title: Patient-specific modeling of multicompartmental fluid and mass exchange during dialysis.
abstract: BACKGROUND
  Dialysis is associated with a non-negligible rate of morbidity, requiring treatment customization. Many mathematical models have been developed describing solute kinetics during hemodialysis (HD) for an average uremic patient. The clinical need can be more adequately addressed by developing a patient-specific, multicompartmental model.
  
  
  METHODS
  The data from 148 sessions (20 patients), recorded at the Regional Hospital of Lugano, Switzerland, were used to develop and validate the mathematical model. Diffusive and convective interactions among patient, dialysate and substitution fluid were considered. Three parameters, related to mass transfer efficiency at the cell membrane, at the dialyzer and at the capillary wall, were used to tune the model. The ability of the model to describe the clinical evolution of a specific HD session was evaluated by comparing model outputs with clinically acquired data on solutes and catabolite concentrations.
  
  
  RESULTS
  The model developed in this study allows electrolyte and catabolite concentration trends during each HD session to be described. The errors obtained before the estimation of the patient-specific parameters drastically decrease after their identification. With the optimized model, plasmatic concentration trends can be described with an average percent error lower than 2.1% for Na+, Cl-, Ca2+ and HCO3-, lower than 5% for K+ and lower than 8% for urea.
  
  
  CONCLUSIONS
  The peculiarity of the proposed model is the possibility it offers to perform a real-time simulation enabling quantitative appraisal of hematochemical quantities whose direct measurement is prohibitive. These will be beneficial to dialysis therapy planning, reducing intradialysis complications and improving patients' quality of life.
authors.affiliation: Department of Chemistry, Materials and Chemical Engineering Giulio Natta, Politecnico di Milano, Milan - Italy.
authors.forename: Giustina
authors.initials: G
authors.lastname: Casagrande
authors.affiliation: Department of Chemistry, Materials and Chemical Engineering Giulio Natta, Politecnico di Milano, Milan - Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Bianchi
authors.affiliation: Department of Chemistry, Materials and Chemical Engineering Giulio Natta, Politecnico di Milano, Milan - Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Vito
authors.affiliation: Nephrology and Dialysis Unit, A. Manzoni Hospital, Lecco - Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Carfagna
authors.affiliation: Nephrology and Dialysis Unit, Sant'Anna Hospital, Como - Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Minoretti
authors.affiliation: Nephrology and Dialysis Unit, A. Manzoni Hospital, Lecco - Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pontoriero
authors.affiliation: Nephrology and Dialysis Unit, Circolo Hospital and Macchi Foundation, Varese - Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rombolà
authors.affiliation: Nephrology and Dialysis Unit, Regional Hospital of Lugano, Lugano - Switzerland.
authors.forename: Carlo
authors.initials: C
authors.lastname: Schoenholzer
authors.affiliation: Department of Chemistry, Materials and Chemical Engineering Giulio Natta, Politecnico di Milano, Milan - Italy.
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Costantino
mesh_terms: D015314:Dialysis Solutions; D006801:Humans; D008962:Models, Theoretical; D066230:Patient-Specific Modeling; D011788:Quality of Life; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000628:therapy*
chemical_list: D015314:Dialysis Solutions