Dialysis therapies: Investigation of transport and regulatory processes using mathematical modelling

Haemodialysis (HD) and peritoneal dialysis (PD) are the main kidney replacement therapies for patients with end-stage renal disease. Both of these life-sustaining therapies replace the key functions of the failing kidneys, i.e. the removal of the excess body water and waste products of metabolism as well as the restoration of fluid-electrolyte and acid-base bal-ance. The dialysis-induced multi-scale transport and regulatory processes are complex and difficult to analyse or predict without the use of mathematical and computational models. Here, following a brief introduction to renal replacement therapies, we present an overview of the most important aspects and challenges of HD and PD, indicating the types and examples of mathematical models that are used to study or optimize these ther-apies. We discuss various compartmental models used for the study of intra-and interdi-alytic fluid and solute kinetics as well as distributed models of water and solute transport taking place across the peritoneal tissue or in the dialyzer. We also discuss models related to blood volume changes and cardiovascular stability during HD, including models of the thermal balance, likely related to intradialytic hypotension. A short overview of models of acid-base equilibration during HD and mineral metabolism in dialysis patients is also provided, along with a brief outline of models related to blood flow in arteriovenous fistulas and cardiovascular adaptations following the fistula creation. Finally, we discuss the model-based methods of assessment of dialysis adequacy in both HD and PD. (c) 2021 Nalecz Institute of Biocybernetics and Biomedical Engineering of the Polish Academy of Sciences. Published by Elsevier B.V. All rights reserved.

Automated summary

Haemodialysis and peritoneal dialysis are crucial kidney replacement therapies for patients with end-stage renal disease. Mathematical and computational models play an essential role in analyzing and predicting the complex transport and regulatory processes during dialysis. This article provides an overview of the important aspects and challenges of these therapies, along with examples of mathematical models used to study and optimize them.