{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T01:01:47Z","timestamp":1785459707251,"version":"3.56.0"},"reference-count":18,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T00:00:00Z","timestamp":1634774400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Hemodialysis corrects metabolic acidosis by transferring bicarbonate or bicarbonate equivalents across the dialysis membrane from the dialysis fluid to the plasma. With the conventional three\u2010stream bicarbonate\u2010based dialysis fluid delivery system, a change in the bicarbonate concentration results in changes in the other electrolytes. In practice, the dialysis machine draws either a little less or more from the bicarbonate concentrate and a little more or less from the acid concentrate, respectively in a three\u2010stream delivery system. The result not only changes the bicarbonate concentration of the final dialysis fluid but also causes a minor change in the other ingredients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We propose a four\u2010stream bicarbonate\u2010based dialysis fluid delivery system consisting of an acid concentrate, a base concentrate, a product water, and a new sodium chloride concentrate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>By adjusting the flow rate ratio between the sodium chloride and sodium bicarbonate concentrates, one can achieve the desired bicarbonate concentration in the dialysis fluid without changing the concentration of sodium or ingredients in the acid concentrate. The chloride concentration mirrors the change in bicarbonate but in the opposite direction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A four\u2010stream, bicarbonate\u2010based dialysis fluid delivery system allows the bicarbonate concentration to be changed without changing the other constituents of the final dialysis fluid.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aor.14083","type":"journal-article","created":{"date-parts":[[2021,10,12]],"date-time":"2021-10-12T23:42:26Z","timestamp":1634082146000},"page":"1576-1581","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A four\u2010stream method for providing variable dialysis fluid bicarbonate concentrations for bicarbonate\u2010based dialysis fluid delivery systems"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1618-1024","authenticated-orcid":false,"given":"Susie Q.","family":"Lew","sequence":"first","affiliation":[{"name":"Department of Medicine George Washington University Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramin","family":"Sam","sequence":"additional","affiliation":[{"name":"Department of Medicine Zuckerberg San Francisco General Hospital and the University of California in San Francisco School of Medicine San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonios H.","family":"Tzamaloukas","sequence":"additional","affiliation":[{"name":"Research Service Department of Medicine Raymond G. Murphy Veterans Affairs Medical Center University of New Mexico School of Medicine Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd S.","family":"Ing","sequence":"additional","affiliation":[{"name":"Department of Medicine Stritch School of Medicine Loyola University Chicago Maywood Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,10,21]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2005.03.003"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2015.08.028"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.5049\/EBP.2007.5.2.95"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/aor.12947"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/aor.13929"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2016.01.010"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-1755.2005.09503.x"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2003.08802.x"},{"issue":"6","key":"e_1_2_6_10_1","first-page":"S17","article-title":"Clinical practice guidelines for nutrition in chronic renal failure. 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Available from:https:\/\/renalcare.baxter.com\/sites\/g\/files\/ebysai1471\/files\/2019\u201003\/Artis_TIF_datasheet_A4_GLBLMG18218\u20100002b_for_web1.pdf"},{"key":"e_1_2_6_14_1","unstructured":"AK 200 ULTRA S service manual HCEN9281 Revision 03 2016."},{"key":"e_1_2_6_15_1","first-page":"53","volume-title":"Preparation apparatus and preparation method for dialysis fluid of variable bicarbonate ion concentration type, dialysate of variable bicarbonate ion concentration type, and dialysis system of variable bicarbonate ion concentration type","author":"Noguchi H","year":"2012"},{"key":"e_1_2_6_16_1","article-title":"A novel method of delivering bicarbonate\u2010based dialysis fluid: a 4\u2010stream approach","volume":"27","author":"Lew SQ","year":"2016","journal-title":"J Am Soc Nephrol"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1711584"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.5935\/0103-507X.20200081"},{"key":"e_1_2_6_19_1","volume-title":"The details of dialysis","author":"Noblitt J","year":"2015"}],"container-title":["Artificial Organs"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aor.14083","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aor.14083","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aor.14083","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T03:20:10Z","timestamp":1692847210000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aor.14083"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,21]]},"references-count":18,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1111\/aor.14083"],"URL":"https:\/\/doi.org\/10.1111\/aor.14083","archive":["Portico"],"relation":{},"ISSN":["0160-564X","1525-1594"],"issn-type":[{"value":"0160-564X","type":"print"},{"value":"1525-1594","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,21]]},"assertion":[{"value":"2021-06-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}