Personalized Ultrafiltration Profiles to Minimize Intradialytic Hypotension in End-Stage Renal Disease

摘要

Over half a million people in the US suffer from end-stage renal disease (ESRD), and rely on hemodialysis (HD) treatment for survival. The main challenge in HD is the inherent conflict between the need to remove a fixed amount of fluid using ultrafiltration (UF) within a (usually) short amount of time and the fact that high ultrafiltration rates (UFRs) can lead to intradialytic hypotension (IDH). The latter has been associated with an increase in morbidity and mortality. We present a novel approach to design robust UFR profiles to remove a target fluid volume from a HD patient within a prescribed time with minimum UFR levels, while hematocrit satisfies a specific critical hematocrit (HCT) constraint. Our approach is based on fluid dynamics during HD described by a nonlinear fluid volume model comprising intravascular and interstitial pools, whose parameters are given in terms of nominal values with uncertainty ranges. We show that under the designed UFR profile, the HCT of the nonlinear model will meet the critical constraint and the states will remain within a pre-defined region. We demonstrate our results through a simulation using a nonlinear model whose parameters were estimated based on clinical data.