PREDICTION OF DIALYSIS THERAPY FOR ADEQUATE REMOVAL OF UREMIC TOXINS, OTHER THAN UREA

Abstract

Because patients with renal failure retain a large variety of uremic solutes, we investigated the influence of a personalized therapy deviating from the standard dialysis scheme of three times four hours a week. This study included 7 stable hemodialysis patients undergoing a standard low flux polysulphone dialysis (F8 and F10HPS). Blood samples were collected from inlet and outlet blood lines at different time points during dialysis. Based on the measured plasma concentrations, a two-pool kinetic model was calibrated for each guanidino compound under study: urea, creatinine (CTN), creatine (CT), guanidinosuccinic acid (GSA), guanidinoacetic acid (GAA), guanidine (G), and methylguanidine (MG). This model allows theoretical calculations, simulating different dialysis strategies: daily short dialysis, daily long slow dialysis, and standard dialysis with enhanced solute clearances. For each strategy in steady state, mean patient plasma concentrations were compared to those for standard dialysis. Because GSA was distributed in a smaller volume (30.6±4.2L) and CTN, CT, GAA, G, and MG showed significantly larger distribution volumes (54.0±5.9L, 98.0±52.3L, 123.8±66.9L, 89.7±21.4L, 102.6±33.9L) compared to urea (42.7±6.0L), intra- and inter-dialytic kinetic behaviors are different. Guanidino compounds, characterized by large distribution volumes, take more advantage of less intermittent such as daily dialysis, and even more when those sessions are performed long and slowly. In conclusion, our model predicts patient clearances such that individualized dialysis therapies can be prescribed.