JP2007029705A - Device for planning combined use of peritoneal dialysis and hemodialysis - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a device for planning combined use of peritoneal dialysis and hemodialysis, having high convenience by always taking input data and data in the process of operation including arithmetic result as an examination object. <P>SOLUTION: A database storage part 51 stores an input item for operation at a computing part 60, an operation item, and a data group including each datum related to simulation results based upon the arithmetic result (to be concrete, patient information, remaining renal function, peritoneal dialysis, hemodialysis, the computed indicator and clinical test data). The contents of the database storage part 51 are suitably selected according to a user's request by a control means 80, and displayed on a display by a select data display part 703 by an output means 70. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a planning method for peritoneal dialysis and hemodialysis, and a combined planning apparatus using the same.

Currently, there are about 200,000 chronic renal failure patients in Japan. Ninety-two to nine percent of patients receive hemodialysis and the remaining seven to eight percent receive artificial dialysis therapy by peritoneal dialysis.
Dialysis refers to various solutes accumulated in the body by metabolic activity (urea (U), creatinine as uremic toxins) by sieving with a molecular size through a membrane and removing molecules by a concentration gradient. (Cr) etc.}, electrolytes (Ca ²⁺ , Cl ⁻ , Na ⁺ , K ⁺ ), excess water, etc. were transferred from the body fluid to the dialysate, and then the dialysate was drained and the patient decreased It assists kidney function. There is a distinction between hemodialysis (HD; HemoDialysis) and peritoneal dialysis (PD; Peritoneal Dialysis) depending on the method of filtering blood with dialysate or introducing dialysate into the abdominal cavity. Conventionally, this method of dialysis has been applied to patients.

Here, in recent years, peritoneal dialysis and hemodialysis (PD + HD) combination therapy has been gradually applied in Japan since the 1990s due to health insurance. In this combination therapy, PD is performed for the purpose of reducing the burden on the patient and utilizing the residual kidney function as much as possible, and HD is supplementarily used in combination with this.
Recently, as in Patent Document 1, a PD system that simulates a patient's peritoneal function state with a computer has been developed. In this PD system, Pyle-Popovich's mathematical model, known as a macroscopic model of PD, is obtained from data such as each solute concentration and water removal amount obtained from the peritoneal equilibration test (PET; 1987). The peritoneal functions such as solute removal ability and water removal ability can be examined by calculating.

Thereby, for example, a weekly PD schedule can be planned. In addition, a PD + HD combined planning method and apparatus are provided that can perform PD + HD combined planning well by using prescription examination parameters common to both PD and HD.
JP 2000-140100 A JP-A-2005-27886

However, in planning for combination therapy, it is necessary to examine not only the calculation results in the apparatus but also a wide range of data.
For example, the strength of dialysis needs to be examined by combining a relatively large number of parameters such as changes in the patient's weight, sex, etc. as needed in addition to conditions such as the type and number of dialysis methods and the osmotic pressure of the dialysate used.

However, in the conventional planning apparatus, only the calculation result is displayed on the display, and it is difficult to perform a study with a flexible and wide range of parameters in view.
Thus, there is still room for improvement in the current PD + HD combination planning.
The present invention has been made in view of the above-described problems, and peritoneal dialysis and blood that enable highly convenient dialysis planning by considering input data and mid-calculation data as needed, including calculation results. It is to provide a dialysis combined planning device.

  In order to solve the above-described problems, the present invention provides a peritoneal dialysis and hemodialysis combined planning apparatus including a calculation unit, an output unit, and a storage unit, and a control unit for controlling the calculation unit, and the storage unit includes a calculation unit. A data group including input items for calculation, calculation items, and each data related to a simulation result based on the calculation result is stored, and the control unit receives any data in the data group in response to a request from a user. It was set as the structure made to output to an output part.

Here, the data group stored in the storage unit may include patient information, residual kidney function, peritoneal dialysis, hemodialysis, the calculated index, and clinical test data.
Further, the control unit may display the same or a plurality of patients on the output unit in time series with respect to the data of the same item selected by the user.
In addition, the control unit can cause the output unit to display the correlation of a plurality of data selected by the user.

In the present invention having the above configuration, various data groups used as temporary data in the conventional combined planning apparatus are stored in the storage unit as a database.
Thereby, a user such as a doctor can appropriately call and display any of the important dialysis index test items stored in the storage unit as well as the calculation result displayed on the output unit such as a display. . This eliminates the need for planning solely on the calculation results, and allows flexible and extensive studies over time while referring to and confirming original data such as patient physical information and various parameter values during the calculation. Thus, reliable planning can be performed.

The number of items that the user can call from the database is theoretically infinite. However, in actuality, the input data, calculation data, simulation results, etc. handled by the device are specified for each item in advance, and the program for operating the control unit It can be realized by including it.

1． Embodiment 1
Hereinafter, the PD + HD combined planning apparatus of the first embodiment applies the Pyle-Popovich model, which is a macroscopic PD model, and the Three Pore Theory model, which is a microscopic PD model, and uses the calculation results. is doing.

  That is, after performing a rough calculation from the Pyle-Popovich model, the calculation result is used to solve the Three Pore Theory model, thereby calculating the cell pore permeability coefficient LPSc and the overall permeability coefficient LPS. In addition, by acquiring the ratio LPSc / LPS and using the ratio LPSc / LPS and the amount of water removed as a test index for peritoneal function, it becomes possible to perform a more detailed peritoneal function test than the Pyle-Popovich model. ing.

Here, as a previous step, each of the mathematical models will be described.

1-1. About the Mathematical Model of PD FIG. 1 is a cross-sectional view of the peritoneum that briefly shows the Pyle-Popovich model. As shown by the direction of the arrow in this figure, solute transfer from the body fluid side to the dialysate side through the peritoneum, which is assumed to be a homogeneous membrane, is the diffusion of solute molecules into the dialysate and convection (mass transfer by moisture transfer). That is, it is shown as the sum of convective transport and regurgitation due to lymphatic absorption under the peritoneum. This mathematical model can be expressed by (1-1) to (1-8) of the following formula 1.

  Thus, the Pyle-Popovich model is based on the material balance equation of each solute in body fluid and the material balance equation on the dialysate side. The terms calculated for each patient in the Pyle-Popovich model are an overall mass transfer-area coefficient (KA) (MTAC), a repulsion coefficient σ, and water removal parameters a1, a2, and a3. Of these, the water removal parameters a1, a2, and a3 are particularly important in evaluating the ability of the patient to remove excess water from the body (this is called water removal ability).

The body fluid volume (VB) can be calculated using an empirical formula created by Hume and Weyers (Hume et al., 1971). This empirical formula is expressed as follows by gender, height [HT (cm)] and weight [WT (Kg)] of the patient.

Male: VB (0) = -14.249 + 0.19678HT + 0. 29571WT
Female: VB (0) = -9.9260 + 0. 17003HT + 0. 21371WT

The dewatering parameters a1, a2, and a3 can be obtained by curve fitting of the drainage amount curve. For the estimation of each value, a modified Powell method that minimizes the error between the clinical data and the calculated value is used. it can.

On the other hand, in contrast to the Pyle-Popovich model, when the peritoneal function is viewed microscopically, it is considered that the permeability of each capillary in the abdominal cavity is partially varied. The peritoneal dialysis model based on this is the Three Pore Theory model.
In Three Pore Theory, it is considered that the capillary has three kinds of pores (Large Pore, Small Pore, Cell Pore) having different sizes. In this case, due to the difference in size of each pore, the type and amount of solute that can permeate through pores of a specific size are sieved. For the same reason, the contributions of pores of various sizes for water removal are also different. Therefore, Three Pore Theory calculates the water transfer rate (filtration rate) for each of the large, medium, and small pores, and determines the total permeate flow rate (total ultrafiltration rate). This mathematical model can be expressed by Equations (2-1) to (2-4), Equation 3, Equation 4, and Equation 5 below.

  A0 / Δx and LPSc appearing in Equations (5-1) and (5-2) are unknown parameters specific to individual patients. Several methods, such as the modified Powell method, have been proposed for calculating this as an approximate solution using the Three Pore Theory model. In this calculation method, at least two types of dialysis fluids having different osmotic pressures are collected and the calculation is performed using this modified Powell method. However, the calculation may be performed using other methods. . The Pyle-Popovich model can be analyzed with two data groups, but the Three Pore Theory model is calculated repeatedly using the modified Powell method, and requires more data groups when calculating A0 / Δx and LPSc. is there.

Cell Pore is considered to be an aquaporin (H ₂ O channel) and is considered to be an important pore having a contribution of 40% of the total water removal amount. Aquaporin is irreversible and cannot be restored once broken, so it has a very important correlation with the patient's ability to remove water. In dialysis therapy, the key point is how to maintain aquaporins without inactivating them in maintaining peritoneal function.
A group of LPS terms (LPSc, LPSs, LPSL) is called the hydraulic conductivity, and LPS is called the overall hydraulic conductivity. A large value indicates a high water removal capacity. It can be said that especially the value of LPSc is high, the patient's water removal ability is maintained relatively well. Therefore, when examining the patient's peritoneal function using the Three Pore Theory, it is very important to examine the permeability coefficient value.

In Three Pore Theory, by updating the concentration gradient of each solute at that time, a new osmotic pressure at that time is obtained, and the movement speed of water is also newly calculated. Then, by calculating for each patient together with the total area value of the peritoneum, it is possible to construct a detailed model of solute movement and water removal.
Here, in the PD + HD combined planning apparatus according to the first embodiment, the water permeability coefficient ratio LPSc / LPS of the aquaporin with respect to the overall permeability coefficient is obtained from the Three Pore Theory model. The LPSc / LPS is a ratio showing the activity ability of aquaporins, which is said to be responsible for about 40% of the water removal ability in the pores existing in the capillaries of the peritoneum. The larger this ratio, the more the water removal ability of the peritoneum. Indicates high. By expressing the correlation between this LPSc / LPS and MTACUn / c and the amount of water removed, a detailed diagnosis of peritoneal function becomes possible.

Furthermore, in Embodiment 1, in the peritoneal function test method using the Three Pore Theory model, LPSc and LPS are calculated, the ratio LPSc / LPS is obtained, and the LPSc / LPS is used as a test index for peritoneal function. In addition, it is possible to conduct a specific function test for water removal ability.
In this case, by further using the LPSc / LPS and the water removal amount as a test index for peritoneal function, a detailed functional test based on aquaporin activity can be performed on the water removal ability of the peritoneum.

1-2. Configuration of PD + HD Combined Planning Device Next, the configuration of the PD + HD combined planning device in the first embodiment will be described. The PD + HD combined planning apparatus can be configured by introducing a program (PD + HD combined planning program) for executing the PD + HD combined planning method into a general-purpose computer.

FIG. 2 shows an example of the configuration of a PD + HD planning apparatus.
Here, the apparatus shows a personal computer (PC) 1 including a main body 11, a keyboard 12 as an input means connected to the main body 11, and a display 10.
The main unit 11 has a basic configuration as a computer having a general architecture including a CPU that forms a control unit, an HD that forms a storage unit, a memory, and the like. The main body 11 is provided with a drive unit for reading various portable recording media 20 (CD-ROM 201, DVD-ROM 202, flexible disk 203, memory card 204) inserted from the outside, and recorded on these recording media 20. The read data or program is appropriately read into the CPU.

The keyboard 12 is connected to the main body 11. The keyboard 12 is an example of input means for inputting data into the main body 11 by a user.
The display 10 is an example of data display (output means) connected to the main body 11. Here, a display 10 using a CRT is shown.
The PD + HD combined planning program may be read into the PC 1 from various portable recording media 20 (CD-ROM 201, DVD-ROM 202, flexible disk 203, memory card 204), for example, or via a communication line. It may be read from the storage device 30 such as another server or PC to the PC 1 side. It is desirable to store the PD + HD combined planning program once read together with the patient data in the HD in PC1.

  In this PD + HD combination planning apparatus, various data obtained from patients in a general clinical test (for example, peritoneal equilibrium test; PET) are used as input data. The CPU in PC1 calculates the data obtained from PET and the mathematical model (Pyle-Popovich model, etc.) for peritoneal function, and based on the data on each solute concentration, water removal amount, etc. obtained from the calculation results. Each curve (drainage curve, D / P curve, change in blood concentration with time) is displayed on the display 10.

  In addition, as a feature of the first embodiment, the memory built in the PD + HD combination planning apparatus has a database of hemodialysis, peritoneal dialysis, combination therapy and other clinical examination items and analysis results for each patient and each facility. Accumulated in. With respect to this data, the CPU can individually display on the display 10 later according to the user's request, so that it is possible to examine the patient's treatment method, the dialysis method change timing, the combination balance, and the like.

The drainage volume curve is an ultrafiltration curve of the low osmotic pressure solution and the medium osmotic pressure solution in the dialysate, and the D / P curve is a curve representing the ratio of the concentration of the solute of interest in the dialysate to the blood concentration.
The display content of the display 10 is to assist in the examination of future PD + HD combination planning, and it is possible to accurately plan the PD + HD combination therapy.

The PD + HD combined planning device does not require any separate special device, calculation method, or new data that has not been used until now to realize its functions. It also has the feature that the heritage can be effectively utilized.

1-3. Configuration of PD + HD Combined Planning Device Expressed in Functional Blocks FIG. 3 is a functional block diagram showing a configuration of the PD + HD combined planning device.

As shown in the figure, when the configuration of the PD + HD combined planning apparatus in which the PD + HD combined planning program is stored in HD is roughly divided as functional blocks, the input means 40, the storage means 50, the calculation unit 60, the output means 70 And can be represented by control means 80.
Among these, the input means 40 includes a patient data input unit 401, a hemodialysis catalog value input unit 402, and a dialysis schedule unit 403. The storage means 50 mainly includes a patient data storage unit 501, a hemodialysis catalog value storage unit 502, a patient peritoneal function storage unit 503, and a dialysis schedule storage unit 504 so as to be connected to each part inside the input unit 40. Exists.

The database storage unit 51 is connected to a control means 80.
As a feature of the present invention, the storage means 50 includes a database storage unit 51 that can share information with an external PC or an external facility in the majority of the storage storage area. The database storage unit 51 includes a calculation process storage unit 505 for expanding the database function in addition to the storage units 501 to 504. The calculation process storage unit 505 is a storage unit for storing each predetermined calculation result among the calculation processes calculated by the calculation of the calculation unit 60.

  As a result, the database storage unit 51 includes a data group (specifically, patient information, residual kidney function, peritoneum) including data relating to the input items, calculation items, and simulation results based on the calculation results calculated by the calculation unit 60. Dialysis, hemodialysis, the calculated index, and clinical test data are all stored). The contents of the database storage unit 51 are appropriately selected by the control unit 80 according to a request from the user, and are displayed on the display by the selection data display unit 703 of the output unit 70. The CPU functions as such a control means 80.

The patient data input unit 401 receives patient clinical data input by the user from the keyboard 12 and stores the clinical data in the patient data storage unit 501 of the storage unit 50.
Specifically, the hemodialysis catalog value input unit 402 receives dialyzer set values and stores them in the hemodialysis catalog value storage unit 502 of the storage unit 50.

The dialysis schedule input unit 403 receives each item of the PD + HD combined planning input by the user from the keyboard 12 and stores it in the dialysis schedule storage unit 504 of the storage unit 50.
The storage means 50 includes a patient peritoneal function storage unit 503. This is connected to the next calculation unit 60.

  The calculation unit 60 receives data from the patient data storage unit 501 in the storage means 50, the hemodialysis catalog value storage unit 502, the patient peritoneum function storage unit 503, and the dialysis schedule storage unit 504, and includes PD / Popleich Popovich models. Various operations are performed on HD. Further, the calculation process storage unit 505 is connected so that the calculation process can be stored as appropriate. While the calculation unit 60 is in operation, the calculation unit 60 overwrites and stores the new calculation result in the patient peritoneum function storage unit 503 in order to repeatedly perform calculations necessary for building the model (for example, determination of the repulsion coefficient). The operation is performed again.

The calculation unit 60 is connected to the output means 70. The output means 70 includes a patient peritoneal function output unit 701 and a dialysis schedule output unit 702.
The patient peritoneal function output unit 701 outputs data representing the patient's peritoneal function (for example, drainage curve, D / P curve, etc.) based on the Pyle-Popovich model obtained from the calculation result of the calculation unit 60 It is.

On the other hand, the dialysis schedule output unit 702 outputs a schedule for PD + HD combined planning based on the Pyle-Popovich model obtained from the calculation result of the calculation unit 60.
Note that the user determines the calculation result output by the output means 70 and re-inputs the data at the dialysis schedule input unit 403 of the input means 40 as necessary. As a result, the calculation is repeated and a more optimal dialysis schedule is determined.

1-4.Operation of PD + HD planning device
The PD + HD combined planning program introduced to PC1 is generally configured to be executed according to the following flow. FIG. 4 is a diagram showing a program flow from the data input to the calculation result display.

  As shown in this figure, the patient's clinical data (patient information, renal function, HD setting items) required for each PD / HD from the predetermined clinical data input screen first displayed on the display 10 of the PC 1 by the user , PD setting item). After this data input, the program can be executed, and various calculations are performed on PD / HD including the Pyle-Popovich model. Using parameters such as water removal parameters, body surface area, body fluid volume, injection volume, residual liquid volume, urea nitrogen production rate, creatinine production rate, etc., obtained from the calculation results, drainage volume curve, D / P curve The solute concentration in blood is displayed on the display 10.

  Based on such curves displayed on the display 10, the user decides each item for PD + HD combination therapy to be set (PD + HD planning). Specifically, HD and PD for a certain period (one week unit here), dialysis schedule by combination of rest days, PD schedule (dialysate osmotic pressure, dialysate volume, storage time, number of exchanges), HD conditions ( Determine dialysis time, water removal amount, urea nitrogen clearance, creatinine clearance) and enter them from the specified PD + HD planning input screen. Based on the input conditions, PC1 calculates the ratio M / C (0) of the clear space from the solute removal amount M in the dialysis plan based on the set conditions and the blood concentration C (0) before dialysis. Then, M / C (0) / VB, which is obtained by dividing this by the body fluid volume VB, is displayed as an integrated sum of HD, PD, and RRF (Residual Renal Function) (PD + HD planning output).

Here, in the present invention, separately from the flow of calculation processing by the program, processing for appropriately displaying data selected according to the user's request on the display 10 is performed.

1-5. Example Next, an example of the apparatus of the first embodiment having the above-described configuration will be described.

In order to operate the device, data first obtained from the patient is required. Prior to explaining the operation of this apparatus, this data acquisition method will be described first.
1-5-1. Acquisition and input of clinical data Here, the procedure for the above-described PD + HD combined planning of the present invention and an example of data acquisition steps are shown. FIG. 5 is a PD data acquisition step diagram (peritoneal function test protocol) at this time. In this data acquisition step, dialysate with low osmotic pressure (360 (mOsm / Kg-solvent)) and medium (400 (mOsm / Kg-solvent)) was used twice in the same order, as shown in Figure 6. The patient exchanges dialysate 4 times in total at the storage interval of 6 hours, 3 hours, 8 hours, and 4 hours (of which 3 times) from the previous night, and obtains drainage samples D1 to D6. (Water removal amount) VDL1, VDL2, VDM1, and VDM2 are measured. After completion of dialysis, blood is collected for hemodialysis (B1). During the series of tests shown in Fig. 6, urine is collected (U1) and urine volume (VU) is measured. The osmotic pressure of the dialysate and the number of exchanges are two or more for each dialysate, but as described above, the present invention is performed if at least two drainage data are obtained for one type of osmotic pressure dialysate. Is possible.

  In the data acquisition step, urea and creatinine solute concentrations, drainage amounts (VDL1, VDL2, VDM1, VDM2), and storage time are acquired from samples D1 to D6 as PD clinical data. Samples D4 to D6 correspond to PET. On the other hand, each solute concentration of urea and creatinine is obtained from the blood sample B1. From the urine sample U1, the urea concentration, creatinine concentration, urine volume VU, and the like are obtained.

  Each item of the patient data obtained in this way is input to the PC 1 as patient data. Normally, patient information, daily prescriptions, peritoneal dialysis data, hemodialysis data, and console setting values are input to these input items. In addition, if necessary, clinical laboratory data of patients that can be quantified such as urea nitrogen, creatinine, pH, GPT, GOT can be input, and other data can be added.

1-5-2.PD + HD combined planning device operation
When the input of each of the above data to the PD + HD combined planning apparatus 1 is completed, the PD + HD combined planning apparatus program (PD + HD combined planning program) can be executed.

When the program is activated on the PC 1, the PC 1 first determines whether or not data necessary for calculating the Pyle-Popovich equation is input in accordance with the program.
If the input data is more than the necessary amount, the PC 1 performs an operation on the Pyle-Popovich model represented by the mathematical formula <Equation 1> based on the clinical data of the patient being input. By this calculation, the overall mass transfer / membrane area coefficients MTACun, MTACc, dewatering parameters a1, a2, a3, etc. of urea nitrogen and creatinine are determined. A specific calculation of simultaneous equations in the Pyle-Popovich model is described in Japanese Patent Laid-Open No. 2000-140100.

PC1 calculates the body surface area (BSA) (m ² ) of the patient from the height and weight of the patient according to the following <Equation 6> (BSA calculation method: Gehan, 1970).

(Equation 6)
BSA = 0.0235 ・ (100 ・ L) exp （0.4226） ・ Wexp （0.51456）
Here, L is height (m) and W is weight (kg).

In the case of patient A, he is 159.5 cm tall and weighs 58.1 kg, so the body surface area BSA is 1.62 m ² according to Equation 6. After the calculation of the body surface area, the PC 1 displays, for example, a drainage curve creation data analysis result screen on the display 10 according to the program. This figure shows <Patient Information> (Body Surface Area, Body Fluid Volume, Injection Volume, Residual Liquid Volume) and Pyle-Popovich Model / Approximate Value Analysis Based on Modified Powell Method. The water removal parameters a1, a2, and a3 of the pressure dialysate are displayed. The user confirms this information, causes the PC 1 to calculate the drainage amount curve, and subsequently causes the display 10 to display the drainage amount curve.

At this time, in the first embodiment, it is possible to display each data (creatinine D / P data, PET curve) as a PET result by adjusting the setting items of the program.
Subsequently, the PC 1 displays a D / P curve creation data analysis result screen on the display 10 based on the clinical data already input. Here, parameter estimation methods, urea nitrogen and creatinine solute formation rates, and dynamic parameters such as general mass transfer / membrane area coefficient (KA = MTAC), repulsion coefficient (σ), and the like are displayed as parameter estimation methods and patient information. The user confirms this information, causes the PC 1 to calculate the D / P curve, and causes the display 10 to display the D / P curve. By verifying this D / P curve, it is possible to confirm whether the clinical data and the calculation result match. Further, by comparing the drainage amount curve and the D / P curve, a dialysis exchange schedule considering the solute removal / water removal amount can be examined.

  Here, either the drainage amount curve or the D / P curve can be displayed, or both of the curves can be displayed side by side by setting the screen of the display 10. In this case, the drainage amount curve is calculated first, and then the D / P curve is calculated. The user checks the patient's peritoneal function parameters (MTAC, σ, a1, a2, a3) based on the curve displayed on the display, and then performs PD + HD combination planning.

  Specifically, as shown in FIG. 7, predetermined setting is performed from the daily prescription input screen for PD + HD combined planning. Specific settings include PD, HD, and rest days for a certain period (here known as the period unit of a general dialysis schedule) and PD schedule (dialysis fluid osmotic pressure, dialysis) Fluid volume, number of exchanges, storage time), and HD conditions (dialysis time, water removal, urea nitrogen clearance, creatinine clearance). When these data for PD + HD planning are input, PC1 determines whether the data is correctly input according to the program, and calculates the treatment efficiency from the schedule.

  Here, PC1 is the amount of solute removal M (mg / week) and blood solute (urea, creatinine) concentration C (0) for PD and HD for a certain period (one week in the present embodiment 1). ) (Mg / mL), the ratio M / C (0) (L / week) is calculated as a clear space, and this is calculated as the sum of clearance PD + HD M / C (0) (L / week) calculate. Specifically, M / C (0) is calculated for each PD and HD, and the total for 7 days is taken to obtain the total M / C (0) (L / week). Then, M / C (0) / VB is calculated by further dividing the calculated M / C (0) (L / week) by the patient's body fluid volume VB.

The PC 1 displays this result on the display 10 as a PD + HD combined planning screen. This allows the user to consider the planning.

1-5-3. Effects of the Present Invention After the above calculation is completed, the user can further study the following as a feature of the present invention.

As described above, in PD-HD combined planning, it may be desirable to consider more precise planning with reference to patient data over time or multiple patient data.
In this case, in the first embodiment, it is possible to display the patient's clear space or the like in the input dialysis schedule. In the present apparatus, the simulation result which is the calculation result is also stored, so that the stored result can be displayed on the display at any time, and a plurality of dialysis schedules can be easily compared. Specifically, simulation results can be saved individually, data can be read out by button selection, and changes in prescription can be visually observed by changes in the graph on the screen.

By storing parameters analyzed by calculation in this way in the database and allowing the user to call them appropriately, analysis data and other test items for the same patient can be obtained even when multiple tests are performed on the same patient. The inspection data of a plurality of times can be displayed as a graph in time series or the like.
In addition, if these items are related with the same examination date and a correlation graph of various examination items is displayed, analysis items (search for indicators, search for risk factors) as dialysis such as hemodialysis, peritoneal dialysis and combination therapy, It can also be used for evaluation.

  Further, when a plurality of examinations are performed on the same patient with different examination dates, it is possible to select the display of the time series / correlation on the right side of FIG. Here, in the example shown in FIG. 8, the patient information, residual kidney function, test items necessary for peritoneal dialysis, hemodialysis, combination indices, and clinical test data are picked up, and the right side in the figure. A time series graph can be displayed by pressing the series graph button.

In the example shown in FIG. 9, the amount of water removed and the creatinine concentration in peritoneal dialysis are shown in time series. That is, it is possible to observe changes in parameters from the past to the present by displaying a plurality of examination data of patients as a single graph in time series for a certain item.
In this way, if the patient's past to present can be evaluated as a time-series graph, the past dialysis volume and dialysis performance can be analyzed, and changes in the data over time during the treatment period can be seen. It is very useful because it can predict future changes.

  Furthermore, in Fig. 8, the X-axis and Y-axis of "Graphs 1 to 4" at the top of the screen show patient information, residual kidney function, and test items necessary for peritoneal dialysis, hemodialysis, combined indicators, and clinical laboratory data. Pick up your favorite data and press the correlation graph button on the right side of Fig. 8 to display the correlation graph. FIG. 10 shows a graph when urea nitrogen clearance in peritoneal dialysis is taken on the X axis and PET blood creatinine concentration is taken on the Y axis.

  In other words, by displaying a correlation graph by displaying items analyzed and analyzed multiple times on the same examination day, it became possible to search for dialysis indices and evaluate the indices for dialysis, especially combination therapy. In this way, not only the test items necessary for dialysis therapy analysis, but also the storage of other test items and the display of time series graphs, the correlation between other test items and dialysis therapy software analysis results, and the correlation graph for other test items It also supports display.

  In addition, as an in-house evaluation, all patient data, analysis results, parameters of various dialysis indicators, average of general clinical laboratory values examined for patient management, dialysis period, time series evaluation of treatment period, and measurement / analysis items Can be evaluated by patients in the facility. Depending on the patient and facility, the correlation of analysis parameters between different dialysis methods such as hemodialysis, peritoneal dialysis and combination therapy can be confirmed.

Therefore, it is considered useful for management between different dialysis, management before introduction of dialysis, and evaluation between these therapies, which has not been possible with conventional dialysis therapy software.
For example, FIGS. 9 and 10 are graphs for one patient, but a plurality of patient data can be displayed. It is also possible to obtain average data of patients in the facility and display a plurality of facilities. Further, the horizontal axis in FIG. 9 can be changed to the examination history of the patient.

By doing this, it is possible to grasp the parameters for each patient or facility unit, to deepen understanding of the test results, and to reflect them in the future dialysis schedule.
In addition, desired results can be displayed by processing data on hemodialysis, peritoneal dialysis, or combination therapy and other clinical test values in the screen at the patient or facility.

Furthermore, the patient can be managed before the introduction of dialysis, and the dialysis can cope with changes in treatment such as hemodialysis and peritoneal dialysis. Moreover, the target value and management value with respect to treatment can be proposed by managing all the data in the facility.
Also, by looking at the correlation between various parameters, it is possible to discover measurement items and test items that are important for treatment and use them as indicators. In addition, it is possible to manage not only the facilities but also parameters depending on the type of dialysis therapy. Further, visual judgment can be made by using many graph displays.

In addition, by introducing the entered test results into a known formula for dialysis therapy analysis, the analyzed parameters and other clinical test values are stored in a database, and rearranged in the order of request, so that the data in the patient and facility By regrouping it, it can be used for patient management, treatment seeking, facility management, setting of target values and management values of such treatments, and the like.

The present invention can be used for the examination of peritoneal permeation of artificial dialysis and combination therapy of hemodialysis.

It is explanatory drawing of a Pyle-Popovich model. It is a schematic diagram of a PD + HD combined planning apparatus using a PC as an application example of the present invention. It is a functional block diagram of an apparatus. It is a figure which shows the flow of a process of a planning program. It is a clinical data input screen. Peritoneal function test protocol. It is a simulation screen of the combination therapy displayed on a display. It is a graph item selection screen displayed on a display. It is a time series graph display screen displayed on a display. It is a correlation graph display screen displayed on a display.

Explanation of symbols

1 PD + HD planning system using PC
10 Display means (monitor)
11 PC
12 Input means (keyboard)
20 Recording media
30 Storage device via communication line

Claims (4)

A peritoneal dialysis and hemodialysis planning device comprising a calculation unit, an output unit and a storage unit, and a control unit for controlling these,
The storage unit stores an input item for calculation in the calculation unit, a calculation item, a data group including each data related to a simulation result based on the calculation result,
The control unit is configured to cause the output unit to output any data in the data group in response to a request from a user. A combined peritoneal dialysis and hemodialysis planning apparatus. The peritoneum according to claim 1, wherein the data group stored in the storage unit includes patient information, residual kidney function, peritoneal dialysis, hemodialysis, the calculated index, and clinical test data. Dialysis and hemodialysis planning system. The peritoneal dialysis and hemodialysis combined planning apparatus according to claim 1, wherein the control unit displays the same or a plurality of patients on the same type of data selected by the user on the output unit in time series. . The peritoneal dialysis and hemodialysis combined planning apparatus according to claim 1, wherein the control unit displays a correlation between the plurality of data selected by the user on an output unit.