P1120QUANTIFICATION OF ACID-BASE TRANSPORT IN HEMODIALYZERS

Abstract

Abstract Background and Aims Quantification of bicarbonate and dissolved carbon dioxide (CO2) transport in hemodialyzers can be described by the product of a dialysance (D) and their respective concentration differences between dialysate and plasma. It is typically assumed that D values are constant for a given hemodialyzer and flow conditions; however, this approach neglects the chemical interconversion of bicarbonate and dissolved CO2 within blood. We assessed the validity of this approach by developing a comprehensive mathematical model of acid-base transport in hemodialyzers. Method Mass balance relationships in a hemodialyzer were defined using a one-dimensional model with counter-current flows of blood and dialysate. The molecular biochemistry of bicarbonate, dissolved CO2, and non-bicarbonate buffer in both plasma and erythrocytes, together with carbaminohemoglobins within erythrocytes, was assumed to be in equilibrium as described by Rees and Andreassen (Crit Rev Biomed Eng 2005). The model equations were solved numerically, and optimal mass transfer-area coefficients for bicarbonate and dissolved CO2 were determined by comparing model predictions with the data from Sombolos et al (Artif Organs 2005). The latter data included measured concentrations of bicarbonate and dissolved CO2 in plasma and dialysate inlet and outlet flows at a blood flow rate of 300 mL/min, dialysate flow rate of 700 mL/min, and dialysate bicarbonate concentration of 32.5 mEq/L. Base excess of blood was assumed as -5 mEq/L. Model simulations then evaluated the effect of the plasma bicarbonate concentration at the blood inlet (assuming constant mass transfer-area coefficients and flow rates) on D for both bicarbonate (Dbic) and dissolved CO2 (DCO2). D values were calculated as the loss of the molecule from the dialysate divided by the difference in inlet concentrations of dialysate and plasma. Results Optimal mass transfer-area coefficients for bicarbonate and dissolved CO2 were 396 and 1360 mL/min, respectively. Simulation results at different plasma bicarbonate concentrations at the blood inlet ([Bicarbonate]) as expected during a typical hemodialysis treatment are tabulated: Conclusion Quantification of acid-base transport in hemodialyzers requires dialysance values for bicarbonate and dissolved CO2 that are not constant but instead are dependent on the plasma bicarbonate concentration at the blood inlet for a given hemodialyzer at fixed blood and dialysate flow rates.