Increasing hemodialysis efficiency by a recirculating dialysate system managed by a telehealthcare center

It is widely accepted that a minimum Kt/V of nearly 1.2 is necessary as an adequate hemodialysis dose for end stage renal disease patients. Nevertheless, delivered HD dose in large patients is often below that value, what increases morbidity and mortality risks. Increasing the area of dialyzer is not always a good solution, because large dialyzers use to have a higher overall mass transfer resistance, R_t, which reduces the efficiency improvement. Other approaches based on arrangements with two dialyzers achieve improvements about 15 %, but are limited first by the high blood flow rate required from the vascular access and second by the cost. This work presents a technique for the optimization of the hemodialyzer efficiency by means of a recirculating dialysate system without absorbent, which profits from the relationship between R_t and the dialysate fluid. Preliminary results obtained from numerical simulation experiments suggest that this system is able to optimize dialysis efficiency in a cost-effective way. We propose an implementation supported by a telehealthcare system based on a patient physiological image that is currently being developed.