Kinetic modeling: applications in renal and related diseases.

Kinetic modeling, as the name implies, involves a study of the dynamics or rate of change of process or system to either gain enhanced understanding or predict an outcome. In applying kinetics to extracorporeal treatment both goals are encompassed. For example, in dialysis treatment the question of mortality has been replaced by questions of morbidity and rehabilitation. To improve the latter, it is essential to study the kinetics of interaction between the patient and the treatment process; mathematical models can provide both useful insights and better patient management. The application of kinetics to hemodialysis treatment is best exemplified by urea and heparin modeling in these cases, the amount of dialysis is geared to the patient's dietary protein intake, if the level is within acceptable limits and heparin requirements are assessed by a particular patient's sensitivity to the drug and his/her rate of elimination of the drug. Other useful examples of the applications of kinetic modeling in extracorporeal treatment include hemoperfusion and therapeutic plasmapheresis. Kinetics is not, however, a treatment panacea, or a substitute for thinking; the real benefit of the procedure is that it forces one to focus on a problem from a different perspective. This, in turn, begets new disease and treatment insights as well as improved health care delivery. The future will see a more widespread use of kinetic analysis in a variety of other medical/surgical procedures.