Model-Based Decision Support System for Individual Prescription of the Dialysate Bicarbonate Concentration in Hemodialysis

Abstract

A decision support system has been developed that determines the optimal dialysate bicarbonate concentration in hemodialysis therapy for each patient individually. The knowledge about the behavior of the acid-base state during treatment has been provided by a mathematical model for the description of dynamic exchange processes during hemodialysis. This model simulates the sodium and water distribution, the acid-base state as well as the ventilation. The decision support system uses the model for the prediction of the end-dialysis acid-base state and calculates by means of linear optimization the dialysate bicarbonate concentration which is necessary to reach a specified end-dialysis state. If the aspired acid-base state can not be reached, the system varies the dialysate sodium concentration and the treatment time. The whole program can be used on a PC and is easy to use. One decision making process lasts between 10 seconds and 5 minutes depending on the computer.