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1 Biocybernetics and Biomedical Engineering

1 2024

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Profiled delivery of bicarbonate during weekly cycle of hemodialysis

Pietribiasi Mauro, Leypoldt John K., Wieliczko Monika, Twardowska-Kawalec Malgorzata, Debowska Malgorzata, Malyszko Jolanta, Waniewski Jacek

Biocybernetics and Biomedical Engineering

2024

Vol. 44, no. 4

836--843

Background: Delivery of bicarbonate during hemodialysis (HD) is aimed at correcting metabolic acidosis in end-stage renal disease patients. We tested modified prescriptions of bicarbonate concentration in dialysis fluid (CD, bic), aimed to achieve an optimal pre-dialytic bicarbonate plasma concentration (CP,bic). Methods: We used a mathematical model to prescribe individualized HD treatments consisting of 1) adjustment of CD,bic to get the pre-dialytic CP,bic in a prescribed range, 2) increase of bicarbonate load before the long interdialytic break, and 3) a single step of increase in CD,bic after two hours. The outcomes were tested in 24 stable HD patients, monitored during a week of standard HD (Test Week) and a week of modified treatment (Intervention Week). Results: The response to the model-based prescription was different whether the average CD,bic during the Intervention Week was higher or lower than the constant value used for the Test Week. For patients with lower average CD,bic during the Intervention Week, a significant fraction achieved the target (22 ≤ CP,bic ≤ 24 mEq/L). In the group with higher average CD,bic, the interventions were effective only in increasing post-dialytic CP,bic. The simple step-increase profile was effective in linearizing the intradialytic increase in bicarbonate and decreasing the amount of time spent by patients at high plasma CP,bic. Conclusions: The interventions were effective mostly in patients who needed to lower their pre-dialytic CP,bic. The resistance of the system to increasing pre-dialytic CP,bic in other patients might be caused by modifications of breathing or in hydrogen generation that were not accounted for by our model.