An Original Computational and Experimental Framework for Optimising Dialysis Dose in Nigerian Chronic Kidney Disease Patients with Unique Physiological Characteristics

Dialysis adequacy in Nigerian chronic kidney disease patients is systematically underachieved, and existing dialysis dose prescription models developed from high-income country patient datasets incorporate physiological assumptions about body composition, protein catabolic rate, and residual kidney function that are not validated for Nigerian patient populations, potentially contributing to underdialysis and its clinical consequences. This dissertation develops an original computational and experimental framework for optimising dialysis dose specifically for Nigerian CKD patients on maintenance haemodialysis, making contributions to dialysis engineering and nephrology. The computational framework development follows three phases. The first phase establishes Nigerian CKD patient-specific physiological parameters through a cross-sectional study of two hundred patients on maintenance haemodialysis at five renal units in Lagos, Abuja, Kano, Enugu, and Port Harcourt, measuring total body water by deuterium dilution, protein catabolic rate by urea kinetic modelling, residual kidney function by urine collection, and nutritional status by bioimpedance spectroscopy. Results demonstrate that Nigerian CKD patients show systematically different total body water to body weight ratios and protein catabolic rates from published North American reference populations, with implications for urea kinetic modelling-based dose calculation. The second phase develops a revised urea kinetic model incorporating Nigerian patient-specific anthropometric scaling and protein metabolism parameters. The third phase constructs a patient-specific dialysis dose optimisation algorithm using model predictive control theory, incorporating the revised kinetic model, real-time inter-dialytic weight gain data, and residual function tracking. Clinical validation in forty patients over twelve months demonstrates significantly improved Kt/V attainment and reduced intradialytic hypotension compared to standard prescription practice. Keywords: dialysis dose optimisation, urea kinetic modelling, chronic kidney disease, computational framework, Nigeria.