title: Mathematical modeling of thermal and circulatory effects during hemodialysis.
abstract: Intradialytic hypotension (IDH) is one of the most common complications of hemodialysis (HD) treatment. The initiating factor of IDH is a decrease in blood volume, which is related to an imbalance between ultrafiltration (UF) and refilling rate. Impaired reactivity of resistance and capacitance vessels in reaction to hypovolemia plays possibly a major role in the occurrence of IDH. These vessels also fulfill an important function in body temperature regulation. UF-induced cutaneous vasoconstriction would result in a reduced surface heat loss and an increase in core temperature. To release body heat, skin blood flow is increased at a later stage of the HD treatment, whereby possibly IDH can occur. The aim of the study is to develop a mathematical model that can provide insight into the impact of thermoregulatory processes on the cardiovascular (CV) system during HD treatment. The mathematical procedure has been created by coupling a thermo-physiological model with a CV model to study regulation mechanisms in the human body during HD + UF. Model simulations for isothermal versus thermoneutral HD + UF were compared with measurement data of patients on chronic intermittent HD (n = 13). Core temperature during simulated HD + UF sessions increased within the range of measurement data (0.23°C vs. 0.32 ± 0.41°C). The model showed a decline in mean arterial pressure of -7% for thermoneutral HD + UF versus -4% for isothermal HD + UF after 200 min during which relative blood volume changed by -13%. In conclusion, simulation results of the combined model show possibilities for predicting circulatory and thermal responses during HD + UF.
authors: Department of Mechanical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors: Rens P J
authors: RP
authors: Droog
authors: Boris R M
authors: BR
authors: Kingma
authors: Wouter D
authors: WD
authors: van Marken Lichtenbelt
authors: Jeroen P
authors: JP
authors: Kooman
authors: Frank M
authors: FM
authors: van der Sande
authors: Nathan W
authors: NW
authors: Levin
authors: Anton A
authors: AA
authors: van Steenhoven
authors: Arjan J H
authors: AJ
authors: Frijns
mesh_terms: D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D001810:Blood Volume; D001833:Body Temperature Regulation; D002319:Cardiovascular System / Q000503:physiopathology; D003198:Computer Simulation; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology; D008875:Middle Aged; D008955:Models, Cardiovascular; D006435:Renal Dialysis / Q000009:adverse effects*