Mathematical modeling of thermal and circulatory effects during hemodialysis.

R. P. Droog, B.R. Kingma, W.D. van Marken Lichtenbelt, J.P. Kooman, F.M. van der Sande, N.W. Levin, A.A. van Steenhoven, A.J. Frijns

Research output: Contribution to journalArticleAcademicpeer-review

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 degrees C vs. 0.32 +/- 0.41 degrees 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.
Original languageEnglish
Pages (from-to)797-811
Number of pages15
JournalArtificial Organs
Volume36
Issue number9
DOIs
Publication statusPublished - Sep 2012

Keywords

  • Cardiovascular modeling
  • Hemodialysis
  • Hypotension
  • Thermoregulation
  • RELATIVE BLOOD-VOLUME
  • ARTERIAL-PRESSURE RESPONSE
  • INDUCED HYPOVOLEMIA
  • HUMAN THERMOREGULATION
  • WIDE-RANGE
  • TEMPERATURE
  • HYPOTENSION
  • ULTRAFILTRATION
  • COLD

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