DE2809303A1 - METHOD AND DEVICE FOR CONTINUOUS AMBULANCE PERITONEAL DIALYSIS (ABDOMINAL FLUSHING) - Google Patents

Description

The functions of the human kidneys include the removal of superfluous metabolites (metabolites), the maintenance of the fluid, electrolyte and acid-base balance, as well as hormone and enzyme synthesis. The loss of normal kidney function (acute or chronic renal insufficiency) is generally caused by dialysis therapy or transplant treated. The transplant, if successful, will restore all normal Functions again. Dialysis partially replaces some of the normal kidney functions. For example, it replaces under among other things, not the hormone or enzyme functions, as chronically uremic due to the greatly reduced blood hemoglobin level (kidney disease) patient becomes evident.

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In general, two types of dialysis therapy are used, and the most common one is hemodialysis, where the blood is purified as it passes through a membrane system outside the body. The superfluous Metabolites diffuse through the membrane and are washed out by dialysis solution, excess fluid is removed by pressure-induced ultrafiltration. The other treatment method - called peritoneal dialysis the dialysis solution is infused directly into the peritoneal space. This space is limited by the peritoneum, which is very vascular. Metabolic products are diffused from the blood into the dialysate via the peritoneum removed. Excess fluid is removed osmotically by using a hypertonic dialysis solution will.

Current dialysis treatments are generally performed periodically under highly efficient conditions performed. Treatments usually take place two or three times a week. The length of the treatment depends on the desired reduction in the level of excess metabolites in the blood, but usually takes time 4 to 6 hours for hemodialysis and 24 to 48 hours for peritoneal dialysis. The time difference reflects the increased effectiveness of hemodialysis, which is the main reason for its greater popularity.

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Both procedures lead to a partial correction of the abnormal levels of metabolites, fluids, electrolytes and pH during treatment.

The blood metabolite levels are greatly reduced, followed by a slow increase in concentration between dialyses _o Kjellstrand (1976) suggested that the resulting concentration fluctuations are harmful to the health of the patient. In fact, high efficiency hemodialysis machines are generally not used to their full potential because of a characteristic disorder called "disequilibrium syndrome" that has developed in certain patients. These patients experience headache, nausea, vomiting and serious blood pressure changes after two or three hours of dialysis. This condition often persists throughout treatment, leaving the patient weak and exhausted. Arieff et al (1975) speculate that this syndrome is a result of large intracellular-to-extracellular concentration (and osmosis) gradients with accompanying Fluid displacements, especially across the "blood-brain barrier".

The Arieff hypothesis is supported by the results of Popovich et al. (1975) who supported the consequences on the physiological Resistance to metabolite extraction from the patient's system - artificial mers investigated »Vitamin B12

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and inulin were used as representative medium-sized molecules selected in their investigation. They showed that very few of the larger test metabolites were found during dialysis treatment were washed out of the intracellular body reserves. This is due to the high resistance to mass transportation over the cell membranes causes and leads to large jumps in concentration after dialysis when the memory come into equilibrium in the time between dialyses.

The conventional hemodialysis procedures need an unacceptably high amount of dialysis fluid, approximately 450 liters per week. It is estimated that the procedure according to the presented invention will need about 70 lists per week.

The continuous ambulatory peritoneal dialysis (CAPD) performed with the device according to the present invention is fundamentally different from all conventional dialysis methods in several respects. It is completely different from the most popular method (hemodialysis) in that it is a natural body membrane used, which avoids the need for an artificial kidney or access to the bloodstream.

The fact that CAPD is continuous results in stable, low levels of toxic substances in the blood.

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Current peritoneal dialysis procedures are intermittent (usually applied extensively two or three times a week) Such intermittent treatments lead to far-reaching results Fluctuations in toxin concentrations to much higher levels than CAPD, which is detrimental to the health of the patient is.

The CAPD process makes optimal use (100% efficiency) from the dialysis fluid. Current methods use short exposure times in order to minimize levels toxic substances in the dialyzed liquid to achieve a maximum rate of toxin removal. This ineffectively high Withdrawal times are because of the short-term, intermittent Type of current procedures required.

The CAPD procedure is outpatient, i.e. the patient can carry out his normal daily chores while being treated. Patients who join a conventional Undergoing peritoneal dialysis are not an outpatient facility. You have to go to your (usually machine) dialysis care unit remain for the full 24 to 48 hours of their treatment.

The CAPD process is economical in use - it is no machines necessary “The estimated consumption of dialysis fluid is approximately 70 liters per week compared to 450 liters per week for the conventional one Hemodi alys e.

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The biggest advantage is in the overall comfort and good The condition of the patient using CAPD.

The continuous removal of toxic substances from the human body by means of the inventive The device, while the patient is completely free to walk around, "takes place in such a way that the infusion of a Dialysis fluid is made into the peritoneal space under prescribed conditions. The poisonous dissolved Substances get into the irrigation fluid through the natural process of diffusion and convection via the peritoneum (Dialysate). Dialysate and poisonous substances are then removed after a prescribed retention period. The inventive Apparatus includes an indwelling balloon catheter that is surgically inserted into a patient's peritoneal space is inserted, a Dacron cuff, which is surgically attached to the abdominal wall, and an external quick connector, attached to the catheter. The device may also have a portable microbiological filter unit to reduce the risk of peritonitis during the Decrease dialysis fluid infusion.

An embodiment of the invention will be described in greater detail the drawing explained.

1 is an exploded view of the components of the CAPD system according to the invention;

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Fig. 2 is a schematic representation of the device as it is used on the patient shall be;

Figure 3 is an exploded perspective view of a portable microbiological filter

for use as an auxiliary component in the System;

Fig. 4 is a schematic representation of an air bubble trap and one controlling the direction of flow Valve for the device according to the invention.

The continuous, outpatient peritoneal dialysis system of the The invention presented is shown in its simplest form in FIG. and is generally designated by the number 10. That Overall system 10 includes:

An infusion system 11, a Kätheder system 12 and a Closure and drainage system 13.

The infusion system 11 comprises a bottle or a Bag 15 with the dialysate, with the outlet tube 16 on one half of a quick release coupling 17 ends, an adjustable flow control clamp 18 is on the hose 16 attached to regulate the rate of liquid outflow from the container 15. The container 15 preferably has one

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Volume capacity of 10 to 12 liters and has markings in two liter intervals. The container 15 can also have a hook 19 at its tip to bring it to any position higher than the connector on the patient to hang.

The Kätheder system 12 includes a surgically deployed one Permanent catheter 20 with a connecting hose 21, which is attached to the matching half of a quick-release coupling 22 ends, and a Dacronabdeckunp 23 which is surgically inserted into the patient's abdominal wall. The peritoneum catheter For example, 20 may be of the Goldberg Balloon type, such as that made by American Hedical Products Coloration is supplied, or a Tenckhoff Kätheder. The catheter 20 is provided with a plurality of openings 24 and a flexible fabric sheath which has been adapted to to prevent the openings 24 from closing during drainage. The Dacron cover is adapted so that it Allowed tissue ingrowth and therefore represents an effective protection against the entry of bacteria into the peritoneal space. The hose 21 protrudes through the Dacron cover 23 and provides the external connection by means of Clutch 22.

The closure and drainage system 13 includes an attachable cap 30 for attachment to the coupling 22 during the outpatient dwell period, a removable drainage

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hose 31 and a sterile drainage container 32 for receiving used dialysate. The hose 31 carries a mating half of a quick release coupling 33 for attachment on coupling 22 during the drainage period.

In operation, the CAPD system is used as follows:

Dialysis fluid is infused into the patient by connecting the coupling 17 to the coupling ^, with about 2 liters flow through the tube 16 into the catheter 20 ,, the Residual flow of the liquid is controlled in a common method by regulating it with the flow control clamp 18. The coupling. 17 is then unplugged and the closure 30 is applied to the coupling 22 for the outpatient dwell time, which can take about 4 to 5 hours.

The closure 30 is then removed and the drainage coupling 33 attached to the coupling 22. The consumed Dialysis fluid is moved by gravity from the patient's peritoneal space via the tube 31 into the drainage container 32 dehydrated «The cycle just described is then repeated so that a basically constant presence of Dialysis fluid is maintained in the patient and therefore dialysis was carried out continuously

A slightly modified embodiment of the invention is shown in Fig. 2, which shows the CAPD system as it

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should be used on the patient, The system shown includes a portable filter unit 40 with many small pores to prevent the introduction of bacteria into the To keep the peritoneal space as small as possible during the infusion of dialysis fluid. The filter unit 40 is in the supply line 16 between the Versoigings bottle 15 and the indwelling catheter 20 inserted. The filter unit 40 comprises a relatively flat filter body 41, an inlet channel 42 for the fluid and an outlet hose or channel 43, the inlet hose 42 has a quick connect coupling 44 which is adapted for attachment to the coupling 17. The outlet hose 43 is connected to a branch of a T-connection 45. A second branch of the T-connection is connected to a hose 46, which leads to the catheter 20. The third branch is connected to a hose 47 leading to the drainage bottle 32 leads. The hose 47 carries a quick release coupling 48 for connection to the coupling 33 of the drainage hose 31. Closing clamps 49 and 50 for the liquid are on the hoses 43 and 47 - respectively - attached The clamps 49 and 50 are alternately during Infusion and drainage - respectively - released.

The portable microbiological filter unit 40 is shown as an exploded view in FIG. 3. The unit includes the relatively flat body or housing 41, a central one

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sheet-like filter 51, the inlet tube 42, and the outlet tube 43. The outer shell or housing 41 is preferably made of two halves 54 and 55, cast Made of flexible medical standard silicone elastomer, bonded to form a shape that hugs the curve of the body. The halves 54 and 55 can also be made with an increased offset longitudinal mandrel 56 and 57, respectively, suitable, in order to prevent the outer shell from collapsing against the filter 51. The filter 51 is preferably made of two sheets 58 and 59 made of membrane material with 0.22 α pore opening, which are connected to one another at their edges. Inlet hose 42 and outlet hose 43 are preferably made of standard silicone elastomer tubing material, which is commercially available.

It is desirable or even necessary to take the risk of one Bringing air into the peritoneal space during the infusion of the dialysis fluid to reduce to a minimum. Therefore, facilities such as the bubble trap and flow directing valve 60 shown schematically in Fig. 4, can be added to the system 10 for improvement. The valve construction 60 shown can include the T-connection 45 and the brackets 49 and 50 supplement or replace. The valve 60 comprises a relatively flat valve housing 61, preferably made of transparent plaabik, and a rotatable one Valve body, also preferably made of clear plastic. The valve housing 61 is with an inlet channel 63, a

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Äuslaßkanal 64, a drainage channel 65 and a vent channel 66 is provided. The valve body 62 is drawn, v / ie, provided with adial channels 67, 68, 69 and 70 connected to one another. Inlet channel 63 and outlet channel 64 are like this constructed to form an upside-down "U". The inlet channel 63 is connected to the outlet hose 43 of the filter unit 40 connected »(As an alternative, the entire valve construction 60 can be designed as an integral part of the filter unit 40 The outlet channel 64 is connected to the catheter 20; the drainage channel 65 is for connection to the drainage bottle 32 provided.

When the valve structure 60 is oriented in a vertical plane and the valve body 52 is in position ^11A "(as in FIG. 4A), any air bubble trapped in channels 63 and 64 can be released through vent channel 66 to atmosphere will"

When the air is then removed from the line, the valve body 62 is in position "I" (as shown in Fig. 4ß ') brought through channels 63, 68, 67 and 64 to catheter 20 for the infusion of dialysis fluid. If the desired Amount of liquid has been infused, the coupling 17-44 is released and a closure for the dwell time placed on the clutch 44. The coupling half 48 is also closed with a cap during the dwell time,

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After the desired period of residence in the peritoneal space the used dialysis fluid is withdrawn by loosening the lock of the coupling half 48, the Coupling 33 is connected to 48 and the valve interior rotated to position "D" (as shown in Fig. 4C). In this position, the inlet channel 63 is clamped, and the Liquid is withdrawn backwards through outlet channel 64, through channels 70 and 68 to drainage channel 65. if the drainage is complete, the valve body 62 is rotated back to position "J", the drainage! '32 loosely disconnected and the supply bottle 15 for infusion the inlet hose 42 reconnected. The cycle is then repeated as described above

It is provided the filter unit 40 and the valve construction 60 periodically rinse with formalin solution or the like to prevent bacterial growth in the filter and the associated channels. To achieve this, the valve body 62 is in the "F" position (as shown in Fig. 4D) rotated while the connection to the outlet channel 64 is interrupted. The formalin solution is supplied through the inlet tube 42, the filter unit 40, passed through the inlet channel 63, the valve channels 70 and 68 to the drainage channel 65. The formalin solution is washed out by subsequently passing a certain amount of the dialysis fluid through it

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before the valve interior 62 is in position η "J" for the infusion rotated

! • Latin model

The skin metabolite levels of fatients are determined by a Balance between the rate of creation and removal ries specifically regulates eligible gifts. Theoretical Relationships have been derived which show the metabolic concentrations existing before dialysis under discontinuous Predict hemodiolysis and peritoneal dialysis conditions. Similar formulas were derived to the current ones I-metabolite concentration level in blood and dialysate during predict infusions in peritoneal dialysis. These analyzes yield equations that are pretty much in the general case are complex. Under steady-state conditions, the equations can be largely simplified. Under these The steady-state blood metabolite level Cg is given by:

where G is the net generation rate and K is the total clearance (Purification rate) of dissolved substances (the sum of Dialysis clearance and residual kidney function clearance).

On the other hand, the net clearance can also be resolved

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Substances that are necessary to maintain a prescribed blood metabolite level are calculated »For example Equation (1) predicts that a total clearance of 7.1 ml / min is required assuming a stationary blood urea (BUN) concentration level of 70 mg / day is desirable at a BUN generation rate of 5.0 mg / min (15.4 g urea / day). This matches with a total clearance of about 10 liters per day «

This result is routinely used by nephrologists. Patients are generally on dialysis when her remaining kidney clearance drops well below 7 ml / min.

The mathematical model also provides a simplification which is possible when the dialysate is completely in equilibrium with the blood, namely at C _ß = C ^ _o Under these conditions, the dialysis clearance is equal to the flow rate of the dialysate, K _Q = Q _DS and Equation (1) can be rewritten:

Q _D (1+ * j _{ \ (2)

% ^l

Kit Kq as the kidney residual c-learanceo Without residual function (K _R = 0), equation (2) is further simplified

C _R = G
^B Q ^ (3)

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This analysis hypothesizes that a patient can be properly dialyzed with acceptable BUN levels, if you have an equilibrium of only 10 liters of dialysis fluid per day with the body fluids enabled (e.g. with a dialysis clearance of 7.0 ml / min and a steady BUN level of about 70 mg / day).

Clinical technique

The desired metabolite balance between blood and Dialysis fluid can be used with occasional peritoneal dialysis can be easily achieved using the system 10 described above. Normal procedure for the Peritoneal dialysis is to infuse 2 liters of dialysate for 15 to 60 minutes. I've found, that a patient can make 5 changes a day with enough time for infusion and drainage if the remaining time is extended to about 4 1/2 hours. This long residence time was found to be sufficient, a balance between plasma and the dialysate for urea and creatinine.

Five changes per day of two liters per change gives 10 liters per day, which was considered necessary to keep the patient at acceptable BUN levels. Stationary

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Conditions can be assumed, since five changes per day with relatively long residence times are made, which can be compared favorably with the usual three hemodialysis treatments per week _o This equilibrium technique in peritoneal dialysis is fundamental for the continuous, ambulatory peritoneal dialysis method of the described and hereby claimed patent Invention.

example

Equilibrium peritoneal dialysis according to the present invention was performed on a 40 year old male (weight 86 kg, height 175 cm) for a period of five times using an indwelling Tenckhoff catheter. The patient has a Vogeschichte the surgical removal of his right kidney at an early age as a secondary result of an injury ₀ He developed a kidney disease about 18 months before reaching a Merenerkrankung in the final stages, "He had revealed an ongoing atherosclerotic coronary artery disease with angina pectoris" Herzkathetrisierung and coronary arteriography atherosclerotic Changes in the left coronary artery and a 90 % occlusion of the small, obtuse-angled branch on this side. The right coronary artery showed a 1 cm narrowing in the middle section with about 50 % occlusion

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Had Buerger's disease at the age of 28 have and had previously had an operation on my left hip in the same year. A gastric mucosal biopsy revealed Nenetrier's disease at the age of 30. He had excessive levels of cholesterol and triglycerides, and had been beginning to be mild for about four years Diagnosed adult diabetes. Both parents had diabetes, with the mother being insulin dependent. Its glomerular The filtration rate in September was 14 ml / min a creatinine level of 9.9 mg / day. At that time he had 8 grams of protein in his urine every 24 hours.

A subcutaneous arteriovenous connection or a Quintin-Schribner connection had been attempted on eight separate occasions to lay. All these attempts were unsuccessful because of thrombosis; only on one occasion was an arteriovenous connection for a single dialysis has been used. It had been recommended to the patient to be referred to a center where chronic peritoneal dialysis could be performed. This wanted or the patient couldn't do it. With these circumstances in mind, the technique of equilibrium peritoneal dialysis as defined here was developed made as a life saving necessity.

With the consent of the appropriately informed patient

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the peritoneal dialysis procedure was established with 5 2 liter changes per 24 hours. The infusion lasted 10 minutes, made with hydrostatic pressure alone, followed by an equilibrium period of 260 minutes on average. The dialysate drained on average 15 minutes. It took three minutes to connect the hose, which resulted in a total of 288 minutes per change. The procedure was originally carried out in the clinic with 1.5% Dianeal ^ solution. This did not allow adequate dehydration; Therefore, 25% solution, after variable plan 4, substituted, until it was found that 1.5% and 4.25% solutions were used alternately to about 2000 cc of fluid per day to as "excess to the given into the peritoneal fluid remove; patient did not adhere to fluid intake restrictions.

approximately

mental basis in the clinic for one month. After stabilizing the patient in the new procedure, he learned to do the procedure at home. In the first month at home he had a temporary peritonitis, which subsequently led to the clogging of the permanent peritoneal _{catheter 0} The catheter was replaced and afterwards no more clogging problems developed.

The patient complained of intermittent abdominal pain

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what probably with the 4.25? oigen hypertonic solution or related to the pH of the solutions. The pH was adjusted with sodium bicarbonate, but ei / continued to show intermittent. abdominal pain., However, this did not stop him starting normal physical activity ζιί, including various trips to distant cities, carrying his dialysis solutions with him in the back of the car. The patient also complained of alternating difficulty sleeping due to flatulence in the abdomen.

In the course of the examination, the patient excreted a small amount of fluid. He had a valued residual clearance of creatinine of 5.0 ml / min and was loss of appetite with nausea and vomiting at the beginning of the investigation 30 June 1975. His BUN cycle was 70 mg / day while he was was on a strict protein diet. Immediately after starting treatment in the clinic, his diet restrictions became apparent canceled. His BUN rates stayed at 70 mg / day with a marked increase in wellbeing. Then the BUN levels took off and stabilized in the range of 35 to 45 mg per day with creatinine levels in the range of 7 to 10 mg per day. The reduction in symptoms of chronic uremia in the patient was comparable to that in patients on hemodialysis, On October 20th, 1975 a residual creatinine clearance of 3.0 ml / min Measured «The treatment was continued by the patient at home until December 9, 1975, when he successfully received a donor kidney was transferred. It currently has a glomerular one

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Filtration rate of 96 ml / min.

Clinical evaluation

A clinical evaluation of the above example was carried out and published in the technical literature. In order to quantify the treatment, the concentration levels of urea, creatinine, uric acid, glucose and cyanocobalamin marked with tritiated were monitored during a single change on November 14, 1975 and for several days. The one-time exchange study was prepared by injecting a dose of 1000 Ug of cyanocobalamin, "followed 24 hours later by labeled cyanocobalamin. After an additional equilibrium period of 24 hours, blood and dialysate samples were taken every 30 minutes for the entire equilibrium period.

Meaningful dialjrsate samples were obtained in situ by peeling and infusion of 50 ml of dialysate received ten times immediately from sampling. The concentration levels of urinary toxins were determined with the Technicon SRA-12 analyzer, while the cyanocobalamin levels with normal liquid scintillator counting technique were obtained.

The dialysis clearance (K _ß ) of the various substances are usually determined from the average

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Concentration in the blood (C,.), The residence time (t), the dehydrated volume (V _ß ) of the dialysate and the concentration (Cjj) in the dialysate with the formula:

K = ^c d - ^v p (4)

c _B. t

For urea and creatinine, blood and dialysate concentrations balance each other out, C ₀ = B ^, so that equation (4) is simplified to:

^K D = Zd = Q _D (5)

where Vy. is the dehydrated volume of dialysate (the sum of the infusion volume and the volume by ultrafiltration).

The jirget misses for an average dwell time of 288 minutes are listed in Table I below “The Middle dehydrated dialysate volume of the patient was 2,400 ml.

Table I.
Clearance of metabolites on equilibrium peritoneal dialysis

material Molecular weight K Lml / minJ urea 60 8.3 Creatinine 113 8.3 uric acid 168 7.7 Cyanocobalamin 1355 5.7

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The experimentally determined mean value of the urea dietary clearance of 8.3 ml / min is slightly greater than the required clearance value that was used when developing the hypothesis It was predicted “The increment is due to the fluid that came from the ultrafiltration

The residual renal clearance of creatinine was three weeks determined before the quantitative examination to 3 «O ml / min. This gives the total clearance, K, for urea and creatinine can be estimated at:

K = K ₀ + K _R

K = 8.3 + 3.0 K = 11.3 ml / min.

Equation (1) above can be used to calculate the predicted steady-state concentrations of urea and creatinine and the rate of production 6 from this value. The results and the experimental values are shown in Table II.

Table II Predicted and Experimental Levels of Metabolites G "loos" r material G (ag / ain) K (al / ain) & _, before- C _B , experiaenttll

Harnitoff 5.0 11.3 44 35-45

Creatinine 1.4 11.3 12 7-10

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The predicted values are in good confidence with the experimental results. It turns out that the actual rates of development in the patient are lower were less than those assumed for the general number of patients. This is in line with the diabetes diet Patient and their reduced activity resulting from their cardiovascular complications.

The clearance values of medium-sized molecules such as vitamin £ 12 are at acceptable levels with this method. Indeed, the steady-state intermediate molecular size retabolic concentration levels of patients with this technique will be considerably lower than those with hemodialysis. For example, Ϊ8 'hours per week of hemodialysis with a B12 clearance of 25 ml / min yield a "total clearance-time product of 27 liters; μτο ¥ oche. The corresponding clearance for equilibrium peritoneal dialysis of 5.7 ml / min (neglecting the Residual clearance) for 168 hours per week provides a total clearance-time product of 57 liters per unit, which predicts that the concentration level of medium-sized molecules in patients who practice the new procedure will be less than half that of Patients on hemodialysis This is primarily caused by the increased time factor, for example

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equilibrium peritoneal dialysis is carried out 24 hours a day, the inpatient nature of treatment becomes also allow a continuous establishment of equilibrium via the cell membrane, which is caused by internal resistance bypasses imposed restrictions reported for intermittent hemodialysis techniques.

In summary, the CAPD system according to the invention offers a number of distinct advantages over existing ones Dialysis techniques. The fact that toxic solutes are constantly being removed eliminates the inconvenience associated with the adaptation of the body to the wide-ranging fluctuations in chemical imbalances, that arise before and after conventional dialysis.

The CAPD process leads to low toxic levels Substance by-products in the blood by the attending physician Regulation of the infused dialysate volume within certain Limits can be specified.

The CAPD year leads because of its continuous nature lower levels of larger toxic solutes in the blood (called "medium-sized molecules").

The CAPD procedure does not require access to the blood

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Zo

compares to all conventional hemodialysis procedures, which are about 90 ' of current dialysis practice. The addition of an anti-coagulant (heparin) is not required. There is no blood loss in the device, also no contact with foreign surfaces, as is the case with all hemodialysis errors.

The CAPD procedure doesn't require an artificial kidney, either not the use of complicated equipment that has to be purchased and serviced.

The CAPD procedure is portable and the patient can Go about your normal activities while you are on dialysis.

The shown and described embodiments of Invention represent only an example; many changes and modifications are possible within the scope of the invention.

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eersei \ e

Claims (4)

A 55 Robert P. Popovich New Claims 1. Device for carrying out continuous, outpatient Peritoneal dialysis, characterized by one surgically into a patient's peritoneal space inserted indwelling catheter with a connection that protrudes through the patient's abdominal wall; a quick coupling at the outer end of the supply connection; a supply unit with dialysis fluid that can be connected to the coupling in order to deliver dialysis fluid into the peritoneal space infuse the patient for a specified dwell time; a drainage hose that can be connected to the coupling, to remove used dialysis fluid from the patient's peritoneal space after a certain residence time; and a sterile cover for attachment to said coupling during the residence time of the dialysis fluid in the Patients, where the patient can go about their normal daily activities while dialysis is taking place. - 1 8O984Ö / O6S0 2. Apparatus according to claim 1, characterized through a portable microbiological filter unit placed between the catheter and the quick connector to prevent the penetration of bacteria with the infused dialysis fluid can be used. 3. Apparatus according to claim 2, marked e t through an air bubble trap and a fluid flow reversing valve connected to the connection and the penetration of air into the peritoneal space during the infusion of dialysis fluid. 4. Apparatus according to claim 3, characterized in that the valve is rotatable between a position in which it vents the connection, a second position in the dialysis fluid in the catheter can infuse, and a third position in which used dialysis fluid from said catheter is removable. - 2 809840/0680