Physiology in daily hemodialysis in terms of the time average concentration/time average deviation concept.
Quotidian or "daily" hemodialysis (DHD) is practiced in widely differing schedules. Yet all those schedules are reported to significantly ameliorate clinical outcome of patients. It is, however, not clear what is the actual cause of this amelioration. Rational possibilities include increased overall dialysis dose and increased weekly time. Conventional mathematical approaches (Kt/V(urea) concept, equivalent renal clearance) cannot be used to study those issues because they do not consider number of dialysis per week and thus ignore the issue of treatment schedule "unphysiology." The time average concentration/time average deviation (TAC/TAD) concept may well be used to visualize impact of treatment schedule on both plasma urea profile statics (TAC) and dynamics (TAD). The concept may further help to stratify studies for elucidation of the key factors of clinical outcome improvement seen on DHD. Actual physiologic mechanisms responsible for this improvement are to be sought among those with having derivative component (i.e., reacting to the rate of a change rather than to the magnitude of the change). It should, however, be kept in mind that the TAC/TAD concept is able to assess unphysiology of a treatment schedule, not unphysiology of a single treatment session.
Lopot
Frantisek
F
General University Hospital and 1st Medical Faculty of Charles University, Department of Internal Medicine, Prague-Strahov, Czech Republic. f.lopot@vfn.cz
Nejedlý
Bohdan
B
Sulková
Sylvie
S