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Background In blood purification therapies for critical care, there are no guidelines for selecting modalities of the treatment or for determining the treatment schedule, treatment time, and operating conditions, such as dialysate flow rate (Q D) and filtration flow rate (Q F). In this paper, the solute removal characteristics of blood purification for critical care and the optimal operating conditions for individual patients are discussed from the viewpoint of kinetic modeling. Method An in vitro study using an aqueous solution involving several marker solutes was performed. Results From a result of the continuous hemodialysis (CHD) experiments, the Q D should be required at least twice the patient’s blood flow rate (Q B) for sufficient removal of small molecular substances. CHD is of limited use for the removal of middle-sized molecules. During the continuous hemofiltration (CHF) experiments in the post-dilution mode, the maximum Q F value can be determined as about 1/4 of the Q B because of the existence of the formed elements. In summary of the continuous hemodiafiltration (CHDF) experiments, the Q F is about 1/4 of Q B value and the Q D should be set up at least twice the Q B value. The determination of adequate operating conditions for individual patients can be summarized from a kinetic modeling viewpoint: 1. Determination of the targeted solute according to the patient’s state.   2. Determination of the generation rate of the targeted solute by collecting spent dialysate and/or filtrate.   3. Determination of the minimal requirement treatment dose from the actual and targeted solute concentration levels.   4. Choice of treatment modality and determination of the treatment time according to the clearance value.   Conclusions Measurement of the removed amount of solute by collecting the spent dialysate and/or filtrate is recommended to maintain an adequate plasma level of the targeted solute of patients, who often have unstable states. The adequate operating conditions for each patient can be determined from a kinetic modeling viewpoint.

Kinetic modeling for blood purification in critical care: this article is based on a study first reported in kidney and dialysis (in Japanese)