AU2012201932B2 - Systems and methods for delivery of peritoneal dialysis (PD) solutions - Google Patents
Systems and methods for delivery of peritoneal dialysis (PD) solutions Download PDFInfo
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Abstract
A container system for peritoneal dialysis (PD) solutions, comprising: a first compartment containing a first PD agent, a second compartment containing a second PD agent, the second compartment being in any of direct and indirect fluid coupling with the first compartment, an outlet fluid pathway coupled to the second compartment being in any of direct and indirect fluid coupling with an external environment to the container system, and a first seal that prevents fluid transfer between the first compartment and the second compartment, a second seal that prevents fluid transfer to the outlet fluid pathway, the container system further configured to inhibit breaking of the second seal prior to mixing of at least a portion of the first PD agent and the second PD agent.
Description
Australian Patents Act 1990- Regulation 3.2 ORIGINAL COMPLETE SPECIFICATION STANDARD PATENT Invention Title: Systems and methods for delivery of peritoneal dialysis (P1D) solutions The following statement is a full description of this invention, including the best method of performing it known to me: P/00/01 1 5951 SYSTEMS AND METHODS FOR DELIVERY OF PERITONEAL DIALYSIS (PD) SOLUTIONS BACKGROUND OF THE INVENTION [0011 This application is a continuation-in-part of United States Patent Application Serial No. 11/046,667, entitled "System and Methods for Dextrose Containing Peritoneal Dialysis (PD) Solutions With Neutral PH And Reduced Glucose Degradation Product," filed January 28, 2005, the teachings of which are incorporated herein by reference. [0021 The invention relates to peritoneal dialysis (PD). In particular, it provides containers and methods for treating peritoneal dialysis solutions that reduce glucose degradation products (GDPs). 10031 Peritoneal dialysis (PD) is a medical procedure for removing toxins from the blood that takes advantage of the semi-permeable membrane surrounding the walls of the abdomen or peritoneal cavity. During a PD procedure, a solution is introduced into the patient's abdomen, where it remains for up to several hours, removing blood toxins via osmotic transfer through that membrane. At completion of the procedure, the solution is drained from the body along with the toxins. [0041 An active constituent of the PD solution is an osmotic agent, such as glucose, that creates an osmotic gradient across the peritoneal membrane, allowing exchange of toxins from the blood into the peritoneal cavity, as described above. Another constituent is an electrolyte composition, such as a mixture of sodium, calcium, potassium, chlorine, magnesium, and so forth, which restores and maintains electrolyte balance in the blood. A final typical constituent is a buffering agent, such as lactate and pyruvate, which ensures that the blood pH remains at a physiological norms during the procedure. [005] A major problem with commercially available PD solutions is the presence of degradation products. These products, which typically arise during long-term storage or sterilization of the solutions, damage the peritoneal wall and can adversely affect proteins elsewhere in the patient's body. 1 H:\jzc\Inienvoven\NRPorlbl\DCCUJZC\7056138_ l.doc-2/12/2014 -2 [006] Attempts to eliminate these degradation products have met some success. An example is the assignee's own United States Patent No. 6,277,815, which utilizes a multi-chamber PVC or polyolefm bag to separate PD constituents during storage and sterilization. That notwithstanding, there remains a continuing need for improved containers and methods for treating PD solutions to reduce glucose degradation products (GDPs). SUMMARY OF THE INVENTION [007] In accordance with the invention, there is provided a container system for peritoneal dialysis (PD) solutions, comprising: a first compartment containing a first PD agent, a second compartment containing a second PD agent, the second compartment being in any of direct and indirect fluid coupling with the first compartment, an outlet fluid pathway coupled to the second compartment being in any of direct and indirect fluid coupling with an external environment to the container system, and a first seal that prevents fluid transfer between the first compartment and the second compartment, a second seal that prevents fluid transfer to the outlet fluid pathway, a protective structure that is not integral with said seals and that is configured to inhibit breaking of the second seal prior to breaking of the first seal. [008] In another aspect, there is provided a container system for peritoneal dialysis (PD) solutions, comprising: A. a first compartment containing a first PD agent, B. a second compartment containing a second PD agent, the second compartment being in any of direct and indirect fluid coupling with the first compartment, a vessel in which the second compartment is formed expelling second PD agent upon application of force, C. a first frangible seal that prevents fluid transfer between the first compartment and, the second compartment, D. a second frangible seal that prevents fluid transfer between the second compartment and an outlet fluid pathway of the container system, H:\jzc\ntenvoven\NRPornbl\DCC\JZC\7056138_ .doc-2/12/2014 -3 E. a protective member slideably disposed on the container system to move from a first position, wherein it inhibits breaking of the second frangible seal, to a second position, wherein it does not inhibit breaking of the second frangible seal, wherein the protective member has a slot or other opening sized to slide over at least a portion of the vessel in which the second compartment is formed and wherein presence of a quantity of second PD agent in the second compartment inhibits the slot or other opening from sliding over at least the portion of the vessel forming the second compartment. [009] In another aspect, there is provided a method of dispensing a peritoneal dialysis solution from a peritoneal dialysis (PD) container system, comprising the steps of: A. breaking a first seal in a PD container system of the type comprising a first compartment containing a first PD agent and a second compartment containing a second PD agent, B. sliding a protective member from a first position, wherein it inhibits breaking of a second seal, to a second position, and C. breaking the second seal to allow fluid to exit the container system via an outlet, wherein a presence of a quantity of fluid in the second compartment prior to breaking of the first seal inhibits sliding of the protective member. [Paragraphs [0010] to [0028] have been deleted] H:\jzckniicnvoven;NRPmihbl\DCCUZC\655997_ IlDOC-3M7/2014 -4 [Pages 4 to 7 are intentionally left blank] BRIEF DESCRIPTION OF THE DRAWINGS [00291 A more complete understanding of the invention may be attained by reference to the drawings, in which: [0030] Figure 1 depicts a system for containing a peritoneal dialysis solution according to one practice of the invention and includes a break-out portion depicting one of the vessels of that system in greater detail; [0031] Figure 2 depicts a sequence for sterilizing and administering a peritoneal dialysis solution according to the invention; [00321 Figure 3 depicts a system for containing a peritoneal dialysis solution according to a further practice of the invention and includes a break-out portion depicting one of the vessels of that system in greater detail; [0033] Figures 4A - 4C depict utilization of the system of Figure 3 to mix agents of the peritoneal dialysis solution (e.g., following sterilization) and to transfer the mixed agents to the patient. [00341 Figure 5 is a schematic of a frangible seal. [00351 Figure 6 depicts a system for containing a peritoneal dialysis solution according to one practice of the invention that includes a protective member adapted to inhibit breaking of a second seal prior to breaking of a first seal. [0036] Figures 7A - 7E illustrate operation of the system of Figure 6. [0037] Figures 8A - 8B illustrate an embodiment of the invention incorporating an alternate configuration of the second container of Figure 6. [0038] Figure 9 illustrates an embodiment of the invention in which the fluid-filled second compartment defines the protective member. 8 [0039] Figures 1OA- 1OD illustrate operation of the system of Figure 9. 9 DETAILED DESCRIPTION [0040] Figure 1 illustrates a container system for PD solutions according to one practice of the invention. The container system 10 has a first vessel 12 that contains, in compartment 12a, a PD osmotic agent solution 14. A second vessel 20 contains, in compartment 20a, PD buffer agent solution 22. The vessels 12, 20 and, more particularly, the compartments 12a, 20a are coupled for fluid exchange via port 18 formed in vessel 12, as shown. A temporary seal 24 is provided in the fluid-transfer path between the compartments, also as shown. This prevents contact between or mixing of the PD osmotic agent and the PD buffer agent, e.g., until after sterilization of the agents. A further temporary seal 26 is provided in a catheter 28 that leads, e.g., to the patient's peritoneal cavity (not shown), and prevents flow of PD solution, e.g., until after mixing of the sterilized agents. [00411 Illustrated first vessel 12 is a conventional medical-grade PVC hanging "transfusion" bag, as illustrated. In other embodiments it may be of other configurations and/or comprised of other materials, such as a glass container or other flexible or non flexible containers (of PVC, polyolefin, polypropylene, or other medical-grade material) of the type typically used to contain and/or administer peritoneal dialysis agents. The compartment 12a is formed within the vessel 12 in the conventional manner and, in the illustrated embodiment, is of standard clinical use capacity (e.g., sized between 1 - 5 liters), though other sizes may be used as well. As indicated above, vessel 12 includes at least one port 18 providing a fluid-transfer path to compartment 12a. This port can be used to transfer agents to and from the vessel 12, e.g., during manufacture at the pharmaceutical plant, during mixing of the agents, and/or during administration of the mixed agents to the patient. Other embodiments may use a greater or fewer number of ports than those illustrated and, indeed, may use no ports at all (e.g., where needles or other methods are used to add and remove agents from the compartment 12a). [00421 Illustrated vessel 20 is a tube-like vessel (or miniature bulb or "mini-bulb") of PVC or other medical grade material suitable for containing at least a PD buffer agent. The illustrated vessel is semi-rigid and, therefore, suitable for squeezing or other 10 manipulation by a patient, health care provider or manufacturer, e.g., to facilitate breaking of the seal 24, extrusion of the PD buffer agent out from compartment 20a and into compartment 12a, and/or mixing of the PD agents. In other embodiments, the vessel may be of other configurations and may be fabricated from other materials (e.g., rubber, polyolefin, polypropylene, and/or other medical grade materials). Moreover, the vessel need not be semi-rigid: it may be rigid or flexible, depending on how the patient, health care provider or manufacturer are expected to use it for purposes of breaking of seal 24, expelling the PD buffer agent and/or mixing of the PD agents Still further, although vessel 20 has a tube-like configuration, other embodiments may utilize vessels of different shapes. Vessel 20 can be formed by a blow molded or dipping-formed bubble in-line with the solution bag outlet. Other methods for forming the second vessel are possible also, such as formation during the tubing extrusion process (commonly called Bump tubing) or heat forming vessel 20 in pre-extruded tubing, [00431 Illustrated vessel 20 is adapted for direct or indirect coupling with vessel 12 so as to provide a fluid transfer path between compartments 12a, 20a. To this end, vessel 20 has a proximal end port 25 adapted for fusing, bonding, interference-fit, screw-fit or other coupling with vessel 12, hereby, by way of its port 18, as shown in the drawing. In other embodiments, fluidic coupling between the compartments 12a, 20a may be attained in other ways, e.g., by needle- or bayonet-like adapters affixed to either vessel (or its respective port) for receipt by the other vessel. [00441 Vessel 20 is likewise adapted for direct or indirect fluid transfer to the patient's peritoneal cavity. In the illustrated embodiment, this is by way of a distal port 27 adapted for fusing, bonding, interference-fit, screw-fit or other coupling with catheter 28, as shown. That catheter may lead directly to the peritoneal cavity or indirectly, e.g., by way of filters, heaters and/or other medical apparatus. [00451 The compartment 20a of the second vessel 20 has small volumetric capacity in comparison to that of the first vessel 12. Thus, for example, where the first compartment 12a of the illustrated embodiment is of a capacity sized between 1 - 5 liters, the second 11 compartment 20a is sized about 5 - 50ml, preferably about 7.5 - 37.5m1. Thus, it will be appreciated that the ratio of volumetric capacity of the first to second compartments is about 20:1 to about 200:1, preferably about 50:1 to about 150:1, and preferably, about 70:1 to about 140:1, and most preferably about 133:1. [00461 Seal 24 is adapted to prevent fluid transfer (or other contact) between the PD agents contained in compartments during manufacture, transport, storage and sterilization of system 10, yet, to permit such fluid transfer upon breaking of that seal 24 (e.g., by a patient, health care provider, or manufacturer) for purposes of mixing the agents following sterilization. In the illustrated embodiment, the patient, health care provider, or manufacturer need not introduce a foreign object (such as a needle) to break the seal 24. Rather, this may be accomplished by squeezing, twisting or other manipulation of vessel 20 and/or port 18. To this end, in the illustrated embodiment, the seal 24 is a frangible member disposed between the aforementioned proximal port of the vessel 20 and the port 18 and is affixed to (and/or formed integrally with) an interior fluid-transfer path of one or both of those ports. [0047] Seal 24 can be fabricated from nylon, plastic, or other medical-grade material, and can be constructed in the manner of conventional frangible seals known in the art and commercially available in the marketplace, e.g., from medical supply manufacturers Baxter, Gambro and Qosina. One preferred seal 24 is constructed in the manner of the frangible seal commercially available from Fresenius Medical Care, e.g., as a component of its Premiere'" Plus Double Bag system. That seal is depicted in Figure 5. [0048] Referring to the drawing, illustrated seal 24 comprises an elongate member having a head portion 24a and a tail portion 24b, as shown. The latter comprises a main body 24c and flanges 24d which, together, clamp the distal end of port 18 and the proximal end of vessel 20 (as shown), thus, providing physical coupling between the vessels 12 and 20. The tail portion 24b has a central throughway which permits fluid coupling between compartments 12a, 20a, when frangible bond 24e is broken, as discussed below. 12 [0049] The head portion 24a, shown here of generally mushroom cap shape, is coupled to tail portion 24b by frangible bond 24e. Head portion 24a does not include a fluid throughway and, hence, prevents fluid from flowing between compartments 12a, 20a through tail portion 24b so long as bond 24e remains intact. That bond 24e, which may be formed by ultrasonic welding, adhesives, interference fit, fusing, integral molding, or otherwise, breaks upon bending or other manipulation of the seal 24 (e.g., by patient, health care provider, or manufacturer), thereby permitting such flow. [0050] Those skilled in the art will appreciate that Figure 5 depicts an example of a type of seal which can be used in practice of the invention and that seals of other configurations (frangible or otherwise) which prevent undesired contact between the PD agents, yet, permit such contact to be established by the patient, health care provider, or manufacturer, may be used instead or in addition. [0051] With reference back to Figure 1, seal 26 is adapted to prevent fluid transfer to the patient prior to both sterilization and mixing of the PD agents. As above, the patient, health care provider, or manufacturer does not need to introduce a foreign object (such as a needle) to break seal 26 but, rather, may be accomplish this by squeezing, twisting or other manipulation of vessel 20, the distal port thereof and/or catheter 28. To this end, as above, the seal 26 of the illustrated embodiment is a frangible member disposed between the aforementioned distal port of the vessel 20 and the catheter and affixed to (and/or formed integrally with) an interior fluid-transfer path of one or both of those. The seal 26, too, can be fabricated from nylon, plastic, or other medical-grade material, and it can be formed in the configurations discussed above in connection with seal 24 (and shown, for example, in Figure 5). 100521 In the embodiment of Figure 1, the focus and/or type of manipulation required to break seal 26 differs from that required to break seal 24. This prevents both seals 24, 26 from being unintentionally broken at the same time and, thus, helps insure that the sterilized fluids are mixed prior to their being transferred to the patient. To facilitate this, the seals 24, 26 can be colored differently to alert and remind the user of the proper order 13 in which they are to be broken. Those skilled in the art will appreciate, of course, that coloration can be used in connection with other elements of the system 10, as well. [0053] Referring to Figure 6, additional structure can be provided to further insure that the seals 24, 26 are broken in the proper order and, therefore, to prevent fluid transfer to the catheter 28 (and any downstream equipment) prior to sterilization and mixing of the PD agents. That drawing depicts container system 50 of the same general configuration as container system 10 of Figure 1 (as indicated by like reference numerals), albeit including a protective member in the form of cover 52 that slides from an initial position, wherein it protects seal 26 from manipulation, to a second position, wherein it permits that seal to be broken. Figures 6 and 7A - 7C show cover 52 in the initial position. Figure 7D - 7E show the cover 52 in the second position. [00541 Referring to Figure 6, cover 52 is shown in its initial position, disposed in protective relation to seal 26. In this regard, cover 52 is, more particularly, (a) disposed in surrounding relation to the distal port of vessel 20, the catheter 28 and/or such other structures of system 50 in vicinity of seal 26 that (as discussed above) the patient, health care provider, or other user manipulates in order to break seal 26, and (b) thereby prevents (or otherwise inhibits) breaking of seal 26 prior to breaking of seal 24. [00551 The cover 52, which can comprise nylon, plastic, or other material (medical grade or otherwise), preferably, in a rigid or semi-rigid formulation, includes an annular or other internal passageway 54 in which seal 26, the distal port of vessel 20, and/or proximal portion of catheter 28 are initially disposed, as shown in the drawing. The internal passageway extends from a distal end 56 to a proximal end 58 and, in the illustrated embodiment, has an intemal diameter that can, though need not, vary therebetween, e.g., as shown. 14 [0056] An inner diameter of the passageway 54, e.g., at the proximal end 58, is sized and shaped to inhibit movement of cover 52 in a distal-to-proximal direction (e.g., "upward" in the drawing) prior to breaking of seal 24, e.g., when vessel 20 contains its post-manufacture complement of PD buffer agent solution 22 (and/or other liquids, gasses or solids). More particularly, the inner diameter of that passageway at the proximal end 58 is smaller than an outer diameter of vessel 20 prior to breaking of seal 24 and any of (a) at least some reduction in that outer diameter (via expulsion of a post manufacture complement of solution 22 and/or other liquids, gasses or solids) from vessel 20 - and, preferably, at least 10% - 30% and, still more preferably, at least 30% 50% and, yet still more preferably, at least 50% - of such reduction, and/or (b) a decrease in resistance to such reduction. [0057] The passageway 54 can have a larger inner diameter at the distal end 56 than at the proximal end 58, as shown in the drawing. This can help prevent bending of catheter 28 (e.g., at the point it emerges from end 56) and possible premature breakage of seal 26 during transport, storage and initial use. [00581 Proximal-to-distal movement of cover 52 can also be constrained by a suitable stop - here, for example, a flange 57 at the proximal end of catheter 28 and/or distal end of vessel 20 sized larger than the inner diameter passageway 54 at its proximal end 58 but smaller than the inner diameter of that passageway at its distal end 56. As shown in the drawing, the flange permits distal-to-proximal movement of the cover 52, but inhibits its proximal-to-distal movement. [00591 In some embodiments of the invention, the cover 52, as well as the seals 24, 26, are colored differently to alert and remind the user of the proper order in which they are to be broken. Those skilled in the art will appreciate, of course, that coloration can be used in connection with other elements of the system 10, as well. [0060] Figures 7A - 7E depict use of cover 52 - initially protecting, then, permitting manipulation (and breaking) of seal 26. 15 [0061] Initially, as shown in FIG. 7A, seals 24, 26 are unbroken and compartment 20a contains its post-manufacture complement of buffer agent 22 (and/or other gasses, fluids, solids). Consistent with the discussion above, with the compartment 20 in this condition, the size differential between outer diameter of vessel 20 and inner diameter of passageway 54 inhibits distal-to-proximal (e.g., "upward") movement of cover 52. 10062] Referring to Figures 7B - 7C, the cover 52 remains in its initial position while the user breaks seal 24 (e.g., by bending the proximal end of vessel 20 relative to port 18) and compresses vessel 20 in order to expel buffer agent 22 for mixing with osmotic agent 14. [0063] Referring to Figure 7D, the user slides the cover in the distal-to-proximal direction over the vessel 20 and away from the seal 26, once the seal 24 has been broken and the outer diameter of vessel 20 has been reduced (or, at least, resistance to such reduction has been eliminated). With the cover 52 moved, the user can more readily manipulate the distal end of vessel 20 and/or the proximal end of catheter 28 in order to break seal 26. See Figure 7E. [00641 Those skilled in the art will appreciate that cover 52 and/or vessel 20 can have shapes other than those shown in Figures 6 and 7, yet, operate in the manner discussed above in connection therewith. 10065] Once such alternate configuration is depicted in Figures 8A - 8B, which shows in front- and side-views, respectively, a vessel 21 having the same function as element 20, above - albeit shaped with a central portion that is elongate in the transverse direction and that generally defines an oval shape, as shown. The vessel 21 of the illustrated embodiment is formed from halves (or other portions) of PVC, polyolefin or other medical-grade flexible or semi-rigid material that are glued, ultrasonically welded or otherwise fused along an edge 21A in the conventional manner known in the art (although the vessel can be formed - from a single portion or multiple portions - in other ways). 16 [0066] The cover 53 of Figures 8A - 8B functions in the same manner as cover 52, above, albeit it includes a slot 53A that skirts the edge 21A when the cover 53 is slid in the distal-to-proximal direction over the vessel 21 and away from the seal 26 (once the seal 24 has been broken and the volume of vessel 21 has been reduced). [00671 In comparison to the configuration of Figures 6 - 7, that shown in Figures 8A 8B requires more complete reduction in outer diameter (via expulsion of a post manufacture complement of solution 22 -and/or other liquids, gasses or solids) from vessel 21 in order to permit distal-to-proximal movement of cover 53. [00681 Referring to Figure 9, an alternate arrangement of the structures shown in Figure 1 can further insure that the seals are broken in an order that prevents fluid transfer to the catheter 28 (and any downstream equipment) prior to mixing of the PD agents. That drawing depicts container system 60 of the same general configuration as container system 10 of Figure 1 (as indicated by like reference numerals), albeit with the second seal (element 26 of Figure 1, element 62 of Figure 9) disposed within vessel 20 (e.g., rather than between the distal port of that vessel 20 and the catheter 28) so as to inhibit its manipulation and breaking until seal 24 is broken and fluid (or other) pressure within the vessel is reduced. 10069] As with seal 26, seal 62 is a frangible member that can be fabricated from nylon, plastic, or other medical-grade material, and that can be formed in the configurations discussed above in connection with seal 24 (and shown, for example, in Figure 5). Moreover, like seal 26, seal 62 can be disposed between the distal port of the vessel 20 and the catheter 28 and affixed to (and/or formed integrally with) an interior fluid transfer path of one or both of those. [00701 Preferably, however, seal 62 is disposed so as to inhibit it from being manipulated (and, more significantly, broken) when vessel 20 contains its post manufacture complement of PD buffer agent solution 22 (and/or other liquids, gasses or solids). In the embodiment of Figure 9, this is achieved by extending the seal 62 within the vessel 20, e.g., in the manner shown in Figure 9, so as to inhibit squeezing, twisting 17 or other manipulation of vessel 20, catheter 28 or otherwise from breaking seal 62 prior to breaking of seal 24 and (i) expulsion of at least some of its post-manufacturing complement of PD buffering agent 22 (and/or other liquids, gasses or solids) - and, preferably, expulsion of at least 10% - 30% and, still more preferably, at least 30% 50% and, yet still more preferably, at least 50% - of such agent (and/or other liquids, gasses or solids) and/or (ii) reduction of the turgidity or other pressure effected within the vessel 20 by that agent 22 (and/or other liquids, gasses or solids). Those skilled in the art will appreciate that configurations of seal 62 other than that shown in Figure 9 can be employed to this same end, as well. [0071] In some embodiments of the invention, the seals 24, 62, are colored differently to alert and remind the user of the proper order in which they are to be broken. Those skilled in the art will appreciate, of course, that coloration can be used in connection with other elements of the system 10, as well. [00721 Figures 1OA - 1OD depict utilization of PD system 60, including seal 62, in a manner according to the invention. [0073] Initially, as shown in FIG. 10A, seals 24, 26 are unbroken and compartment 20a contains its post-manufacture complement of buffer agent 22 (and/or other gasses, fluids, solids). Consistent with the discussion above, vessel 20 is under sufficient fluid (or other) pressure to inhibit squeezing, twisting or other manipulation of it sufficient to break seal 62. 100741 Referring to Figures 10B - 10C, seal 62 remains intact while the user breaks seal 24 (e.g., by bending the proximal end of vessel 20 relative to port 18) and compresses vessel 20 in order to expel buffer agent 22 for mixing with osmotic agent 14. [00751 Referring to Figure 1OD, the user bends or otherwise manipulates vessel 20 in order to break seal 62, once the seal 24 has been broken and the pressure within vessel 20 has been reduced. Once that seal 62 is broken, the mixed PD constituents can pass to catheter 28 (and/or other downstream equipment). 18 [0076] Systems as described above (and below) can be used to contain, mix and dispense a variety of constitutes. In one embodiment, the first compartment houses a PD osmotic agent at physiological use concentrations, i.e., substantially at concentrations at which that agent will be introduced into the patient's abdomen. Those concentrations for example of dextrose is about 1.5% - 4.25%, more preferably, about 2.0% - 4.0% and, still more preferably, about 2.0% - 3.0%. The PD osmotic agent is also at a physiologically low pH, i.e., a pH below that at which that agent will be introduced into the patient's abdomen, preferably, the pH is about 1.0 - 6.0 and, most preferably, about 1.0 - 3.0. [00771 Examples of suitable PD osmotic agents include, but are not limited to, sugars such as glucose (e.g., dextrose), poly(glucose) (i.e., a polymer made from repeating glucose residues, e.g., icodextrin, made from repeating dextrose units), fructose, dextrans, polyanions, and the like. Other PD osmotic agents may be non-sugar osmotic agent that function as an equivalent could be a viable substitute, such as small amino acids. 100781 In a preferred example, the PD osmotic agent is dextrose. The concentration of dextrose is about 1.5% - 4.25%, more preferably, about 2.0% - 4.0% and, still more preferably, about 2.0% - 3.0%. [0079] As used herein, "mEq/L" refers to the concentration of a particular PD solution component (solute) present in proportion to the amount of water present. More specifically, mEq/L refers to the number of milli-equivalents of solute per liter of water. Milli-equivalents per liter are calculated by multiplying the moles per liter of solute by the number of charged species (groups) per molecule of solute, which is then multiplied by a factor of 1,000. As an example, when 10 grams of citric acid are added to a liter of water, the citric acid is present at a concentration of 10 g/L. Anhydrous citric acid has a molecular weight of 192.12 g/mol; therefore, the number of moles per liter of citric acid, and consequently citrate anion (since there is one mole of citrate anion per mole of citric acid), is 10 g/L divided by 192.12 g/mol, which is 0.05 mol/L. Citrate anion has three negatively charged species in the form of carboxylate groups. Accordingly, the citrate concentration of 0.05 mol/L is multiplied by three and then by 1,000, in order to provide 19 a concentration of citrate in terms of mEq/L, which in the present example is 156 mEq/L of citrate anion. 10080] The same method of calculation can be used to determine the mEq/L of other agents such as lactate and dextrose. For example, 4.48 grams of sodium lactate (molecular weight of 112.1 gram/mol) per liter of water provides 40 mEq/L of sodium cations and 40 mEq/L of lactate anions. For dextrose, 42.5 grams of dextrose (molecular weight of 180.2 gram/mol) per liter of water provides 235.8 mEq/L of dextrose. [0081] The PD osmotic agent can contain electrolytes, in addition to the osmotic agent. Suitable electrolytes may include, for example, sodium, potassium, calcium and magnesium. In the PD solution composition, the preferred concentration range for sodium is from about 100 to about 132 mEq/L. The preferred concentration range for potassium is less than about 3.50 mEq/L. The preferred concentration range for calcium is less than about 2.50 mEq/L. The preferred concentration range for magnesium is less than about 1.50 mEq/L. [0082] The solution in the second container can be a concentrated agent and, specifically, in the illustrated embodiment (for example), a concentrated PD buffer solution. The term "concentrated" as used herein refers to an agent that is stronger than the chemically "Normal" concentration for that particular agent. The terms "Normal" and "Normal concentration" are used herein in the conventional sense of the chemical arts to refer to solutions having a concentration of 1 gram equivalent per liter of a solute. Thus, the Normal concentration of an ionic buffer agent is effectively equal to the molar concentration divided by the valence (the number of free or missing electrons) of the ion. For example, if a standard amount of a buffer agent is 60% (w/w), then 60mls of that buffer agent would be added to one liter of water in order to obtain Normal concentration for that agent. In order to achieve a 10-fold increase in concentration (e.g., as in some embodiments of the invention), only 6mls of the buffer is needed in one liter of solution. [0083] The concentrated agent and, more specifically, the concentrated buffer utilized in systems and methods according to the invention can be of any concentration that is 20 stronger than the chemically Normal concentration. For example, the concentrated buffer can be about 3-fold higher than Normal, 5-fold, 7-fold, 10-fold, 15-fold, and up to at least 50-fold higher than the Normal buffer. As those skilled in the art will appreciate, conventional, commercially available PD solutions, such as Deflex, by way of non limiting example, are of chemically "Normal" concentration. Thus, the concentrated PD buffer agents utilized in embodiments of the present invention are of manifold increases in concentration relative to the commercial norm. The advantage of using concentrated buffers is that they can be stored and sterilized in small volume containers. [0084] Alternatively, a Normal concentration of a buffer can be stored in a reduced volume. For example, a Normal amount of lactate buffer is typically 60% (w/w), i.e., 7.46 grams of sodium lactate buffer to one liter of solution. In this invention, the lactate buffer can be contained in the vessel 20 such that 7.46 grams of sodium lactate is contained in a vessel with a volumetric capacity of about 15mls. The advantage of the invention is that the buffers can be contained and sterilized in small volume containers. [0085] Examples of buffers include, but are not limited to, lactates, acetates, pyruvates, citrates, and the like. The lactate source may be any of lactic acid, sodium lactate, potassium lactate, calcium lactate, magnesium lactate, and the like. The acetate source may be any of acetic acid, sodium acetate, potassium acetate, calcium acetate, calcium acetate, magnesium acetate, and the like. Any or all of these chemicals are commercially available, in USP-grade if desired, from many chemical supply houses including, for example, Aldrich Chemical Co., Milwaukee Wis. [00861 A preferred example of a PD buffer solution is a concentrated lactate buffer solution comprising lactate at a concentration of 20 milliliter equivalent per liter (mEq/l) to about 60 mEq/1, preferably a concentration of about 30 mEq/l to about 50 mEq/l, and most preferably, a concentration of 40 mEq/1. In addition, the lactate buffer solution may further comprise a bicarbonate at a concentration of about 5 mEq/l to about 10 mEq/l. A preferred buffer comprises 30 - 35 mEq/L of sodium lactate and 10 - 5.0 mEq/L of sodium bicarbonate. 21 10087] The pH range of the PD osmotic agent solution is about 1.0 - 6.0 and, most preferably, between 1.0 - 3.0. The pH range of the PD buffer agent solution is about 8.0 to about 14.0, and, more preferably, a pH of about 9.0 to about 12 and, still more preferably, a pH of about 9.0 to about 10.0. [0088] The different PD components can be dissolved in water that is essentially pyrogen-free and that at least meets the purity requirements established by United States Pharmacopia (USP)-grade for PD solutions. [0089] A Normal PD solution typically comprises dextrose, sodium chloride, magnesium chloride and calcium chloride, sodium lactate, sodium hydroxide or hydrochloric acid added to adjust pH levels. The resulting pH of Normal PD solutions is about pH 5.0-6.0, which is less than optimum for blood, which has a pH of about 7.35 and 7.45. The Normal PD solutions often also contain GDPs. The seven commonly identified and published GDPs are acetaldehyde (AcA), 3-deoxglucosone (3-DG), 5 hydroxymethylfuraldehyde (5-HMF), glyoxal (Glx), methglyoxal (M-Glx), formaldehyde (FoA), and furaldehyde (FurA). [0090] The systems and methods of the present invention provide PD solutions with reduced GDPs, as well as with more physiologically optimal concentrations and pH's. To this end, the PD osmotic agent solution and PD buffer agent are sterilized separately, thus, reducing the formation of degradation products that would otherwise result from the reaction of those agents at sterilization (or other high temperatures). The pH of the separate solutions is adjusted, moreover, in the illustrated embodiment, to further minimize GDP production during sterilization. That is to say the pH range of the PD osmotic agent solution is about 1.0 - 6.0 and, more preferably, between 1.0 - 3.0, while the pH range of the PD buffer agent solution is about 8.0 to about 14.0, and, more preferably, a pH of about 9.0 to about 12 and, still more preferably, a pH of about 9.0 to about 10.0. After sterilization, the buffer agent can be added to the osmotic agent solution, producing a mixed PD solution with a pH in the physiologically optimal range of about 5.0 to about 8.0 and, more preferably, about 6.0 to about 7.0, and, most 22 preferably, about pH 7.2. As a result, systems and methods as described herein can provide PD solutions with an overall reduction in GDPs in the range of about 50% to about 80% compared with Normal PD solutions. [0091] With continued reference to the drawings, in order to keep the PD osmotic and buffer agents separate prior to sterilization, vessels 12 and 20 are manufactured, shipped and stored with seals 24 and 26 intact. Those containers may be pre-assembled, e.g., so that they are available for use by a patient, health care provider or manufacturer in the configuration shown in Figure 1 (not including attachment of catheter 28), or they may be manufactured, shipped and stored as kits, e.g., with the vessels 12 and 20 filled with their respective PD agents, but in unassembled form. The seal 24 may also be broken after sterilization at the time of manufacture. [0092] Regardless, the vessels 12, 20 are sterilized before the seal 24 is broken and, therefore, before their respective contents have had a chance to mix. This is shown in step 30 of Figure 2, which is a flow chart depicting a sequence for sterilizing and administering a PD solution according to the invention. This sterilization, which can be performed by the manufacturer and/or the health care provider, is achieved by steam sterilization or other such conventional methods known in the art. Sterilization times and temperatures/pressures are in accord with those appropriate for the separated agents contained in vessels 12, 20, not reduced times and temperatures/pressures which might otherwise be necessary to prevent GDP build-up in sterilization of the combined components. [0093] With continued reference to Figure 2, step 32, following sterilization, seal 24 is broken (e.g., by squeezing and/or twisting of vessel 20 and/or port 18) to permit mixing of the PD buffer agent with the PD osmotic agent. The agents can be mixed by shaking, kneading or other action on the vessels 12, 20. See step 34. Thereafter, the solution is ready for administration - pending, for example, warming or other steps necessary for patient comfort or well being. To this end, seal 26 is broken, e.g., by squeezing or twisting of the distal port of vessel 20 and/or its interface with catheter 28. See step 36. 23 Where a protective member (such as cover 52) is present, step 36 can further include the step of moving the protective member to allow access to, and breaking of, seal 26. Once seal 26 is broken, the PD solution can exit from the port into the catheter (and any downstream equipment) and, finally, to a patient. See step 38. [00941 Figure 3 depicts system 40 according to a further embodiment of the invention generally constructed and utilized (as indicated by like reference numerals) as system 10, described above. Differences in construction and utilization are discussed in the text that follows and are evident in the drawings. [0095] Vessel 42 of system 40 comprises compartment 42a for, by way of example, PD buffer agent solution 22, as generally described above. Compartment 42a and vessel 42 are collapsible - i.e., they are configured such that force applied thereto, e.g., by a patient, health care provider or other, causes the volume of compartment 42a to at least temporarily decrease so as to expel fluid contained therein. To this end, in the illustrated embodiment, vessel 42 has fan-fold walls, or bellows, along an axis aligned with a direction of fluid expulsion - here, along the fluid transfer path between vessel 42 and vessel 12. Other embodiments may utilize walls of other construction to facilitate collapse along the same or other axes. Regardless, those walls are preferably sufficiently durable to prevent leakage, e.g., so that after fluid expulsion, the compartment 42a can form part of a fluid transfer path between the compartment 12a and the patient's peritoneal cavity. [0096] Illustrated vessel 42 may be fabricated from PVC, polyolefin, polypropylene, rubber and/or other medical grade materials suitable for forming a collapsible container as described herein. As with vessel 20 (Figure 1), above, vessel 42 can be formed, e.g., by blow molding, dip-forming, or otherwise. [0097] As above, seal 24 is adapted to prevent fluid transfer (or other contact) between the PD agents contained in the compartments during manufacture, transport, storage and sterilization of system 40, yet, to permit such fluid transfer upon squeezing, twisting or 24 other manipulation of vessel 42 and/or port 18 by a patient, health care provider, or manufacturer, e.g., following sterilization. [0098] Like seal 26 of systems 10 and 50 (Figures 1 and 6), seal 44 of system 40 is adapted to prevent fluid transfer to the catheter 28 (and any downstream equipment) prior to sterilization and mixing of the PD agents. However, unlike seal 26, seal 44 (which, too, is disposed at the distal port of the vessel 42) is broken by a further member 46 that is disposed in compartment 42a and that pierces, cuts or otherwise breaks seal 44 when the vessel 42 and compartment 42a have been compressed sufficiently to insure expulsion of the fluid 22 into compartment 12a. [00991 Seal 44 can be formed of PVC, polyolefin, polypropylene, rubber and/or other medical grade materials suitable for preventing fluid transfer, e.g., during manufacture, shipping, storage, sterilization, but susceptible to being broken, e.g., by member 46 as described here, following sterilization and mixing of the agents 14, 22. 1001001 In the illustrated embodiment, member 46 is depicted as a bayonet, though in other embodiments it may be of another shape. It can be constructed of the same materials utilized, e.g., for element 24. Member 46 can be formed near the proximal port of vessel 42 (e.g., opposite seal 24) and affixed to (and/or formed integrally with) an interior fluid-transfer path between the vessels, as shown, though in other embodiments it may be disposed elsewhere, e.g., preferably so that it breaks member 44 upon sufficient compression of vessel 42 and compartment 42a. To this end, in the illustration, member 46 is of such length that its tip (for piercing seal 44) is disposed approximately 40% from the proximal end of compartment 42a. In other embodiments, the member may be of other lengths, depending upon the compressibility of compartment 42a and on the desired degree of expulsion of fluid 22 from compartment 42a to compartment 12a prior to piercing of seal 44. 100101] As above, the container system 40 permits the PD osmotic agent solution and PD buffer agent to be sterilized separately, thus, reducing the formation of degradation products that would otherwise result from the reaction of the osmotic agent with the 25 buffer agent at high temperature. To this end, the vessels 12 and 42 are manufactured, shipped and stored with seals 24 and 44 intact. Those containers may be pre-assembled, e.g., so that they are available for use by a patient or health care provider in the configuration shown in Figure 3 (not including attachment of catheter 28), or they may be manufactured, shipped and stored as kits, e.g., with the vessels 12 and 42 filled with their respective PD agents, but in unassembled form. As noted above, the seal 24 may also be broken after sterilization at the time of manufacture. [00102] Regardless, as above, the vessels 12, 42 are sterilized before the seal 24 is broken and, therefore, before their respective contents have had a chance to mix. Such sterilization may be accomplished as described above, e.g., in connection with step 30 of Figure 2. 1001031 Following sterilization, a factory worker, health care provider, a patient, or other, breaks seal 24 (e.g., by squeezing and/or twisting of vessel 42 and/or port 18); see, Figure 4A. He or she then compresses (or collapses) vessel 42 to expel agent 22 from compartment 42a into compartment 12a, thereby, facilitating its mixing with agent 14; see, Figure 4B. [001041 The factory worker, health care provider, patient or other continues compressing (or collapsing) vessel 42 until the tip of member 46 contacts and breaks seal 44; see, Figure 4C. This allows the PD solution to exit from the port into the catheter (and any downstream equipment) and, finally, to a patient. [00105] It will be appreciated that systems and methods according to the invention are applicable to a range of peritoneal dialysis applications and other medical applications in which at least one agent (or combination of agents) requires separate sterilization prior to combination with another agent (or combination thereof). According to conventional practice, such agents are sometimes combined prior to sterilization or, if combined after sterilization, for example, by injecting one of them into a medication port of a container that holds the other agent. The former increases risk of degradation of the agents. The latter increases the risk to health care personnel and/or the patient. Systems and methods 26 of the invention avoid these risks and other shortcomings of the prior art by allowing the agent(s) to be sterilized separately and, then, combined, e.g., without the use of needles or other mechanisms that are expensive, unwieldy, and/or place the agent(s), health care personnel and/or patients at risk. [00106] Another advantage of systems and methods of the invention, is that depending on the requirements of the agent that will be added to the medical solution, the second vessel can be coated with materials that maintain the shelf life and/or stability of the agent or additive. Examples of additives that can be administered with this invention are amino acids, proteins, heparin, and vitamins. [00107] As evident in the examples below, systems and method of the invention have been used to prepare PD solutions with reduced GDPs and a more physiologically optimal pH levels. Table 1- Samples Preparation Label pH mL of 1.0 M WFI Glucose CaCl2*2H 2 0 MgC12*2H 2 0 NaCl Adjusted HCI per Liter To of Solution 13.0 1.37 2 4.0 0.37 80L 3,400 g 14.72 g 4.072 g 430.16 g 3 1 4.5 0.27 4 5.2 0.18 Buffer Straight Lactate Syrup up to I OOOg in a 1-Liter Bag [001081 Table 1 shows sample preparations with the PD solutions constituents at different pH values. The sample labeled "Buffer" has concentrated lactate buffer solution added to it. [00109] Table 2 shows the results of HPLC analysis of the samples to examine the various degradation products. The seven degradation products that were analyzed are as follows: acetaldehyde (AcA), 3-deoxglucosone (3-DG), 5-hydroxymethylfuraldehyde (5 HMF), glyoxal (Gix), methglyoxal (M-Gix), formaldehyde (FoA), and furaldehyde (FurA). The data from Table 2 shows that GDPs formation around pH 3.0 is the lowest 27 among the solutions prepared and the Normal/commercial products. Sodium lactate as a buffer agent in PD solutions results in acetaldehyde (AcA) formation (See column entitled "pH" in Table 2). The results also demonstrate the effectiveness of reducing AcA formation by separating sodium lactate from the rest of the PD solution for steam sterilization. By adding sodium lactate buffer solution to the main PD solution at pH 3.0 (group 1), the resulting mixed PD solution has a pH of 5.2, which is the same as Normal PD solutions (referred to as "Delflex" in Table 2), but with significantly reduced GDPs than Normal PD solutions. This data demonstrates that reduced GDPs are obtained under current formulation and pH levels using the system of the invention. The data also shows that PD formulations with reduced GDPs are obtained at a physiological of around pH 7.0 (Table 4). Thus, the systems and methods of the invention provide significantly reduce GDPs in PD solutions that contain dextrose as an osmotic agent and sodium lactate as buffer. Table 2: GDPs results from HPLC Analysis Label pH Cl 3-DG AcA 5-HMF Gix M-Gix FoA FurA S(mEq/L) (Amol/L) (pmon/) (pmol/L (smol/L) (pmol/L (pmol/L) (pLmol/L) Buffer 8.1 - ND 15 ND ND ND 3 ND 1-A 3.0 - 37 ND ND ND 7 ND ND 1-B 3.0 - 119 ND 18 ND 8 ND ND 1-C 3.0 - 115 2 23 ND 7 ND ND 1-D 3.0 - 119 1 22 ND 9 ND ND 2-A 4.0 - 65 ND ND ND 9 ND ND 2-B 4.0 - 299 ND 39 ND 8 1 ND 2-C 4.0 - 299 ND 38 ND 13 ND ND 2-D 4.0 - 248 ND 34 0.2 8 ND ND 3-A 4.7 - 91 ND ND ND 9 ND ND 3-B 4.4 - 526 0.1 45 0.5 9 ND ND 3-C 4.4 - 532 ND 46 ND 9 ND ND 3-D 4.4 - 513 ND 46 0.7 14 ND ND 4-A 5.5 - 112 ND ND 0.2 7 ND ND 4-B 4.5 - 699 ND 54 0.7 8 ND ND 4-C 4.5 - 653 ND 51 1.6 11 ND ND 4-D 4.5 - 649 0.2 44 0.6 8 3 ND 1-A (buffered) 5.3 95.5 45 6 ND ND 9 ND ND 1-B (buffered) 5.3 95.6 131 16 26 ND 8 ND ND 1-C (buffered) 5.3 94.8 128 15 25 ND 9 ND ND I-D (buffered) 5.3 95.4 134 15 25 ND 10 ND ND 28 Table 2: GDPs results from HPLC Analysis Label pH C1 3-DG AcA 5-HMF Gix M-Gix FoA FurA (m~/L) (pmo/L) (pmol/L) (pmol/L) (pmo/L) (pimol/L) (pmol/L) (4mol/L) 2-A (buffered) 6.1 95.7 90 6 ND ND 10 ND ND 2-B (buffered) 6.1 95.2 316 20 39 ND 7 ND ND 2-C (buffered) 6.1 95.3 307 19 40 ND 11 ND ND 2-D (buffered) 6.1 95.0 303 2 35 ND 9 ND ND 3-A (buffered) 6.4 95.1 95 10 ND 0.5 11 ND ND 3-B (buffered) 6.3 95.3 570 18 46 0.3 7 ND ND 3-C (buffered) 6.3 95.1 537 3 45 0.5 13 ND ND 3-D (buffered) 6.3 95.4 560 20 45 ND 7 ND ND 4-A (buffered) 6.6 95.4 121 7 ND 0.4 10 ND ND 4-B (buffered) 6.3 95.0 650 16 52 ND 9 ND ND 4-C (buffered) 6.3 95.8 668 3 50 1.7 13 ND ND 4-D (buffered) 6.3 96.2 685 19 50 0.7 10 4 ND 4.25% Delfex 5.2 95 348 323 38 4 25 12 ND Balce 7.0 - 175 49 12 4 14 4 ND [001101 In some embodiments of the invention, the PD solutions are produced with reduced GDPs by using a buffer solution with a bicarbonate (e.g., sodium bicarbonate). The first vessel 12 contains a PD osmotic agent solution with dextrose, sodium chloride, magnesium chloride, calcium chloride, and hydrochloric acid to adjust the pH to 3.0. In one example, the vessel 20 is filled with a concentrated PD lactate buffer solution with lactate only, adjusted to a pH of about 10.0 to about 12.0. Sodium hydroxide can be used to adjust the pH of the lactate buffer. A suitable concentration of lactate buffer is 40 mEq/1 lactate buffer. In another example, the second vessel 20 is filled with a concentrated PD lactate buffer solution comprising a bicarbonate buffer, adjusted to a pH of about 8.0 to about 9.0. Suitable concentrations are, 37 mEq/1 lactate buffer with 3 mEq/l bicarbonate buffer. [001111 The results obtained by using the methods and compositions of the present invention using buffer solutions are summarized in Tables 3 and 4. Table 3: Formulation Comparison as Delivered to a Patient FORMULATION, LowCA PVC Product Bubble I Soln | lactate | bicarb I total Na Cl Mg Dextrose 29 Design with (mini- or buffer Bubble bag) NaOH Vol pH [mEq/1] [mEq/1] [mEq/l] [mEq/l) [mEq/1] [mEq/1] [%) [m/11 I Neutral pH PD 6.7 7.4 38.04 1.06 of 40 132 95 0.5 1.50% solution, NaOH 4.25% lactate/NaOH in bubble 2 Neutral pH PD 10 7.4 37 3 of 40 132 95 0.5 1.50% solution; sodium 4.25% lactate/bicarb biacarb buffer in bubble onate 3 Delflex (current NA 5.3 40 0 40 132 95 0.5 1.50% Product as 4.25% reference) 4 Balance (as NA 7.0 40 0 40 134 101.5 1.0 1.50% reference only) 4.25% [00112] Table 4 shows the results of an average of 3 samples. The concentrated PD lactate buffer was mixed with PVC bag contents containing the PD osmotic agent solution post sterilization. After combining the PD lactate buffer with the PD osmotic agent buffer, the resulting PD solution was examined and had a significantly reduced amount of AcA compared with the existing commercially available PD solutions referred to as "Deflex" and "Balance." Also, by maintaining the pH of the PD osmotic solution at 3.0 and then by adding concentrated PD lactate buffer at a pH of 10.0 to 12.0, the final pH of the resulting PD solution was at a more physiologically optimal pH of 7.2 (Table 4). Table 4: GDP Results GDPs Delflex Balance pH 3 pH 3 (p mole/L) (4.25%) (4.25%) Dextrose-side Dextrose-side pH (Final, Mixed) 5.2 6.9 5.3 7.1 Buffer Lactate Lac/bic Lactate only Lactate/NaOH 3-DG 348 175 131 106 AcA 323 49 15 13 5-HMF 38 12 25 28 Glx 4 4 ND 1 M-Glx 25 14 9 8 FoA 12 2 ND 1 Reduction Ratio 0% 65% 76% 80% (%) 30 100113] Collectively, these demonstrate that by sterilizing a concentrated PD lactate buffer separately from the PD osmotic agent, and then adding the concentrated PD lactate buffer just before use, the amount of GDPs are significantly reduced. In addition, the resulting PD solution has a near neutral pH of about 7.4 optimized for peritoneal dialysis. Furthermore, the concentrated PD lactate buffer may also contain bicarbonate. When the PD lactate-bicarbonate buffer was added to the PD osmotic agent solution, the resulting PD solution also had significantly reduced GDPs, and a near neutral pH of about 7.4. 100114] Described above are systems and method meeting the desired objects, among others. It will be appreciated that the embodiments illustrated and described herein are merely examples of the invention and that other embodiments, incorporating changes thereto, fall within the scope of the invention. Thus, by way of non-limiting example, it will be appreciated that although the first and second PD agent-containing compartments are shown as formed in separate vessels (e.g., bag 12 and tube 20), in other embodiments those compartments may be formed in a single vessel (e.g., a dual compartment bag). Moreover, it will be appreciated that, by way of further non-limiting example, although the text above describes breaking of the temporary seals (e.g., seals 24, 26, 44, 62) by manual manipulation, e.g., of the vessel 20, other embodiments may be adapted for breaking of those seals by automated apparatus (e.g., manipulation of the vessel or mini tube 20 by robotic equipment or otherwise). In this context, what we claim is: 31 H:\izccatenvoventNR~ortblDCCUZC0599g71_I DOC40M/2014 -31A 100115] The reference in this specification to any prior publication (or information derived from it), or to any matter which is known, is not, and should not be taken as, an acknowledgement or admission or any form of suggestion that that prior publication (or information derived from it) or known matter forms part of the common general knowledge in the field of endeavour to which this specification relates. 1001161 Throughout this specification and the claims which follow, unless the context requires otherwise, the word "comprise", and variations such as "comprises" or "comprising", will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not the exclusion of any other integer or step or group of integers or steps.
Claims (21)
1. A container system for peritoneal dialysis (PD) solutions, comprising: a first compartment containing a first PD agent, 5 a second compartment containing a second PD agent, the second compartment being in any of direct and indirect fluid coupling with the first compartment, an outlet fluid pathway coupled to the second compartment being in any of direct and indirect fluid coupling with an external environment to the container system, and a first seal that prevents fluid transfer between the first compartment and the second 10 compartment, a second seal that prevents fluid transfer to the outlet fluid pathway, a protective structure that is not integral with said seals and that is configured to inhibit breaking of the second seal prior to breaking of the first seal. 15
2. The container system of claim 1, wherein the protective structure is slideably disposed on said container system to move from a first position to a second position, wherein breaking of the second seal is inhibited when the protective structure is in the first position, and breaking of the second seal is not inhibited when the protective structure is in the second position, and further optionally, wherein the protective structure comprises a cover that is 20 slideably disposed on the container system.
3. The container system of claim 1, wherein the second seal is disposed such that the second seal is inhibited from manipulation until at least a portion of the second PD agent is expelled to the first compartment. 25
4. The container system of claim 1, wherein the first and second seals comprise frangible seals, and wherein the second frangible seal is disposed within the second compartment, and optionally, wherein the container system further comprises a piercing member disposed within the second compartment, the second frangible seal and the piercing member being arranged 30 such that compression of the second compartment results in breaking of the second seal by the piercing member. H:\jzc\ntenvoven\NRPortbl\DCC\JZC\7056285_ .DOC-2/12/2014 -33 5. The container system of claim 6, wherein a presence of a quantity of buffer agent in the second compartment prior to breaking of the first frangible seal inhibits compression of the second compartment.
5
6. The container system of claim 6, wherein a vessel in which the second compartment is formed is collapsible along an axis substantially aligned with a direction of fluid flow between the first and second compartments, and optionally, wherein the vessel in which the second compartment is formed has walls that are fan-folded along at least a portion of a length 10 thereof.
7. The system of claim 1 or claim 3, wherein in the first position the cover is disposed in surrounding relation to at least one of i. the second seal, and 15 ii. one or more other structures of the container system in vicinity of the second seal that a patient, health care provider, or other manipulates in order to break that second seal.
8. The system of claim 7, wherein the cover has an inner passageway sized to slide over at least a portion of a vessel forming the second compartment, and optionally, wherein, prior 20 to breaking of the first seal, movement of the cover from the first position to the second position is restrained by the vessel forming the second compartment, and further optionally, wherein the vessel forming the second compartment has a first outer diameter prior to breaking of the first seal and a lesser outer diameter after breaking of the first seal, and further optionally, wherein the cover has an internal diameter that is (i) smaller than the first outer 25 diameter and (ii) sized to slide over the vessel forming the second compartment when it has the lesser outer diameter, and further optionally, wherein the second vessel is configured in the shape of a miniature bulb, and further optionally, wherein the first vessel comprises an infusion bag or infusion bottle. 30
9. The container system of any of claims 1, 3, or 4, wherein the second vessel is adapted for manipulation by a patient, health care provider, or other, to facilitate breaking at least the H:\jzc\ ntenvoven\NRPortbl\DCC\JZC\7056285_L.DOC-2/12/2014 - 34 second frangible seal, and optionally, wherein the second vessel comprises rubber, polyolefin, polypropylene, and/or other medical grade material suitable for squeezing, twisting or other manipulation by the patient, health care provider, or other, to facilitate breaking any of the first and second frangible seals. 5
10. The container system of claim 9, wherein the presence of the quantity of buffer agent in the second compartment prior to breaking of the first seal inhibits any of squeezing, twisting or other manipulation of the second vessel for purposes of breaking of the second seal. 10
11. A container system for peritoneal dialysis (PD) solutions, comprising: A. a first compartment containing a first PD agent, B. a second compartment containing a second PD agent, the second compartment being in any of direct and indirect fluid coupling with the first compartment, a vessel in which the second compartment is formed expelling second PD agent upon application 15 of force, C. a first frangible seal that prevents fluid transfer between the first compartment and, the second compartment, D. a second frangible seal that prevents fluid transfer between the second compartment and an outlet fluid pathway of the container system, 20 E. a protective member slideably disposed on the container system to move from a first position, wherein it inhibits breaking of the second frangible seal, to a second position, wherein it does not inhibit breaking of the second frangible seal, wherein the protective member has a slot or other opening sized to slide over at least a portion of the vessel in which the second compartment is formed and wherein presence of a 25 quantity of second PD agent in the second compartment inhibits the slot or other opening from sliding over at least the portion of the vessel forming the second compartment.
12. The container system of claim 11, wherein the slot or other opening is arranged to slide 30 over at least the portion of the vessel in which the second compartment is formed only after a quantity of second PD agent originally contained in that compartment has been expelled H:\jzc\lnenvoven\NRPortbl\DCC\JZC\7056285_1IDOC-2/12/2014 -35 therefrom, and optionally, only after at least 10%-30% of a quantity of second PD agent originally contained in that compartment has been expelled therefrom, and further optionally, only after at least 30%-50% of a quantity of second PD agent originally contained in that compartment has been expelled therefrom. 5
13. The container system of claim 11, wherein optionally the first compartment is formed in a vessel that comprises an infusion bag or infusion bottle, further optionally the vessel in which the second compartment is formed is adapted for manipulation by a patient, health care provider, or other, to facilitate folding thereof, further optionally any of the first and second 10 frangible seals is adapted for manipulation by a patient, health care provider, or other, to facilitate breaking thereof, and further optionally the first PD agent is a PD osmotic agent and the second PD agent is a PD buffer agent.
14. The container system of claim 11, wherein two or more of the first seal, the protective 15 member, and second seal bear visual indicia of an order in which they are to be manipulated by a patient, health care provider or other, and optionally, wherein the visual indicia is coloring, and further optionally, wherein the first seal, protective member and second seal are colored differently from one another. 20
15. A method of dispensing a peritoneal dialysis solution from a peritoneal dialysis (PD) container system, comprising the steps of: A. breaking a first seal in a PD container system of the type comprising a first compartment containing a first PD agent and a second compartment containing a second PD agent, 25 B. sliding a protective member from a first position, wherein it inhibits breaking of a second seal, to a second position, and C. breaking the second seal to allow fluid to exit the container system via an outlet, wherein a presence of a quantity of fluid in the second compartment prior to breaking of the first seal inhibits sliding of the protective member. 30
16. The method of claim 15, further comprising: H:\jzc\lnteovcn\NRPortb\DCC\JZC\7056285_I.DOC-2/12/2014 - 36 preventing fluid transfer between the first compartment and the second compartment before breaking the first seal, preventing fluid transfer between the second compartment and the outlet before breaking the second seal, and 5 inhibiting breakage of the second seal with the protective member prior to breaking of the first seal.
17. The method of claim 15, wherein the protective member is a cover that is slideably disposed on the PD container system, and wherein the cover at the second position does not 10 inhibit breaking of the second seal, and optionally, further comprising disposing the cover in the first position in surrounding relation to at least one of i. the second seal, and ii. one or more other structures of the container system in vicinity of the second seal that a patient, health care provider, or other manipulates in order to break that second seal. 15
18. The method of claim 17, wherein sliding the protective member comprises sliding an inner passageway of the cover over at least a portion of a vessel forming the second compartment, and optionally, further comprising restraining movement of the cover from the first position to the second position with the vessel forming the second compartment prior to 20 breaking of the first seal, and further optionally, wherein breaking the first seal includes decreasing an outer diameter of the second compartment, and further optionally, wherein the cover has an internal diameter that is (i) smaller than an original outer diameter of the second compartment and (ii) sized to slide over the vessel forming the second compartment after decreasing the outer diameter of the second compartment. 25
19. The method of any of claims 15-18, wherein optionally the first PD agent is a PD osmotic agent and the second PD agent is a PD buffer agent and further optionally the first and second seals are frangible. 30
20. A vessel comprising: a first compartment containing a first agent of a solution, H:\jzc\ntenvoven\NRPortbi\DCC\JZC\7056285_ .DOC-2/T12/2014 -37 a second compartment containing a second agent of the solution, the second compartment being in any of direct and indirect fluid coupling with the first compartment, at least one of the first and second compartments being adapted to be manipulated at least partially independently of the other of said first and second compartments, 5 a first seal preventing fluid transfer between the first compartment and the second compartment, and a second seal preventing fluid transfer between the second compartment and an outlet fluid pathway of the system, a protective structure that is not integral with said seals and that is coupled to the vessel 10 to inhibit breaking of the second seal prior to breaking of the first seal.
21. The vessel of claim 20, wherein the protective structure is slideably disposed on the system and adapted to move from a first position, wherein the protective structure inhibits breaking of the second seal, to a second position, wherein the protective structure does not 15 inhibit breaking of the second seal, and optionally, wherein, prior to breaking of the first seal, movement of the protective structure from the first position to the second position is restrained by the second compartment, and further optionally, wherein presence of a quantity of fluid in the second compartment inhibits the protective structure from sliding to the second position. 20
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU2012201932A AU2012201932B2 (en) | 2005-01-28 | 2012-04-03 | Systems and methods for delivery of peritoneal dialysis (PD) solutions |
Applications Claiming Priority (3)
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US6277815B1 (en) * | 1997-10-31 | 2001-08-21 | Fresenius Medical Care Deutschland Gmbh | Solution for peritoneal dialysis |
US20030199846A1 (en) * | 1998-09-15 | 2003-10-23 | Baxter International Inc. | Sliding reconstitution device for a diluent container |
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