Computational dose predictions for combined treatment of hemofiltration with weekly hemodialysis

Hemodialysis (HD) has sufficient efficacy as a conventional diffusive treatment for removing small molecules, whereas hemofiltration (HF), which is a convective treatment, has an improved the clearance of intermediate-sized molecules. This paper reports a combined treatment (CT) which combines the diffusive and convective efficacies of HF several times weekly with HD weekly. CT modalities with various schedules and prescriptions are described mathematically using a variable-volume two-compartment kinetics model, and the kinetic parameters were obtained from previous clinical reports and a hemodialysis-related database. The blood concentration profiles of the three waste molecules for 52 weeks were calculated in order to compare the capability of removing small and intermediate-sized molecules to those of other renal treatments. The results by a computer simulation show that CT can reduce the frequency of sessions and the volume of replacement fluid compared with daily convective treatment, and achieve the adequate treatment efficiency with both small and intermediate-sized molecules for chronic renal failure patients.