The Danish Diabetes Academy, Odense University Hospital, Odense, Denmark.
Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
Exp Physiol. 2023 Oct;108(10):1325-1336. doi: 10.1113/EP091201. Epub 2023 Aug 11.
A coagulation component should be considered in phosphate kinetics modelling because intradialytic coagulation of the extracorporeal circuit and dialyser might reduce phosphate removal in haemodialysis. Thus, the objective of this study was to add and evaluate coagulation as an individual linear clearance reduction component to a promising three-compartment model assuming progressive intradialytic clotting. The model was modified and validated on intradialytic plasma and dialysate phosphate samples from 12 haemodialysis patients collected during two treatments (HD1 and HD2) at a Danish hospital ward. The most suitable clearance reduction in each treatment was identified by minimizing the root mean square error (RMSE). The model simulations with and without clearance reduction were compared based on RMSE and coefficient of determination (R ) values. Improvements were found for 17 of the 24 model simulations when clearance reduction was added to the model. The slopes of the clearance reduction were in the range of 0.011-0.632/h. Three improvements were found to be statistically significant (|observed z value| > 1.96). A very significant correlation (R = 0.708) between the slopes for HD1 and HD2 was found. Adding the clearance reduction component to the model seems promising in phosphate kinetics modelling and might be explained, at least in part, by intradialytic coagulation. In future studies, the model might be developed further to serve as a potentially useful tool for the quantitative detection of clotting problems in haemodialysis. NEW FINDINGS: What is the central question of this study? The aim was to add an intradialytic coagulation component to a modified version of a promising three-compartment phosphate kinetics model. The hypothesis was that circuit and dialyser clotting can be modelled by an individual linear phosphate clearance reduction component during haemodialysis treatment. What is the main finding and its importance? Improvements were found for 17 of 24 model simulations when clearance reduction was added to the model. Thus, the kinetics model seems promising and could be a useful tool for the quantitative detection of clotting problems in haemodialysis patients.
在磷酸盐动力学建模中应考虑凝血成分，因为体外循环和透析器在透析过程中的凝血可能会降低血液透析中的磷酸盐清除率。因此，本研究的目的是在一个有前途的三腔模型中添加凝血，并将其作为一个单独的线性清除率降低成分进行评估，假设在透析过程中存在逐渐的凝血。该模型在丹麦医院病房的 12 名血液透析患者的两次治疗（HD1 和 HD2）期间收集的透析液和透析液磷酸盐样本中进行了修改和验证。通过最小化均方根误差（RMSE）来确定每个治疗中最适合的清除率降低。基于 RMSE 和决定系数（R）值，比较了添加和不添加清除率降低的模型模拟。当将清除率降低添加到模型中时，24 个模型模拟中有 17 个得到了改善。清除率降低的斜率范围为 0.011-0.632/h。发现有 3 个改进在统计学上是显著的（|观察 z 值|>1.96）。在 HD1 和 HD2 之间发现了非常显著的相关性（R=0.708）。在磷酸盐动力学建模中，向模型添加清除率降低成分似乎很有前途，这至少可以部分解释为透析过程中的凝血。在未来的研究中，该模型可能会进一步发展，成为血液透析中凝血问题定量检测的潜在有用工具。新发现：这项研究的核心问题是什么？目的是在改良的三腔磷酸盐动力学模型中添加一个透析过程中的凝血组件。假设可以通过在血液透析治疗期间使用单独的线性磷酸盐清除率降低成分来模拟体外循环和透析器的凝血。主要发现及其重要性是什么？当向模型中添加清除率降低时，24 个模型模拟中有 17 个得到了改善。因此，该动力学模型似乎很有前途，可以成为血液透析患者凝血问题定量检测的有用工具。
