Development and critical evaluation of an improved comprehensive multicompartment model for the exchange processes during hemodialysis.

An improved comprehensive multicompartment model for the simulation of the most important metabolic state variables in the patient during dialysis is presented. With this approach time courses of urea, creatinine, K+, Na+, Cl-, HCO3-, H+ and CO2 can be predicted. Additionally, osmotic water shifts as well as resting membrane potentials are calculated. The model contains the following extensions compared to classical approaches: For the calculation of osmotic water shifts, not only sodium, but also urea, potassium, chloride and unspecified indiffusable ions are taken into account. Furthermore, hemodynamic aspects are considered by assuming two tissue groups with different perfusion. Thus it is possible to estimate the influence of hemodynamic parameters (e.g. cardiac output or blood flow distribution) on the exchange processes. The model can be adjusted individually by several system parameters. This adjustment is performed by minimizing the sum of the quadratic differences between simulated and measured plasma concentrations of the considered substances. A first validation has been performed successfully with measured data from 18 dialysis patients. After the effective whole-body exchange area of the resting cell membranes for potassium, sodium and chloride had been estimated, rebound effects for those electrolytes could be simulated successfully.