title: Combining dialysate and blood recirculation to boost uremic toxin removal: theory and simulation study.
abstract: Emerging concepts in renal replacement therapies such as daily hemodialysis (HD) and wearable artificial kidney (WAK) meet the challenges derived from the aging of renal disease population. The successful results of blood recirculation to improve the dialysis clearance of medium-high uremic toxins suggest that this technique could be used both in daily HD and WAK. However, blood recirculation induces a reduction of small solutes clearance. This work analyzes the ability of a nonregenerated recirculating dialysate technique to avoid that reduction. The study uses in silico simulations with in vitro data from several commercial dialyzers and very compact dialyzer models derived from them. The resulting combined optimization system (recirculating blood-dialysate system [RBDS]) reached low solute dialysance improvements above 100% in different scenarios. Our outcomes show the RBDS performs best with very compact dialyzers, in agreement with the requirements of daily HD and WAK.
authors.affiliation: Biomedical Engineering Group, University of Seville and CIBER-BBN, Seville, Spain. mpradovelasco@ieee.org
authors.forename: Manuel
authors.initials: M
authors.lastname: Prado
authors.forename: Laura
authors.initials: L
authors.lastname: Roa
mesh_terms: D003198:Computer Simulation; D015312:Hemodialysis Solutions / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008955:Models, Cardiovascular; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods; D014511:Uremia / Q000209:etiology / Q000628:therapy*
chemical_list: D015312:Hemodialysis Solutions