WO1998010745A1 - Formulations chimiques de dialysate en lots - Google Patents
Formulations chimiques de dialysate en lots Download PDFInfo
- Publication number
- WO1998010745A1 WO1998010745A1 PCT/US1997/014094 US9714094W WO9810745A1 WO 1998010745 A1 WO1998010745 A1 WO 1998010745A1 US 9714094 W US9714094 W US 9714094W WO 9810745 A1 WO9810745 A1 WO 9810745A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- dialysate
- batch
- concentrate
- bicarbonate
- acid
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Ceased
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K33/00—Medicinal preparations containing inorganic active ingredients
- A61K33/14—Alkali metal chlorides; Alkaline earth metal chlorides
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
- A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes
- A61M1/1654—Dialysates therefor
- A61M1/1656—Apparatus for preparing dialysates
- A61M1/1666—Apparatus for preparing dialysates by dissolving solids
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
- A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes
- A61M1/1654—Dialysates therefor
Definitions
- This invention relates generally to chemical formulations that are used for the preparation of dialysate solutions, and more particularly to the distribution of chemicals into two dialysate concentrate formulations that are particularly suitable for use in preparing batch quantities of dialysate.
- batch refers to the quantity of dialysate constituents, that when mixed with the proper amount of water, forms enough dialysate solution sufficient for one complete dialysis session for a single patient.
- Dialysis including hemodialysis and peritoneal dialysis, is a treatment for patients that suffer from inadequate kidney function.
- hemodialysis blood is pumped from the patient's body through an extracorporeal artificial kidney circuit, where blood-borne toxins and excess water are filtered out of the blood through a semipermeable dialyzer membrane into an electrolyte (dialysate) medium.
- dialysate electrolyte
- peritoneal dialysis the patient infuses a quantity of dialysate into the peritoneal cavity, and the peritoneal membrane acts as the semipermeable membrane. After a dwell period, the dialysate fluid is drained and a fresh supply of peritoneal dialysate is added to the peritoneum.
- concentrate formulations for preparing dialysis solutions used in hemodialysers or in peritoneal dialysis are known. See, for instance, U.S. Patent Nos. 4,336,881 ; 4,489,535; and 4,756,838. These formulations vary not only with respect to specific constituents, but also with respect to the concentrations of these constituents.
- concentrate formulations include sodium chloride as the major constituent and potassium chloride, calcium chloride and magnesium chloride as minor constituents. If required by the patient, dextrose may also be included.
- Sodium acetate and/or sodium bicarbonate are also included as a buffer source to correct for metabolic acidosis With acetate buffer, all of the constituents can be combined into a single concentrate. With bicarbonate buffer, two concentrates are necessary to prevent the precipitation of calcium and magnesium as carbonate salts.
- One concentrate usually called the acid concentrate, contains the chloride salts of sodium, potassium, calcium and magnesium, along with an acid such as acetic acid.
- the other concentrate called the bicarbonate concentrate, contains sodium bicarbonate and usually sodium chloride as well. Both concentrates may exist in either liquid or powdered form.
- the sequential mixing of the two concentrates with purified water generates carbonic acid as a reaction product of the acid with bicarbonate and results in a dialysate having a pH within physiological limits but with sufficient acidity to prevent calcium and magnesium carbonate precipitation.
- a number of dialysate delivery systems are available for preparing and delivering dialysate. Traditionally, dialysis systems were used for the preparation of large batches (e.g. , 120 L) of dialysate.
- dialysates can be prepared continuously on-line by combining water, which has been first purified by a separate water treatment system, with liquid concentrates of the dialysate constituents using a proportioning pump.
- a representative patent discussing this technique is the patent to Serrez, U.S. No. 3,441 , 135.
- Proportioning systems are considered to be less advantageous for use in a home hemo- or peritoneal dialysis machine, as compared to a batch system, because: (a) proportioning systems are dependent on two or three pumps to meter concentrate and water accurately and thus, instantaneous variation in flow rates can cause undesirable concentration changes.
- a batch system has only one pump and quality of dialysate is assured throughout the treatment cycle; (b) loss of one or more pumps in proportioning system can cause serious harm to the patient if unattended for long periods of time whereas batch system pump failure simply stops dialysis and the patient is not subjected to harmful dialysate anytime; (c) proportioning systems have more moving parts and hence are subjected to more wear and tear and subsequent break down; and (d) adjustment of dialysate flow rates in proportioning systems requires adjustments of concentrate pump flow rates whereas in batch systems, a simple adjustment in one pump flow is all that is required. Moreover, batch systems are safer to use because a one time check of conductivity assures good quality dialysate until the quantity of the batch is used up.
- a fu ⁇ her object of the invention is to provide concentrate formulations that assures patient safety and will withstand temperature extremes when the concentrates are shipped from the location where they are formulated and bottled to the eventual destination.
- the present invention constitutes batch quantity dialysate formulations that are suitable for use in preparing a batch quantity of dialysate solution, and kits and methods employing the same.
- the dialysate chemical formulations for one batch of dialysate comprise a liquid acid concentrate unit stored in a first vessel, and a dry bicarbonate concentrate unit stored in a second vessel.
- the contents of the first and second vessels are emptied into a dialysate preparation tank and mixed with water to form a batch quantity of dialysate solution.
- the mixing of chemicals and dilution with water is accomplished in an enclosed environment, under small pressure such that carbon dioxide formed remains dissolved in the solution.
- the present invention relates specifically to the dialysate chemical formulations; the vessels containing the chemicals and the machine that prepares the solution are not considered a part of the present invention per se.
- the assignee of the present invention has developed a daily hemodialysis machine that is particularly suitable for use in the home, nursing home, and limited care environment.
- the machine is described in patent application of Kenley et al. , Serial No. 08/388,275, filed February 13, 1995, and is incorporated by reference herein.
- the machine prepares the dialysate solution a batch at a time, just prior to the start of the dialysis session
- the dialysate chemicals are shipped to the machine site in vessels that each contain the batch quantity of either powdered or liquid dialysate chemicals.
- the dialysate chemicals are used in conjunction with the machine desc ⁇ bed in the above Kenley et al. application.
- dialysate concentrate formulations for preparing bicarbonate-based dialysate in batch quantities, consisting of a dry bicarbonate concentrate and a liquid acid concentrate which are stored in separate containers and vessels and mixed together in a suitable dialysate solution tank to form a batch quantity of a physiologically balanced dialysate solution suitable for hemodialysis.
- the acid concentrates and bicarbonate concentrates of the invention are specially formulated to allow a physician to selectively tailor a dialysate formulation to a patient's particular health needs and to allow a patient to easily prepare batch size quantities of dialysate using a home dialysis machine described in Kenley et al. patent application.
- the final dialysate preferably includes the following constituents (Table 1 ):
- the acid concentrate of the invention includes sodium chloride, dextrose and minor amounts of chloride salts of potassium, calcium and magnesium in acetic acid. Dextrose is included in the acid concentrate in solubilized form to circumvent any potential dissolution problems in preparing the final dialysate formulation.
- the acid concentrate (410 mL volume per unit) is prepackaged in container, admixed with the bicarbonate concentrate in a dialysate preparation tank with a predetermined volume of water, then diluted to produce a 56 L batch dialysate using a home dialysis system su ⁇ h as the one described in the above referenced Kenley et al. application.
- the acid concentrate contains 119.737 g/L of sodium chloride (15 mEq/L final concentration in 56 L of dialysate); 204.878 g/L of dextrose (1.5 g/L in final concentration in 56 L); and 32.805 g/L of glacial acetic acid ( 4 mEq/L final concentration in 56 L).
- the desired concentration of potassium, calcium and magnesium ions in the acid concentrate varies from patient to patient.
- the amount of potassium chloride is present in an amount ranging between about 0.00 g and about 40.441 g/L of acid concentrate.
- the amount of calcium chloride (dihydrate form, CaCl 2 .2H 2 O) generally ranges between about 0.00 and about 34.888 g/L of acid concentrate.
- the amount of magnesium chloride (hexahydrate form, MgCl 2 .6H 2 O) generally ranges between about 6.893 and about 20.68 g/L of acid concentrate.
- a stable acid concentrate is produced which can be shipped and stored for prolonged periods at a broad range of temperatures, including temperatures ranging between about -10 to -20F, without freezing solid or precipitating out.
- chloride salts of sodium, potassium, calcium and magnesium are preferred in practicing this invention, it will be understood by the practitioner that other water soluble physiologically acceptable salts of sodium, potassium, calcium and magnesium ions may be used to replace all or part of the corresponding chloride salts. Suitable, but non-limiting, salts include sulfates, carbonates, phosphates, acetates, lactates, and gluconates. If desired, hydrochloric acid may also be used to replace all or part of the acetic acid employed in the acid concentrate.
- the bicarbonate concentrate of the invention includes an admixture of sodium chloride and sodium bicarbonate in a predetermined ratio.
- the bicarbonate concentrate includes sodium chloride in an amount ranging between about 217.6 and about 358.4 g and sodium bicarbonate in an amount ranging between about 143.5 and about 204.7 g per unit.
- Admixture of the bicarbonate concentrate batch unit with any of the acid concentrate batch units of the invention in an appropriate amount of water will result in a physiologically acceptable dialysate solution.
- both the acid concentrate and the bicarbonate concentrates of the invention are preferably in the form of physically discrete units suitable as unitary dosages for each dialysis session, each unit containing a predetermined quantity of the various constituents such when combined with water results in a batch dialysate formulation having the desired concentrations of constituents
- the unit dosage forms are preferably contained in prepackaged sealed unit dose containers or vessels such as the one desc ⁇ bed in the Treu et al.
- the present dialysate chemical formulation invention is of course applicable to other vessel designs and machines.
- the conductivity of the acid concentrate of the invention generally ranges between about 2-3 mS/cm while the bicarbonate concentrate of the invention generally ranges about 10.5 to 12.7 mS/cm.
- the combined conductivity ranges between about 12.8 to 15 mS/cm.
- the distribution of the chemicals in the acid and bicarbonate concentrates of the invention results in a minimum total volume and weight of concentrates per given volume of final dialysate compared with current commercial packages available.
- Conventional dialysis systems such as the ones produced by Baxter and Fressenius generally require 3.43 liters of acid and 6.23 liters of bicarbonate concentrate for one 4-hour dialysis treatment. Since a daily dialysis session is typically for 90 minutes, conventional system volumes required for daily dialysis are 1.29 and 2.34 liters, respectively.
- the present invention can provide a total concentrate volume of as little as 0.9 liters (2 X 450 mL bottle) versus a conventional system of 3.63 liters (1.29 L+ 2.34 L).
- the acid and bicarbonate concentrates of the invention are about 3 to 4 (3.63/0.9) times more compact in terms of volume compared to conventional systems.
- the nearly saturated acid concentrate provides protection against freezing and dextrose recrystal zation, a common problem found in conventional acid
- the distribution of the chemicals in the acid and bicarbonate concentrates of the invention results in greater control and accuracy of sodium and chloride ion concentrations in the dialysate.
- One of the problems with the conventional systems is maintaining high level accuracy for sodium and chloride ions Many physicians prefer +1-2% for these ions. Since the conventional systems involve making a concentrate for sodium bicarbonate (with or without sodium chloride) and then subsequently dilute to final volume, high accuracy cannot be obtained.
- the concentrate formulations of the present invention are designed to have only small portions of sodium chloride in acid concentrate and have all the rest of sodium in powder from which is diluted directly.
- both the acid and bicarbonate concentrates of the invention occupy nearly equal volumes and this advantageously allows for identical container design, thus reducing costs of molds and manufacturing processes. Furthermore, identical container design makes it easier for the manufacturer as well as for the user. Since the connection to the machines are identical and mix-up eliminated by color coding, electronic button checking and conductivity assurance, the use of the acid and bicarbonate concentrates of the invention for prepare batch dialysate provide the highest degree of quality assurance and safety to the patients.
- the two salts are simply added to the batch quantity vessel and sealed. No additional mixing in the vessel is required because both of them are completely dissolved in the dialysate tank.
- a 56 liter dialysate chemical solution tank is installed in a dialysis machine.
- the tank has a chemical loading platform that acts as a means for receiving the dialysate chemicals and for introducing the chemicals into the tank.
- the tank is filled up to the level of the chemical loading platform, or roughly 50 percent of capacity.
- the chemical loading platform has a slanted shelf which is in fluid communication with the interior of the tank.
- the contents of the vessels containing the batch quantity dry bicarbonate chemicals and the batch quantity liquid acid concentrate are gradually released from the vessels by gravity and are deposited onto the slanted shelf of the loading platform.
- the vessels can be either manually opened or automatically opened (in the manner described in the above-referenced Treu et al.
- a nozzle sprays reverse-osmosis filtered water onto the slanted shelf to disperse the chemicals into the interior of the tank.
- the tank is then filled completely with RO water.
- the solution is mixed by swirling the fluid in the tank, accomplished by introducing the RO water into the bottom of the tank generally parallel to the side of the tank, and by withdrawing solution from the bottom of the tank and reintroducing it at the top of the tank in a turbulent manner with a sprayer.
- the flow path of the dialysate when it is withdrawn from the bottom of the tank and reintroduced at the top of the tank includes a conductivity sensor.
- the conductivity sensor sends conductivity readings to a central processing unit controlling the operation of the machine.
- the solution is deemed mixed and the mixing process ceases.
- the dialysis session then commences according to well known techniques.
- Table 4 lists representative formulation ranges for different liquid acid concentrates. All quantities are in grams/L, with a total volume in each bottle being 290 to 440 ml. The quantities are for dilution to a 40 to 60 liter batch of dialysate. The particular formulation to be used for preparation of a batch of dialysate depends upon the medical condition of the patient, and will be prescnbed by a physician The conductivity of acid concentrate when diluted to the required volume by itself (without powder) will range between 2-3 mS/cm.
- Table 5 shows representative formulation ranges for different batch quantity dry bicarbonate chemicals formulations
- the dialysate solution is prepared by mixing one of the formulations from Table 4 with one of the formulations from Table 5 As was the case with
- Table 4 the particular formulation to be selected from Table 5 depends on the medical condition of the patient, and will be prescribed by the patient's physician Also, the formulation is for dilution to a 56 liter batch of dialysate Again, the precise quantities of the salt and bicarbonate may vary depending on the final volume of dialysate that is prepared Since there are 14 representative acid concentrate formulations and 4 representative bicarbonate concentrate formulations, there are 56 possible final dialysate combinations as listed in Tables 6, 7, 8 and 9 Table 6 consists of a combination of all of the fourteen acid concentrate formulations with the bicarbonate concentrate PI Table 7 consists of a combination of all of the fourteen acid concentrate formulations with the bicarbonate concentrate P2 Table 8 consists of a combination of all of the fourteen acid concentrate formulations with the bicarbonate concentrate P3. Table 9 consists of a combination of all of the fourteen acid concentrate formulations with the bicarbonate concentrate P4.
- Tables 10-13 list the dialysate ionic formulations resulting from the 56 possible combinations of acid concentrate and bicarbonate concentrate, when diluted to 56 liters final volume with reverse osmosis filtered water
- the conductivity of bicarbonate chemicals formulation when diluted to the required volume by itself (without acid) will range 10.5-12.7 mS/cm.
- P3 contains 127 meq/L of Na* and 43 meq/L HCO 3 ' TABLE 13: DIALYSATE IONIC FORMULATIONS
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Abstract
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| AU39766/97A AU3976697A (en) | 1996-09-11 | 1997-08-12 | Batch quantity dialysate chemical formulations |
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US71242496A | 1996-09-11 | 1996-09-11 | |
| US08/712,424 | 1996-09-11 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| WO1998010745A1 true WO1998010745A1 (fr) | 1998-03-19 |
Family
ID=24862054
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| PCT/US1997/014094 Ceased WO1998010745A1 (fr) | 1996-09-11 | 1997-08-12 | Formulations chimiques de dialysate en lots |
Country Status (2)
| Country | Link |
|---|---|
| AU (1) | AU3976697A (fr) |
| WO (1) | WO1998010745A1 (fr) |
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| US6743191B1 (en) | 1999-04-26 | 2004-06-01 | Edwards Lifesciences Ag | Substitution infusion fluid and citrate anticoagulation |
| US7186420B2 (en) | 1999-04-26 | 2007-03-06 | Edwards Lifesciences Corporation | Multi-part substitution infusion fluids and matching anticoagulants |
| EP1716875A3 (fr) * | 2005-04-26 | 2007-11-28 | B. Braun Medizintechnologie GmbH | Ensemble de containers pour concentré de solution de dialyse |
| DE19931077B4 (de) * | 1999-07-06 | 2009-02-26 | Sterisafe Gmbh | Verfahrung zur Herstellung von Saurem Dialysekonzentrat |
| US7544301B2 (en) | 2004-08-19 | 2009-06-09 | Hhd Llc | Citrate-based dialysate chemical formulations |
| US8105258B2 (en) | 1999-04-26 | 2012-01-31 | Baxter International Inc. | Citrate anticoagulation system for extracorporeal blood treatments |
| US9598691B2 (en) | 2008-04-29 | 2017-03-21 | Virginia Tech Intellectual Properties, Inc. | Irreversible electroporation to create tissue scaffolds |
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| US10335224B2 (en) | 2000-08-17 | 2019-07-02 | Angiodynamics, Inc. | Method of destroying tissue cells by electroporation |
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| US10471254B2 (en) | 2014-05-12 | 2019-11-12 | Virginia Tech Intellectual Properties, Inc. | Selective modulation of intracellular effects of cells using pulsed electric fields |
| US10470822B2 (en) | 2008-04-29 | 2019-11-12 | Virginia Tech Intellectual Properties, Inc. | System and method for estimating a treatment volume for administering electrical-energy based therapies |
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- 1997-08-12 WO PCT/US1997/014094 patent/WO1998010745A1/fr not_active Ceased
- 1997-08-12 AU AU39766/97A patent/AU3976697A/en not_active Abandoned
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