋白质浓度；后者解释了吉布斯-唐南效应。模型模拟表明，尽管透析液钙浓度较低，为1.25 mmol/L，但我们的一些患者在透析过程中仍可能摄入钙。这种从透析液到血液侧的钙净通量可能是血管钙化的一个潜在因素，而血管钙化是血液透析患者心血管死亡的主要原因。
