JP2007268257A - Hemodialysis machine - Google Patents

Abstract

[Problem] To provide a hemodialysis apparatus in which the transfer of a substance from the blood side to the dialysate side does not occur as much as possible during blood purification and the leakage of a useful protein such as albumin is small.
A hemodialysis apparatus comprising a dialyzer connected to a blood system comprising an arterial blood circuit and a venous blood circuit having a blood pump, and a dialysate system comprising a dialysate supply line and a dialysate discharge line. Based on the dialysate flow rate input from the input unit, adjust the dialysate flow rate for a predetermined time immediately after the start of dialysis or immediately after large-scale replenishment with rapid filtration dialysate or immediately after rapid replacement, and immediately after the start of dialysis or with reverse filtration dialysate A hemodialysis apparatus provided with albumin leakage suppression means for suppressing leakage of albumin immediately after a large amount of fluid replacement or immediately after rapid fluid replacement.
[Selection] Figure 2

Description

  The present invention relates to a hemodialysis apparatus that purifies blood by applying extracorporeal circulation as a therapeutic means that replaces the kidney of a patient with renal failure, and in particular, blood that can suppress leakage of a substance useful for a living body during dialysis. The present invention relates to a dialysis machine.

  Various blood purification methods are known as a method for purifying blood taken from the patient's body and returning it to the body again for the treatment of patients with renal failure. There are hemodialysis (HD) performed using the principle of diffusion using HD and hemodiafiltration (HDF) performed using the principle of diffusion and ultrafiltration.

  In these HD and HDF, internal filtration by the pressure difference between the inlet pressure and the outlet pressure of the dialysate on the dialysate side in the dialyzer part and the pressure difference between the inlet pressure and the outlet pressure of the patient blood dialyzer ( Dialysis fluid moves from the outer side of the hollow fiber to the inner blood flow path side). By increasing (promoting) the amount of internal filtration, for example, hemodialysis even in the hemodialysis system Attempts have been made to aim for a solute removal effect close to filtration (HDF).

  FIG. 4 is a diagram for explaining a filtration phenomenon caused by a pressure gradient in an actual internal filtration type dialyzer. The horizontal axis of FIG. 4 represents the dialyzer distance, where A is the arterial side and V is the venous side. The vertical axis indicates the pressure. The directions of blood flow and dialysate flow are opposite, and the dialysate is introduced from the vein-side inlet of the dialyzer and discharged from the artery-side outlet. Therefore, the blood pressure (solid line) entering from the artery side of the dialyzer is high and gradually decreases toward the venous side. Since the blood pressure exceeds the dialysate pressure from the arterial side to the middle of the dialyzer, solute (small molecule) and solvent transfer (filtration) from the blood side to the dialysate side occur, and the middle to vein side Conversely, since the dialysate pressure exceeds the blood pressure, the dialysate moves from the dialysate side to the blood side (internal filtration).

In recent years, in the internal filtration hemodialysis system and hemodiafiltration system described above, there has been a phenomenon in which leakage of proteins useful for living bodies (albumin is a representative example) increases at the beginning of dialysis, There has been concern about performance degradation (decrease in the removal rate of the removed substance) due to deterioration of the hollow fiber membrane (caused by fouling) due to accelerated filtration. Conventionally, it has been recommended to suppress the leakage of albumin at the beginning of dialysis as much as possible. In actual hemodiafiltration (HDF), it is a guideline to suppress albumin leakage to 4 g or less. As a conventional means for suppressing albumin leakage, for example, as shown in Patent Document 1, a method of suppressing leakage of albumin by designing a dialyzer dialysis membrane has been proposed.
JP 09-285536 A

  However, the conventional albumin suppression methods described above are effective because the amount of albumin leakage varies due to the influence of treatment conditions (water removal flow rate, water removal rate) and patient-side factors (hemacrit value, total protein amount, etc.). It was difficult to suppress albumin, and many problems remained to be applied to actual dialysis treatment. In addition, if the leakage of albumin is simply suppressed, the removal rate of a substance such as α1-microglobulin (α1-MG), which is a representative of the removed substance, also decreases as shown in FIG. Therefore, there is a problem to be solved in the suppression of albumin from this point as well. FIG. 3 shows the relationship between albumin and α1MG removal rate and elapsed time when blood circulation is performed under normal dialysate flow rate and dewatering flow rate. In a relatively early stage, albumin and α1MG The same trend is shown.

  It is an object of the present invention to provide a hemodialysis apparatus capable of a treatment mode in which useful substances such as albumin are not leaked as much as possible when transferring blood from the blood side to the dialysate side as much as possible during blood purification. And Another object of the present invention is to provide a hemodialysis apparatus that can exhibit the α1-MG removal ability of the removal substance to some extent and that can be rationally linked to the water removal mechanism and the blood pump.

  In order to achieve the above object, a hemodialysis apparatus according to the present invention comprises a dialyzer comprising a blood system comprising an arterial blood circuit and a venous blood circuit having a blood pump, a dialysate supply line, and a dialysate discharge line. A hemodialyzer that connects each of the fluid systems, and a mechanism (albumin leakage suppression means) for controlling both the dialysate flow rate after the start of dialysis or both the dialysate flow rate and the drainage flow rate is provided in the dialysate system. In particular, it is characterized by suppressing leakage of substances in the initial stage of blood circulation. In addition, the hemodialysis apparatus according to the present invention includes an input unit for inputting an operating condition of a working unit composed of both a blood system and a dialysate system, an input value from the input unit, and a measuring unit provided in the working unit. A display unit that displays at least one of the measured values from the control unit, a control unit that controls the operation of the working unit based on the input value or the measured value, and a storage unit that stores at least one of the input value and the measured value In this dialysis apparatus, it is particularly preferable that a dewatering / replacement mechanism is disposed in at least one of the dialysate supply line and the dialysate discharge line.

  The mechanism for controlling the dialysate flow rate is either (1) adjusting the flow rate with a flow rate adjusting valve provided in the dialysate system, or (2) providing a plurality of solenoid valve lines in parallel and Adjust the number to open, (3) install a bypass circuit in the dialysate system to stop the inflow of dialysate, or (4) control the dialysate circulation pump capacity provided in the dialysate system to control the dialysate flow rate It is either configured to be variable, or (5) the liquid feeding speed of the liquid feeding means provided in the dialysate supply line and the dialysate discharge line is adjusted. These mechanisms may be selected in consideration of various conditions such as dialysis conditions, operation modes, and costs.

  Further, the dialysate flow rate after the start of dialysis is adjusted over time based on a preset program, or the inflow is stopped, or the dialysate flow rate and the flow rate for at least 1 to 60 minutes after the start of dialysis It is preferable to set the water removal flow rate to 0 or low. Specifically, the dialysate flow rate is preferably 0 to 200 mL / min, and the dewatering flow rate is preferably 0 to 5 mL / min.

  Further, in the above hemodialysis apparatus, the flow rate control of the dialysate is arbitrarily set on the operation panel of the apparatus and is performed in conjunction with the water removal program of the water removal / replacement mechanism. It is preferable to adjust the blood flow rate over time according to the dialysate flow rate control program and the water removal program, which are set at the end of the rapid filtration replenishment and arbitrarily set on the operation panel of the apparatus. In this way, by implementing reverse filtration rapid replenishment with a replenishment mechanism and controlling the dialysate flow rate and dewatering flow rate, it is possible to suppress albumin leakage and maximize the removal ability of β2MG, α1MG, etc. It becomes.

  Furthermore, as the dialyzer, an internal filtration type dialyzer utilizing a pressure gradient of the blood system and dialysate system is used. In the use of this internal filtration type dialyzer, ECUM (dialysate flow rate = 0 mL / min) By carrying out hemodiafiltration (Tidal HDF: see Japanese Patent Application Laid-Open No. 2005-649) that repeats dehydration / replacement by repeating the state and the HD state, according to the data set in advance by inputting the measurement result of hemacrit, Determining the dialysate flow rate, changing the dialysate flow rate in conjunction with the hematocrit value in the hematocrit measuring device, and optimizing the amount of dialysate used by controlling the dialysate flow rate (dialysate in internal filtration dialyzer) It is possible to reduce and save dialysate usage by optimizing the flow rate) Implemented in the hemodialysis apparatus according to the present invention described above.

According to the hemodialysis apparatus according to the present invention, the movement of useful substances from the blood side to the dialysate side is effectively suppressed, and leakage of proteins such as useful albumin can be prevented.
In addition, the present invention can achieve a certain degree of removal of β2MG as a removal substance, can be rationally linked with a water removal mechanism and a blood pump, and has a light burden on equipment and is extremely practical. It can be a device.
Furthermore, when the present invention is applied to an internal filtration type dialyzer, it is possible to carry out hemodiafiltration (Tidal HDF) in which water removal / replacement fluid is repeated, and to reduce and save the amount of dialysate used. There is also an advantage that makes it possible.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.
FIG. 1 shows a specific example of a hemodialysis apparatus effective in carrying out the present invention. An arterial blood is provided on the blood introduction side of one end of a dialyzer (dialyzer) 1 for purifying blood by extracorporeal circulation of blood. The circuit 2 is connected, and the blood discharge side at the other end is connected to the venous blood circuit 3 to form a blood system. These blood circuits are respectively connected to the arterial connection 4a and the venous connection 4b of the patient. It is connected. A blood pump 5 is arranged in the middle of the arterial blood circuit 2 to remove blood from the patient and send this blood to the dialyzer. When the dialyzer is of the internal filtration type, it is considered to increase the pressure by, for example, increasing the effective length of the main body or reducing the inner diameter of the hollow fiber filled therein. The internal filtration type dialyzer according to the present invention or the internal filtration type dialyzer described in the present specification refers to a dialyzer that spontaneously generates internal filtration during dialysis treatment.

  On the other hand, a dialysate supply line 6 and a dialysate discharge line 7 are connected to the side surface of the dialyzer 1 to constitute a dialysate system, and blood is passed through each hollow fiber in the dialyzer. And, by passing dialysate outside these hollow fibers, the solute moves from the blood to the dialysate due to diffusion and filtration action between the blood and dialysate through the hollow fiber membrane. Removal is performed and blood purification is performed. For efficient blood purification, the dialysate supply line 6 and the dialysate discharge line 7 are usually attached to the dialyzer 1 in the opposite direction to the inlet and outlet on the blood circuit side. The flow is countercurrent.

  The dialysate supply line 6 and the dialysate discharge line 7 are provided with a first liquid feeding means (dialysate supply side) 8 and a second liquid feeding means 9 (dialysate drainage side), respectively. In the dialysate discharge line, a bypass line 11 is provided to connect the upstream side and the downstream side of the second liquid feeding means 9 so that the amount of dialysate for water removal / replacement can be adjusted in the bypass line 11. A third liquid feeding means 10 capable of feeding in both reverse directions is provided. In the example shown in the figure, the bypass line 11 capable of feeding in both forward and reverse directions is provided only in the dialysate discharge line 7, but the present invention is not limited to this, and only the dialysate supply line 6 is provided. Alternatively, both the dialysate supply line 6 and the dialysate discharge line 7 can be provided. As the liquid feeding means described above, known means such as a reciprocating pump or a rotary pump may be used.

  In addition to the dialysate flow rate adjusting mechanism 12 comprising the above-described liquid feeding means, a dialysate flow rate adjusting unit for adjusting the dialysate flow rate is disposed near the dialyzer of the dialysis system, and these are the blood pump 5. At the same time, it is appropriately controlled by the control unit 15. In addition, the hemodialysis apparatus according to the present invention includes an input unit for inputting an operating condition of a working unit composed of both a blood system and a dialysate system, an input value from the input unit, and a measuring unit provided in the working unit. A display unit that displays at least one of the measured values from the control unit, a control unit that controls the operation of the working unit based on the input value or the measured value, and a storage unit that stores at least one of the input value and the measured value Is provided.

  In the dialysis facility as shown in FIG. 1 described above, the present invention is characterized in that, for example, the control method shown in FIG. 2 is adopted. That is, a mechanism for controlling the dialysate flow rate over a certain period of time after the start of dialysis is provided in the dialysate system to suppress substance leakage (particularly, leakage of proteins such as albumin) in the initial stage of dialysis. .

  As an example of the control, as shown in FIG. 2, the dialysate flow rate is set to 0 mL / min for 30 minutes from the start of dialysis, the next 30 minutes is set to 100 mL / min, and then returned to the normal flow rate of 500 mL / min. Or based on the dialysate flow rate input from the input unit. The state where only water removal is performed when the dialysate flow rate is 0 mL / min corresponds to a so-called ECUM (Extra Corporate Ultrafiltration Method) state. Stop means (eg dewatering / replacement pump) to maintain 0 mL / min. In the time zone in which the dialysate flow rate and the dewatering flow rate are 0 mL / min, the dialysate is in a stagnation state even if there is a blood flow in the dialyzer 1 (the blood pump is operating), and the substantial diffusion No filtration is performed. Therefore, almost no leakage of albumin occurs during this time period.

  On the other hand, as shown in FIG. 5, in the conventional program water removal, the water removal flow rate was changed over time in accordance with the change pattern of the water removal flow rate set in advance during dialysis. As shown in the figure, albumin leaked frequently due to the large water removal flow rate in the initial stage of dialysis. When the water removal flow rate is large, the amount of filtration inevitably increases, so it can be said that conventionally, no consideration was given to leakage of albumin at an early stage after the start of blood circulation.

In the present invention, the dialysate flow rate at the initial stage of dialysis is thus kept extremely low (for example, within the range of 0 to blood flow rate mL / min), and the flow rate is stopped if necessary (the dewatering flow rate is reduced to 0).
The reason (including the case of setting to mL / min) is that when dialysis is started at a normal dialysate flow rate as described above, leakage of useful substances such as protein (albumin) in the initial stage cannot be suppressed. By maintaining the dialysate flow rate at a low level for a certain period of time from the start of dialysis, preferably, the dialysate flow rate in the range of 1 to 60 minutes immediately after the start of dialysis is 0 to 200 mL / min, so that protein (albumin) is wasted. Leakage can be controlled. This fixed time zone requires about 60 minutes at the maximum from the start of dialysis, and the optimum time zone is about 30 minutes, and a minimum time of about 15 minutes is required. This is due to the reason that albumin leakage is the largest in the period of about 15 minutes from the start in normal dialysis.

  The flow rate pattern in FIG. 2 shows an example, and the present invention is not limited to this, and any other flow rate pattern can be adopted. For example, a pattern in which the dialysate flow rate is set to 0 for 15 minutes after the start and the flow rate is increased stepwise in the subsequent 45 minutes, or a pattern in which the flow rate is increased from 0 in a stepwise manner at regular intervals, etc. . This flow rate pattern needs to be appropriately determined in consideration of the entire set dialysis time, dialysate flow rate, blood flow rate, drainage flow rate, patient-side situation (Ht value), and the like. Note that the flow rate pattern is preferably input to the input unit in the form of a flow rate and a duration time for maintaining the flow rate, so that the flow rate can be increased and decreased and the duration time can be changed.

[Specific dialysate flow control example]
(1) Example of using throttle valve (flow rate adjusting valve) In FIG. 6, the dialysate supply line 6 is provided with a dialysate flow rate detector 13 and a flow rate adjusting valve, for example, a needle valve 14, and the flow rate signal from the detector 13 is provided. Is input to the control unit 15, and the control unit 15 calculates an appropriate dialysate flow rate based on the flow rate signal and the signal from the dialysate flow rate adjustment mechanism 12, and the instruction signal is used as a motor for operating the needle valve 14. (Stepping motor or the like) 16 outputs to adjust the flow rate. This type is effective when finely adjusting the flow rate.

(2) Example of opening and closing a flow path using an electromagnetic valve In FIG. 7, an electromagnetic valve 17 for opening and closing the flow path is provided in each of the dialysate supply line 6 and the dialysate discharge line 7, and the control unit 15 The solenoid valve 17 can be closed based on an instruction from, and the dialysate flow rate can be made zero. The flow rate may be switched between 0 mL / min or a normal flow rate (for example, 500 mL / min) as necessary. This type has high practicality in actual operation because the operation is simple because it is necessary to pay attention to the switching timing.

(3) Example of providing a bypass circuit In FIG. 8, the dialysate supply line 6 and the dialysate discharge line 7 are each provided with an electromagnetic valve 18 for opening and closing the flow path, and the dialysate supply on the anti-dialyzer side of these solenoid valves. A bypass path connecting the line 6 and the dialysate discharge line 7 is provided, and an electromagnetic valve 19 is also provided in the bypass path. If the two solenoid valves 18 are closed and another solenoid valve 19 is opened, the dialysate does not reach the dialyzer 1 and returns through the bypass. It is desirable to apply this type to a device that operates while adjusting the dialysate, such as a personal dialyzer, and is difficult to return immediately after stopping.

(4) Example using dialysate circulation pump Adjusting the capacities of the first and second liquid feeding means (pumps P1, P2) in the dialysate flow rate adjusting mechanism 12 or the dialysate flow rate adjusting mechanism of the dialysate discharge line 7 12, the dialysate flow rate is controlled by adjusting the capacity of the circulating pump 20 installed on the dialyzer side. This type is effective when the control time is short and the dialysate flow rate is varied programmatically.

(5) Example of adjusting the liquid feeding speed of the liquid feeding means The dialysate flow rate is controlled by adjusting the liquid feeding speed of the liquid feeding means P1 on the dialysate supply line and the liquid feeding means P2 on the dialysate discharge line. To do. This type is effective when the control time is short and the dialysate flow rate is varied programmatically.

  In each of the above embodiments (1) to (4), the dialysate flow rate detector 13 and the needle valve 14 of (1), the solenoid valve 17 of (2), the solenoid valve 18 and the solenoid valve 19 of (3). , (4) each of the circulation pumps 20 corresponds to the dialysate flow rate adjustment unit of FIG. In addition, the dialysate flow rate adjusting unit and the liquid feeding means P1 and the liquid feeding means P2 of the above (5) are based on the dialysate flow rate input from the input unit, immediately after the start of dialysis or immediately after large-scale replenishment with reverse-filtered dialysate. Alternatively, by adjusting the dialysate flow rate for a predetermined time immediately after the rapid replacement fluid, the leakage of albumin immediately after the start of dialysis or immediately after the large-scale fluid replacement by the reverse filtration dialysate or immediately after the rapid fluid replacement is controlled. The means corresponds to albumin leakage suppression means provided in the hemodialysis apparatus according to the present invention.

  In the present invention, the flow rate control of the dialysate is arbitrarily set on the operation panel of the apparatus which is an input unit for inputting the operating condition of the actual working unit, and is performed in conjunction with the water removal program of the water removal / replacement mechanism. And the blood flow rate over time according to the dialysate flow control program and the water removal / replacement program set arbitrarily on the operation panel of the device. It is also possible to adjust to. It is also possible to adjust both the dialysate flow rate and the drainage flow rate based on the dialysate flow rate input from the input unit and the drainage flow rate input in association with the dialysate flow rate. Here, the association refers to an input form in which, for example, if the dialysate flow rate is reduced by 50%, the water removal flow rate is also reduced by 50%.

  FIG. 10 shows an example linked with such a water removal program. When the dialysate flow rate pattern as shown in FIG. 2 is adopted, the water removal flow rate is adjusted as shown in the lower diagram. . For example, both dialysate and water removal are maintained at 0 mL / min for a certain period of time at the start of dialysis, but when the dialysate flow rate rises to a certain amount, it is started with a smaller dewatering flow rate and then dialyzed at a normal flow rate. After continuing the liquid and water removal, the dialysate maintains the normal flow rate and gradually decreases the water removal rate over the latter half. Remove water. This last time zone is in the ECUM state.

  In the case of using an internal filtration type dialyzer utilizing a blood system and dialysate system pressure gradient as the dialyzer used in the present invention, the ECUM (dialysate flow rate = 0 mL / It is possible to perform hemodiafiltration (Tidal HDF) in which water removal / replacement fluid is repeated by repeating the (min) state and the HD state. As described above, by using the internal filtration type dialyzer in the present invention, it is possible to carry out efficient hemodiafiltration (Tidal HDF) even with substantially HD equipment, and the advantages are great. Further, the present invention can be carried out without the replacement fluid mechanism of the third liquid feeding means.

  Further, in the present invention, it is possible to determine the optimum dialysate flow rate each time based on the data set in advance by inputting the measurement result of blood hematocrit. The rate of increase / decrease in dialysate flow rate is set according to the difference between the target hematocrit value set in advance and the flow rate is adjusted from the hematocrit value, target hematocrit, and rate of increase / decrease in actual dialysis treatment. To do.

  In addition, an appropriate dialysate flow rate can always be ensured by appropriately changing the dialysate flow rate in conjunction with the hematocrit value in the hematocrit measurement device. Although it is the same as the above process, the measurement interval of the hematocrit is shortened, and the adjustment frequency of the dialysate flow rate is increased accordingly.

  In addition, by controlling the dialysate flow rate according to the present invention, the dialysate use amount can be reduced and saved by optimizing the dialysate use amount (optimization of the dialysate flow rate in the internal filtration dialyzer). The blood flow rate and dialysate flow rate in hemodialysis are parameters that affect dialysis efficiency, but it is not simply a matter of increasing the speed, and the rate of increase in dialysis efficiency is also reduced above a certain speed range. Therefore, it is useless to speed up the dialysate flow rate above a certain speed range, and it is most efficient to set the flow rate appropriately.

  As described above, in the present invention, the movement of the substance is suppressed by stopping the dialysate flow rate or maintaining it at a low level in a certain time zone immediately after the start of dialysis. Thus, even when reflux of the dialysate is started, leakage of albumin is suppressed more than when the dialysate is refluxed from the beginning. In addition, to reduce the removal rate of substances to be removed such as α1MG, clogging of the membrane of the dialyzer is eliminated by performing a reverse filtration replenisher as described later, and medium and large molecular substances such as β2MG and α1MG. It is also possible to recover the removal performance and maximize the performance.

  The dialysate flow rate control is set at the input part of the apparatus (by setting the dialysate flow rate at arbitrary time intervals, and set at a plurality of arbitrary time intervals). This can be performed in conjunction with the water removal program of the replacement fluid mechanism. At the beginning of dialysis, there is a large amount of leakage of albumin, which is a useful substance. In order to suppress this, it is considered useful to suppress the water removal flow rate and to reduce the dialysate flow rate to suppress internal filtration. Even if it is effective, it is expected to be effective at the same time.

  That is, as the albumin leakage suppression means provided in the hemodialysis apparatus according to the present invention, mainly after the start of dialysis, based on the flow rate and the dialysate flow rate input to the input unit in the form of the duration for maintaining the flow rate. The above-described needle valve 14 and electromagnetic valve 17 that adjust the dialysis fluid flow rate during a predetermined time may be configured, or may be input in association with the dialysis fluid flow rate input from the input unit and the dialysis fluid flow rate. Based on the water removal flow rate, it may be composed of actual means for adjusting both the dialysate flow rate and the water removal water amount for a predetermined time immediately after the start of dialysis. The adjustment of the amount of water to be removed in the latter is desirably performed by a water removal / replacement mechanism disposed in at least one of the dialysate supply line and the dialysate discharge line. The dewatering / replacement mechanism is also one of working means in the working part. Here, the actual means for adjusting both the dialysate flow rate or the dialysate flow rate and the dewatered water amount for a predetermined time immediately after the start of dialysis is used, but the actual means, that is, the albumin leakage suppression means is a reverse filtration dialysis described later. Contributing to the suppression of albumin leakage immediately after large-scale replenishment with a fluid or immediately after rapid replenishment is the same as in the case immediately after the start of dialysis.

  However, it is effective that the leakage of albumin can be suppressed by controlling in this way in a certain time zone (0 to 60 minutes) immediately after the start of dialysis, or after a reverse filtration rapid replacement fluid described later. At other timings, it is desirable to adjust the dialysate flow rate in accordance with the solute removal performance, and it is desirable to adjust the water removal flow rate according to the blood state. In this case, a hematocrit value that is a measured value is appropriate as a marker.

  The amount of albumin leakage increases immediately after large-scale replenishment with reverse filtration dialysate or immediately after rapid replenishment. As dialysis treatment proceeds, fouling of hollow fibers in hemodialyzers, clogging of membrane pores, etc. However, if a large volume or rapid replenishment with reverse filtration dialysate is performed, reverse filtration at a rate sufficiently faster than the rate of internal filtration that occurs spontaneously during dialysis treatment. In order to carry out the process, once the substance deposited on the surface of the hollow fiber of the hemodialyzer is peeled off, the removal rate of removed substances such as β2-MG and α1-MG is restored, and albumin which is a useful substance This is because the amount of leakage increases.

  The progress of clogging of fouling and membrane pores can be determined to some extent by the increase in TMP, and is determined by the progress of clogging of fouling and membrane pores. By performing the replacement fluid or the rapid replacement fluid, clogging of the membrane pores is eliminated, and the removal rate of β2-MG, α1-MG, and the like can be increased. However, since the leakage of albumin also increases at the same time, in the hemodialysis apparatus according to the present invention, in order to suppress the leakage of albumin immediately after large-scale replenishment with a reverse filtration dialysate or immediately after rapid replenishment, as in the initial stage of dialysis. In addition, the dialysate flow rate and the dewatering flow rate are lowered to the lower level in conjunction with the end timing of the large volume replacement fluid / rapid replacement fluid. For example, as in the case immediately after the start of dialysis, it is desirable to adjust the dialysate flow rate in the range of 1 to 60 minutes immediately after the large-scale replenishment with the reverse filtration dialysate or immediately after the rapid replenishment to 0 to 200 mL / min by the albumin leakage suppression means. Further, when both the dialysate flow rate and the drainage flow rate are adjusted, that is, when the drainage water amount is input to the input unit in association with the dialysate flow rate, the drainage flow rate is reduced to 0 by the albumin leakage suppression means. It is desirable to adjust to -5 mL / min.

  When rapid replacement is performed, it is desirable to prevent the blood flow returning from the vein side to the patient side from changing for the purpose of suppressing fluctuations in circulatory dynamics as much as possible. For example, when the blood pump speed is 200 mL / min before the replacement is performed and the rapid replacement is performed at 100 mL / min, the speed at which the blood pump speed is reduced to 100 mL / min, It will not change, and the fluctuation of circulatory dynamics can be reduced. Furthermore, dialysis efficiency, especially low molecular weight substances (urea, etc.) are mainly removed by diffusion. If blood flow increases, clearance can be improved by increasing the dialysate flow rate accordingly. An optimum dialysate flow rate can be set. When the blood flow rate increases, the rotation speed of the blood pump increases. By extracting the rotation signal from the blood pump, it is possible to calculate the speed increase of the blood pump and increase the dialysate flow rate in conjunction with the increase rate.

  Further, in the hemodialysis apparatus according to the present invention, based on the measured value from the measuring means provided in the actual working part, more specifically, based on the hematocrit value or TMP value measured by the measuring means, the control part Operates the hematocrit value on the working part.

  There is a correlation between the hematocrit value and the patient's blood pressure.For example, as one of the causes of blood pressure lowering symptoms that occur relatively well in the second half of dialysis treatment, there is a decrease in circulating blood volume. The value indicating the percentage occupied by the volume of blood cells in the blood is low because of the excess water content, but the hematocrit value increases as water removal by hemodialysis proceeds. In addition, the blood volume itself circulating in the blood vessel is also reduced accordingly, which may cause a blood pressure lowering symptom. The hemodialysis apparatus according to the present invention provides a large-volume replenishment solution or rapid replenishment solution based on a reverse filtration dialysis solution based on a hematocrit value that is correlated with a patient's blood pressure in order to recover a circulating blood volume that is a cause of a blood pressure lowering symptom. To implement.

  Pressure fluctuations in the TMP value (transmembrane pressure difference) can be caused by fouling of the dialyzer membrane, pressure increase that occurs during mass transfer from the blood side to the dialysate side due to clogging of the membrane pores, and a decrease in patient blood pressure. It may be due to the accompanying pressure drop on the blood circuit side. In the conventional dialysis treatment, a method such as performing a rapid fluid replacement in order to prevent a blood pressure lowering symptom in advance by looking at fluctuations in the TMP value is taken, and when the TMP value rises, the water removal rate is lowered. Adjustments were made. In the hemodialysis apparatus according to the present invention, when the TMP value rises, the fouling of the hollow fiber membrane and the clogging of the membrane pore are positively carried out by carrying out a large volume replenishment or rapid replenishment with the reverse filtration dialysate. Wash Out to restore the removal rate of α1-MG and β2-MG.

Preferred embodiments of the present invention are listed below.
The dialysate flow rate adjusting mechanism in the hemodialyzer has a general performance of having a closed system as a dialysate feeding mechanism, and, for example, a dialysate supply line for supplying dialysate to the dialyzer and a dialysate from the dialyzer Each of the dialysate discharge lines for discharging the dialysis fluid is provided with a solenoid valve, and in the dialysate flow rate adjustment mechanism, for example, a bypass line is provided between the upstream side and the downstream side of the dialysate discharge pump of the dialysate discharge line. The bypass circuit is equipped with a pump (water removal / replacement pump) capable of feeding in both directions from the downstream side to the upstream side or from the upstream side to the downstream side as liquid feeding means.
The blood circuit is composed of an arterial blood circuit and a venous blood circuit, and the arterial blood circuit has a connection with an arterial puncture needle, a blood pump segment, a heparin injection segment, an arterial chamber, and a connection with a dialyzer.
The venous blood circuit has a connection with a dialyzer, a venous chamber, a venous pressure monitor line, and a connection with a venous puncture needle.

  In this hemodialysis machine, it is important to control the dialysis fluid circulation state, the dewatering flow rate from the blood side, and the blood side circulation state in conjunction with each other. It is desirable to configure so that interlocking control can be performed. Furthermore, it is desirable to communicate with the solenoid valve connected to the dialysate supply line and the dialysate discharge line for controlling (stopping) the dialysate flow rate, and to perform interlock control. Prior to the start of hemodialysis, a water removal program and a dialysate flow program (and a blood flow program if necessary) are set on the operation panel of the hemodialysis apparatus. Setting is a method of setting each flow velocity for each time division, and it can be done by changing the graph-like figure displayed on the screen, or changing the time division and numerical value of each flow velocity displayed in a table format. May be implemented. In addition, the time division timing of the dialysate flow rate program, the time division timing of the water removal program, and the time division timing of the blood flow rate program should be matched in each time division to facilitate the setting of the linked operation. desirable.

  Immediately after the start of hemodialysis treatment, treatment is performed with the water removal flow rate and the dialysate flow rate set to 0 mL / min for the first 15 minutes according to the water removal program and the dialysate flow rate program. In this case, the device configuration merely sets whether to stop or flow the dialysate, and therefore, 15 minutes later, reflux is started at the adjusted dialysate flow rate (for example, 500 mL / min). This state (water removal flow rate remains at 0 mL / min) is continued for 15 minutes, and then water removal is started. Thus, it was confirmed that the leakage of albumin immediately after the start of hemodialysis was suppressed even when the amount of the replacement liquid by internal filtration was increased using an internal filtration dialyzer.

It is explanatory drawing which shows the outline of the dialysis apparatus for implementing this invention. It is a flow rate pattern figure which shows the example of a control system of the dialysate flow volume performed using the dialyzer of this invention. It is a figure which shows the removal rate of the albumin leaked from the blood to a dialysate under normal dialysate flow volume, and (alpha) 1MG with time. It is a figure explaining the filtration phenomenon which arises by the pressure gradient in a dialyzer. It is explanatory drawing which shows an example of the conventional water removal pattern. It is explanatory drawing which shows an example of the control means of the dialysate flow volume in this invention. It is explanatory drawing which shows the other example of the control means of the dialysate flow volume in this invention. It is explanatory drawing which shows the other example of the control means of the dialysate flow volume in this invention. It is explanatory drawing which shows the other example of the control means of the dialysate flow volume in this invention. It is explanatory drawing which shows the relationship between the dialysate flow volume and water removal flow volume in this invention. It is a flowchart which shows the example of a setting input in this invention. 1 is a configuration block diagram of a hemodialysis apparatus according to the present invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Dializer 2 Arterial side blood circuit 3 Vein side blood circuit 4a Arterial side connection part 4b Vein side connection part 5 Blood pump 6 Dialysate supply line 7 Dialysate discharge line 8 1st liquid feeding means 9 2nd liquid feeding means 10 Bypass line DESCRIPTION OF SYMBOLS 11 3rd liquid feeding means 12 Dialysate flow rate adjustment mechanism 13 Dialysate flow rate detector 14 Needle valve 15 Control part 16 Motor 17-19 Electromagnetic valve 20 Dialysate circulation pump

Claims (11)

A hemodialysis apparatus in which a dialyzer is connected to a blood system comprising an arterial blood circuit and a venous blood circuit having a blood pump, and a dialysate system comprising a dialysate supply line and a dialysate discharge line,
An input unit for inputting the operating conditions of the working unit composed of both the blood system and the dialysate system;
A display unit that displays at least one of an input value from the input unit and a measurement value from a measuring unit provided in the working unit;
A control unit for controlling the operation of the working unit based on the input value or the measured value;
A storage unit for storing at least one of the input value and the measured value;
Based on the dialysate flow rate input from the input unit, the dialysate flow rate is adjusted immediately after the start of dialysis or immediately after a large amount of replenishment with a reverse filtration dialysate or immediately after a rapid replenishment, and immediately after the start of dialysis or the reverse filtration dialysate A hemodialysis apparatus provided with albumin leakage suppression means for suppressing leakage of albumin immediately after a large volume replacement fluid or a rapid replacement fluid.
A hemodialysis apparatus in which a dialyzer is connected to a blood system comprising an arterial blood circuit and a venous blood circuit having a blood pump, and a dialysate system comprising a dialysate supply line and a dialysate discharge line,
An input unit for inputting the operating conditions of the working unit composed of both the blood system and the dialysate system;
A display unit that displays at least one of an input value from the input unit and a measurement value from a measuring unit provided in the working unit;
A control unit for controlling the operation of the working unit based on the input value or the measured value;
A storage unit for storing at least one of the input value and the measured value;
Based on the dialysate flow rate input from the input unit and the dewatering flow rate input in association with the dialysate flow rate, the dialysate at a predetermined time immediately after the start of dialysis, immediately after large-scale replenishment with reverse filtration dialysate, or immediately after rapid replenishment A hemodialysis apparatus comprising an albumin leakage suppression means that regulates both the flow rate and the dewatering flow rate to suppress leakage of albumin immediately after the start of dialysis or immediately after a large-scale replenishment with a reverse filtration dialysate or immediately after a rapid replenishment.
Adjustment of the dialysate flow rate
(1) Adjust the flow rate with the flow rate adjustment valve provided in the dialysate system,
(2) A plurality of solenoid valve lines are provided in parallel and the number of open solenoid valve lines is adjusted.
(3) Install a bypass circuit in the dialysate system to stop the inflow of dialysate to the dialyzer,
(4) The dialysate circulation pump capacity is controlled to change the dialysate flow rate,
(5) The hemodialysis apparatus according to claim 1 or 2, wherein the liquid feeding speed of the liquid feeding means provided in the dialysate supply line and the dialysate discharge line is adjusted.
The dialysate flow rate is input in the form of a flow rate and a duration for maintaining the flow rate, and the flow rate can be increased and decreased and the duration can be changed. Hemodialysis machine.
The hemodialysis apparatus according to any one of claims 2 to 4, wherein the water removal flow rate is adjusted by a water removal / replacement mechanism disposed in at least one of the dialysate supply line and the dialysate discharge line.
The hemodialysis apparatus according to any one of claims 1 to 5, wherein the dialysis fluid flow rate is set to 0 to 200 mL / min immediately after the start of dialysis or immediately after a large-scale replenishment with a reverse filtration dialysate or immediately after a rapid replenishment.
The hemodialysis apparatus according to any one of claims 2 to 6, wherein a dewatering flow rate is set to 0 to 5 mL / min immediately after the start of dialysis or immediately after a large-scale replenishment with a reverse filtration dialysate or immediately after a rapid replenishment.
The hemodiafiltration (HDF) which repeats dehydration / replacement fluid can be performed by repeating the ECUM state and the HD state in which the dialysate flow rate is 0 mL / min, according to any one of claims 1 to 7. Hemodialysis machine.
The hemodialysis apparatus according to any one of claims 1 to 8, wherein one of the measured values is a hematocrit value, and the dialysate flow rate can be changed in conjunction with the hematocrit value.
The controller according to any one of claims 1 to 9, wherein the controller performs a large-scale replenishment operation or a rapid replenishment operation with a reverse filtration dialysate on the active part based on a measurement value from a measuring unit provided in the active part. The hemodialysis apparatus as described.
The hemodialysis apparatus according to claim 10, wherein the measured value according to claim 10 is a hematocrit value or a TMP value.

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