{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T05:01:17Z","timestamp":1792213277838,"version":"4.4.0"},"reference-count":54,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T00:00:00Z","timestamp":1741219200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hemodialysis International"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Previously, two reports proposed a four\u2010stream dialysis fluid delivery system consisting of an acid concentrate, a base concentrate, a sodium chloride concentrate, and product water for correcting dysnatremias and metabolic acid\u2013base disorders separately, by hemodialysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This report describes a new method for the clinical use of the previously reported four\u2010stream dialysis fluid delivery system to treat concurrently dysnatremias and metabolic acid\u2013base disturbances by hemodialysis. Pumps attached to each concentrate are designed to control its flow rate. Formulas were derived to determine the flow rate of each of the pumps controlling the flows of the product water (<jats:bold>\n<jats:italic>W<\/jats:italic>\n<\/jats:bold>), the base concentrate (<jats:bold>\n<jats:italic>B<\/jats:italic>\n<\/jats:bold>), and the sodium chloride concentrate (<jats:bold>\n<jats:italic>S<\/jats:italic>\n<\/jats:bold>) for any prescribed combination of sodium and bicarbonate concentrations is the final dialysis fluid. In this scheme, the flow rate of the acid concentrate (<jats:bold>\n<jats:italic>A<\/jats:italic>\n<\/jats:bold>), the concentrations of its contents in the final dialysis fluid remain constant. The flow rate ratio <jats:bold>\n<jats:italic>W<\/jats:italic>:<jats:italic>S<\/jats:italic>:<jats:italic>B<\/jats:italic>:<jats:italic>A<\/jats:italic>\n<\/jats:bold> remains also constant at 45 (i.e., 45X).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The formulas were entered in an EXCEL flow sheet which determines the flow rate ratio <jats:bold>\n<jats:italic>W<\/jats:italic>:<jats:italic>S<\/jats:italic>:<jats:italic>B<\/jats:italic>:<jats:italic>A<\/jats:italic>\n<\/jats:bold> for any desired combination of sodium and bicarbonate concentrations in the dialysis fluid. The upper and lower limits of the concentrations of sodium and bicarbonate in the dialysis fluid were computed. The system has not been applied clinically. Measurements of any electrolyte concentrations have not been made.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>This system makes the treatment of profound dysnatremias, metabolic acid\u2013base disorders, and combined dysnatremias and metabolic acid\u2013base disorders feasible. The clinical application of the system demands prior in\u00a0vitro or ex\u00a0vivo studies plus fastidious and expert attention to ensure safe and dependable application.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hdi.13205","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T17:14:42Z","timestamp":1741713282000},"page":"319-326","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Concurrent Control of Sodium and Bicarbonate Serum Concentrations Using a Four\u2010Stream Hemodialysis Fluid Delivery System"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0934-1560","authenticated-orcid":false,"given":"Deepak","family":"Malhotra","sequence":"first","affiliation":[{"name":"Department of Medicine University of Toledo School of Medicine  Toledo Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susie Q.","family":"Lew","sequence":"additional","affiliation":[{"name":"Department of Medicine George Washington University  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond E.","family":"Garrett","sequence":"additional","affiliation":[{"name":"Trauma Research, Swedish Medical Center  Englewood Colorado 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":"Robert H.","family":"Glew","sequence":"additional","affiliation":[{"name":"Department of Surgery 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"}]},{"given":"Antonios H.","family":"Tzamaloukas","sequence":"additional","affiliation":[{"name":"Research Service, Department of Medicine Raymond G. 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