JP3933512B2 - Hemodialysis machine - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a hemodialysis apparatus, and more particularly, to a hemodialysis apparatus capable of reliably monitoring whether or not the amount of dialysate supplied to a patient and the amount of water removed from a patient are appropriate.
[0002]
[Prior art]
Hemodialysis apparatuses are already known and widely put into practical use. As a typical example, an apparatus as shown in FIG. 6 is known. In the hemodialysis apparatus 1 shown in FIG. 6, reference numeral 2 denotes a hemodialysis element (dialyzer) having a dialysis membrane 5 between the blood flow path 3 and the dialysate flow path 4 and performing hemodialysis between the flow paths 3 and 4. Also called). Blood from the artery 6 of the patient is supplied to the blood flow path 3 via a blood pump 8 comprising a metering pump provided in the blood circuit 7, and dialyzed blood is returned to the vein 9.
[0003]
The dialysate flow path 4 of the hemodialysis element 2 is connected to and communicated with a dialysate circulation path 10 that is substantially a closed circuit. The dialysis fluid before dialysis from the dialysate forward path 10a of the dialysate circulation path 10 is supplied to the dialysate flow path 4 by the circulation pump 11 provided in the dialysate circulation path 10, and the dialyzed dialysate is returned to the dialysate return path. 10b is returned. The dialysate circulation path 10 is configured in a substantially closed circuit as described above. Since a small amount of dialysate is quantitatively discharged from the closed circuit by a water removal pump described later, a small amount corresponding to the dialysate circulation path 10 is provided. Water is extracted from the blood through the dialysis membrane 5 from the patient's blood into the dialysate circuit 10.
[0004]
A dialysate supply chamber 13a of a dialysate supply / reception element 12a is connected to the forward path 10a of the dialysate circulation path 10, and the dialysate before dialysis is supplied from here to the forward path 10a. A dialysate receiving chamber 14a of the dialysate supply / reception element 12a is connected to the return path 10b of the dialysate circulation path 10, and dialyzed dialysate is returned here. The dialysate supply chamber 13a and the dialysate receiving chamber 14a are separated by an elastic membrane 15a, and the dialysate receiving chamber 14a can expand by the amount of the dialysate supply chamber 13a contracted by the dialysate supply.
[0005]
In addition to the dialysate supply / reception element 12a, another dialysate supply / reception element 12b is provided. The dialysate supply / reception element 12b has the same configuration, and includes a dialysate supply chamber 13b, It has a liquid receiving chamber 14b and an elastic membrane 15b.
[0006]
At the inlet / outlet of the dialysate supply / reception elements 12a, 12b of the dialysate circulation path 10, switching valves 16a, 16b comprising open / close valves (two-way valves) on the forward path 10a side and open / close valves (two-way) on the return path 10b side are provided. Switching valves 17a and 17b each comprising a valve) are provided, and by switching by these switching valves, each dialysate supply / acceptance element can be alternately switched and used for dialysis.
[0007]
Either one of the dialysate supply / reception elements 12a and 12b used for switching is used for dialysis and communicated with the dialysate circulation circuit 10, while the other is disconnected from the dialysate circulation circuit 10, A new, unused dialysate is supplied to and a used dialysate is discharged.
[0008]
A new unused dialysate is supplied to a dialysate supply chamber of a dialysate supply / receiving element during a dialysis stop through a dialysate supply path 19 including switching valves 18a and 18b. Is discharged to the dialysate receiving chamber of the dialysate supply / receiving element during the dialysis stop through the used dialysate discharge path 21 provided with the switching valves 20a and 20b.
[0009]
A water removal path 22 is connected to the return path 10 b of the dialysate circulation path 10, and a small amount of dialysate is quantitatively discharged by a water removal pump 23 including a metering pump provided in the water removal path 22. . Since the dialysate circuit 10 is substantially a closed circuit, a small amount of water corresponding to the discharged dialysate is extracted from the blood of the patient through the dialysate membrane 5 into the dialysate circuit 10. Thus, the same amount of dialysate containing the water as the extracted water is discharged through the water removal path 22. This dewatering path 22 is joined to the above-mentioned spent dialysate discharge path 21 so that the dialysate containing the extracted water is discharged to an appropriate place.
[0010]
Open / close valves 24 and 25 are provided at the inlet / outlet of the hemodialysis element 2 in the dialysate circulation path 10 so that the inlet / outlet can be shut off when the hemodialysis element 2 is replaced or washed. A flow regulating valve 26, a flow meter 27, and a temperature sensor 28 are provided in the forward path 10a of the dialysate circulation path 10, so that dialysate can be supplied under predetermined conditions. The forward path 10a and the return path 10b of the dialysate circulation path 10 are connected by a bypass path 30 having a bypass valve 29. Normally, the bypass valve 29 is closed, but when the dialysate circulation path 10 is washed. When the hemodialysis element 2 is replaced, the bypass valve 29 can be opened as necessary to open the bypass passage 30.
[0011]
Further, due to the operation of the circulation pump 23 provided in the return path 10b of the dialysate circulation path 10, a negative pressure is generated on the upstream side in particular, but this dialysate pressure can be detected by the dialysate pressure sensor 31. . Further, a gas-liquid separator 32 is provided on the downstream side of the circulation pump 23 so that air can be vented from the dialysate circulation path 10. The air vent line 33 of the gas-liquid separator 32 is also joined to the aforementioned spent dialysate discharge path 21 via the atmospheric discharge valve 34.
[0012]
Further, a branch path 36 having a negative pressure release valve 35 is connected to the return path 10 b of the dialysate circulation path 10, and the other end of the branch path 36 is joined to the spent dialysate discharge path 21. By opening the negative pressure release valve 35 as necessary, the spent dialysate discharge path 21 can be prevented from causing excessive air pressure in the return path 10b by the amount of bubbles expelled by the gas-liquid separator 32. The dialysis solution can be replenished.
[0013]
The dialysate supply path 19 is provided with a filter 37, a pressure switch 38, a pressure reducing valve 39, a shutoff valve 40, a deaeration pump 41, a heater 42, a temperature sensor 43, and a deaeration tank 44. A dialysate adjusted to an appropriate condition is supplied to the dialysate supply chamber 13a or 13b of the dialysate supply / reception element 12a or 12b in standby. An air vent line 45 from the deaeration tank 44 is also joined to the spent dialysate discharge path 21 described above.
[0014]
[Problems to be solved by the invention]
In the hemodialysis apparatus 1 configured as described above, there is no particular problem when the system is operating normally. However, when an abnormality occurs in any part of the system, the dialysate supply / acceptance element There is a risk that excessive dialysis fluid may be supplied to the patient or the amount of water removed from the patient may deviate from the target amount, and there is no means to properly monitor such excessive dialysis fluid supply or excess water removal. It was.
[0015]
Since the dialysate circulation path 10 is configured as a closed circuit, if excess dialysate is supplied to the dialysate supply path to the dialysate supply / acceptance element, and it is used for dialysis, it will be excessive. Only the patient side has an outlet side for receiving an excessive amount of the dialysate, resulting in an increase in the weight of the patient. Such excessive supply of dialysate may result in insufficient drainage from the patient or a problem of weight gain when the amount of water removed from the dialysate circulation path 10 is constant. Arise.
[0016]
In addition, since a reliable metering pump (including an adjustable pump) is used for the water removal pump 23, the water removal amount discharged through the water removal path 22 itself provided with the water removal pump 23 is usually as follows. The target amount can be controlled with sufficiently high accuracy without monitoring. However, for example, when leakage occurs in the air release valve 34 or the negative pressure release valve 35, the dialysate circulation path 10 discharges excess dialysate via the air vent line 33 or the branch path 36, and the dialysate circulation path. Since 10 is configured as a closed circuit, the patient is excessively drained from the patient by an amount commensurate with the excessively discharged dialysate. When such excessive water removal occurs, the patient's weight is excessively reduced, which places a heavy burden on the patient.
[0017]
Therefore, the problem of the present invention is to pay attention to the problems in the conventional apparatus as described above, and to detect excessive supply of dialysis fluid to the patient side and excessive water removal from the patient with simple modification, and these problems are solved. An object of the present invention is to provide a hemodialysis apparatus that can prevent the patient from continuing and prevent an undesired increase or decrease in the weight of a patient.
[0018]
[Means for Solving the Problems]
In order to solve the above problems, a hemodialysis apparatus of the present invention comprises a hemodialysis element having a dialysis membrane between a blood flow path and a dialysate flow path, and a substantially closed circuit. A dialysate circulation path communicating with the dialysate flow path, a dialysate supply chamber connected to the dialysate outbound path to the dialysate flow path of the dialysate circulation path, and the dialysate flow path from the dialysate flow path A dialysate receiving chamber connected to the dialysate return path, and at least two dialysate supply / acceptance elements that can be switched for dialysis alternately via a switching valve provided in the dialysate circulation path; Connected to the circulation pump provided in the dialysate circulation path and each dialysate supply chamber of each dialysate supply / reception element, and alternately to each dialysate supply chamber of each dialysate supply / reception element via a switching valve Dialysate supply path for supplying unused dialysate to the dialysis fluid and each dialysate supply / receiving element Is connected to each dialysate receiving chamber, spent for discharging the spent dialysate alternately from each dialysate receiving chamber of the dialysate supplying and receiving element via the switching valve to the dialysate circulation passage outside consisting of said closed circuit In the hemodialyzer having a dialysate discharge path and a water removal path connected to the dialysate return path of the dialysate circulation path and having a water removal pump capable of removing water from the dialysate return path, the dialysate supply A first flow meter or a flow switch is provided at a position upstream of the switching valve in the dialysate supply path, and the switching valve in the used dialysate discharge path of the used dialysate discharge path. The second flow meter or the flow switch is provided at a position downstream of the second water flow meter, and the second flow meter or the flow switch is disposed at a position unrelated to the water removal amount in the water removal path. Consisting of
[0019]
In this hemodialysis apparatus, when at least one branch path is connected to the dialysate return path of the dialysate circulation path via an opening / closing valve, the branch path is downstream of the opening / closing valve as viewed from the dialysate return path side. It can be set as the structure connected to the position of the upstream of the said 2nd flow meter or flow switch of the said used dialysate discharge path | route in the position of the side.
[0020]
The first flow meter and the second flow meter may be flow meters with a flow switch that outputs a signal when a certain flow rate is detected.
[0021]
In the hemodialysis apparatus according to the present invention as described above, either the first flow meter or the flow switch and either the second flow meter or the flow switch can be provided. The first flow meter is provided in the dialysate supply path for supplying new dialysate to the waiting dialysate supply / reception element, and the dialysate supply / reception element in standby is used. A second flow meter is provided in the spent dialysate discharge path for discharging dialysate. And the water removal path provided with the water removal pump is configured regardless of the position where the second flow meter is provided, or the second flow meter is bypassed, and the water removal amount in the water removal path is the first. This is not detected by the flow meter of 2. Normal operation from the completion of the supply of the new dialysate to the waiting dialysate supply / reception element until the dialysate supply / reception element is used for the next dialysis (acceptance waiting period) In the state, the flow rate becomes zero at both the installation positions of the first flow meter and the second flow meter. However, for example, if there is a leak in the switching valve on the inlet side of the dialysate supply / acceptance element that is on standby, the flow rate of the first flowmeter does not become zero particularly during the acceptance completion standby period, Indicates a certain flow rate value. Therefore, when such a flow value is detected, it can be determined that there is an abnormality in the inlet side of the dialysate supply / reception element, particularly the switching valve, and restoration based on the determination can be performed. As a result, it is possible to prevent an increase in body weight due to excessive supply of dialysate to the dialysate supply / acceptance element and consequently supply of dialysate to the patient.
[0022]
In addition, since the water removal pump that can quantitatively remove water is composed of a highly reliable metering pump, dialysate containing water discharged through the water removal path by this water removal pump is detected at a separate flow rate. Even if it is not performed, the desired flow rate is accurately controlled. However, if there is a leak from the branch of the dialysate circuit, etc., it will be discharged from the dialysate circuit configured in a closed circuit, thereby reducing the amount of water removed from the patient. Increasing the target value will lead to undesirable weight loss for the patient. Such a leakage path is merged with the used dialysate discharge path, and the second flow meter is installed at a position downstream of the merge position and unrelated to the water removal amount in the water removal path. When such a leak occurs, the leak flow rate is detected even during a period in which the flow rate detected by the second flow meter should be zero, particularly during the acceptance completion waiting period. Therefore, if a certain flow rate is detected by the second flow meter during the acceptance completion waiting period, it can be determined that such a leak has occurred, and restoration based on the determination can be performed. As a result, it is possible to prevent the generation of excessive water removal and, in turn, it is possible to prevent undesirable weight loss due to excessive water withdrawal from the patient.
[0023]
Furthermore, the flow rate detection by the first flow meter and the second flow meter during the acceptance completion waiting period can be detected separately for each of the first and second flow meters. A flow meter with a flow switch that outputs a signal when a certain flow rate is detected, a system that can detect the flow rate of at least one of the first and second flow meters, that is, which flow meter detects the flow rate It is also possible to use a system regardless of whether the system is used. Even in this way, it is possible to determine which dialysate supply / receiving element has a problem in the dialysate supply circuit by determining at which timing the flow rate was detected during the acceptance completion waiting period. When the flow rate is detected during the acceptance completion waiting period, the flow rate is detected regardless of which dialysate supply / reception element is used. It becomes possible to judge that
[0024]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, preferred embodiments of the present invention will be described with reference to the drawings.
FIG. 1 shows a hemodialysis apparatus according to an embodiment of the present invention. In the hemodialysis apparatus 51 shown in FIG. 1, the same reference numerals as those shown in FIG. 6 have substantially the same configuration as the hemodialysis apparatus 1 shown in FIG. Therefore, the configuration and function of these parts are the same as those described above with reference to FIG.
[0025]
In the hemodialysis apparatus 51 according to the present invention, upstream of the switching valves 18a and 18b provided on the inlet side of the two dialysate supply / reception elements 12a and 12b in the dialysate supply path 19 in the dialysate supply path 19. A first flow meter 52 is provided at the position on the side. Therefore, the first flow meter 52 can detect the flow rate of the circuit that reaches the switching valves 18a and 18b. A second flow meter 53 is provided at a position downstream of the switching valves 20 a and 20 b in the used dialysate discharge path 21 in the used dialysate discharge path 21. And this 2nd flow meter 53 is arrange | positioned in the position unrelated to the amount of water removal in the water removal path | route 22, and in this embodiment, the water removal path | route 22 makes the 2nd flow meter 53 bypass. Are joined to the drain circuit. Therefore, when the flow rate through the used dialysate discharge path 21 is generated, it is detected regardless of the water removal amount in the water removal path 22.
[0026]
The junction position of the branch path 36 connected to the dialysate return path 10b of the dialysate circulation path 10 via the open / close valve 35 (negative pressure release valve) is the second flow rate. It is arranged upstream of the total 53, and if the dialysate leaks from this branch path 36, the second flow meter 53 can detect it. Furthermore, the air vent line 33 from the gas-liquid separator 32 provided in the dialysate return path 10b of the dialysate circulation path 10 also joins the spent dialysate discharge path 21 downstream of the on-off valve 34 (atmospheric release valve). The merging position is disposed upstream of the second flow meter 53, and if the dialysate leaks from the air vent line 33, the second flow meter 53 can detect the merging position. It is like that. The air vent line 33 also constitutes a kind of branch path for the dialysate return path 10 b of the dialysate circulation path 10.
[0027]
Further, in the present embodiment, the first flow meter 52 and the second flow meter 53 are composed of a flow meter with a flow switch that emits a signal when a predetermined flow rate or more is detected. It is also possible to independently issue individual signals from the first flow meter 52 and the second flow meter 53, and when one of the flow meters emits a signal, which flow meter is determined. Regardless, it is possible to simply issue a detection signal that a leak has occurred in any of the flow meter installation circuits.
[0028]
The operation of the hemodialysis apparatus 51 according to the present invention in which the first flow meter 52 and the second flow meter 53 are provided as described above and the water removal path 22 bypasses the second flow meter 53 will be described.
[0029]
First, when there is no abnormality in the hemodialysis apparatus 51 and it is operating normally, for example, as shown in FIG. 2 (a), the dialysate supply / receiving element 12a (indicated as A in FIGS. 2 to 5), 12b (shown as B in FIGS. 2 to 5) is used by alternately switching for dialysis, for example, every 30 seconds, and is supplied by the flow meter 27 (diameter of FIG. 2A). Is controlled at a predetermined constant flow rate substantially constantly. That is, substantially continuous dialysis is performed by repeating this switching operation. At this time, the waiting dialysate supply / reception elements 12b and 12a that are not used for dialysis, as shown in FIG. A new unused dialysate is received in the dialysate supply chamber through the dialysate discharge passage 21, and the used dialysate is discharged from the dialysate receiving chamber 21. The remaining 7 seconds are waited. While waiting for the completion of acceptance, in the normal operating state, no flow rate is generated in the first flow meter 52, and no leakage from a branching path, which will be described later, occurs. The flow rate is not generated in the flow meter 53 of FIG. Therefore, for example, if the vertical axis in (b) of FIG. 2 is the total flow rate detected by the first flow meter 52 and the second flow meter 53, this flow rate becomes zero during the completion of the acceptance.
[0030]
However, if leakage occurs in the dialysate supply / reception element 12b side, particularly the switching valve 16b on the inlet side, a predetermined amount of dialysis is introduced into the dialysate reception chamber 13b of the dialysate supply / reception element 12b as shown in FIG. In spite of the completion of the acceptance of the liquid, a flow rate is generated in the first flowmeter 52 during the waiting for the completion of the acceptance, and this is detected. Of course, even if the flow rates of the first flow meter 52 and the second flow meter 53 are totally detected as in this embodiment, this flow rate generation state is detected. Similarly, when leakage occurs in the dialysate supply / reception element 12a side, particularly the switching valve 16a on the inlet side, as shown in FIG. 4, the dialysate supply chamber 13a of the dialysate supply / reception element 12a has a predetermined amount. In spite of the completion of the reception of the dialysate, a flow rate is generated in the first flow meter 52 during the completion of the reception, and this is detected.
[0031]
As described above, when the leakage flow rate is detected only during the acceptance completion waiting at any timing among the acceptance completion waiting that occurs intermittently sequentially, any of the dialysate supply / reception elements 12a and 12b. Depending on the timing at which it is determined that an abnormality has occurred in the dialysate supply, particularly the switching valve on the inlet side, and which of the dialysate supply / reception elements 12a, 12b side is abnormal Can be identified. That is, both the leak judgment and the leak location can be performed at the same time. Due to the occurrence of such an abnormality, as described above, unnecessary dialysate may be supplied to the patient side from the dialysate circulation path 10 in the closed circuit configuration, which may lead to an increase in the weight of the patient. Since abnormalities are promptly detected and monitored appropriately in a state where the site is specified, the occurrence of this type of malfunction is substantially prevented.
[0032]
Further, when a leak occurs in the negative pressure release valve 35 of the branch path 36, this leak occurs even while waiting for the completion of the reception (that is, while dialysis is being performed by the other dialysate supply / reception element). Therefore, as shown in FIG. 5, regardless of which dialysate supply / acceptance element is waiting for completion of reception, the flow rate is supplied to the second flow meter 53 during reception completion of reception at all timings. This leak is detected. Of course, even if the flow rates of the first flow meter 52 and the second flow meter 53 are totally detected as in this embodiment, this flow rate generation state is detected. Since the second flow meter 53 is removed from the water removal path 22, this leakage is detected regardless of the water removal being performed quantitatively.
[0033]
Similarly, if a leak occurs in the atmospheric release valve 34, this leak also occurs during the above-described waiting for completion of acceptance. Therefore, as shown in FIG. 5, any dialysate supply / acceptance element waits for acceptance completion. Regardless of whether it is in the middle or not, the flow rate is generated in the second flow meter 53 during the completion of the acceptance of all timings, and this leakage is detected. Of course, even if the flow rates of the first flow meter 52 and the second flow meter 53 are totally detected as in this embodiment, this flow rate generation state is detected.
[0034]
Therefore, if the flow rate is detected while waiting for completion of reception at all timings as shown in FIG. 5, it can be determined that a leak has occurred from the dialysate circulation path 10, and the leak location is determined by the negative pressure release valve 35. Alternatively, it can be determined that there is a high possibility of being the atmospheric release valve 34, and both the leak determination and the leak location can be performed at the same time.
[0035]
If such a leakage occurrence state is left untreated, the fluid is excessively drained from the dialysate circulation circuit 10 having a closed circuit configuration, and excessive water is removed from the patient. Excessive water removal (excessive pulling) will lead to undesirable weight loss for the patient. However, according to the present invention, this abnormality is detected and monitored promptly and in a state where the site is specified, so that the occurrence of this type of problem is substantially prevented.
[0036]
In the above embodiment, the first flow meter 52 and the second flow meter 53 are provided so that the flow rate can be detected. However, in the present invention, only the presence or absence of the flow rate exceeding a certain level is detected. It can also be a flow switch.
[0037]
【The invention's effect】
As described above, according to the hemodialysis apparatus of the present invention, the first flow meter or the flow switch is connected to the inlet side of the dialysate supply / reception element, and the branch path or the like joins with the water removal path removed. A second flow meter or flow switch is provided in the used dialysate drainage path so that it can be detected quickly and accurately when an undesirable leak occurs in each path. It is possible to reliably detect excessive supply and excessive water removal from the patient to prevent these problems from continuing and to reliably prevent an undesirable increase or decrease in the weight of the patient.
[0038]
Further, in the present invention, it is possible to immediately identify an undesired leak occurrence point as described above. Therefore, the configuration according to the present invention is used for self-diagnosis of a hemodialyzer system, in particular, a self-diagnosis of a water removal mechanism. It can be used for. Therefore, the present invention can contribute to improving the reliability of the system so that the hemodialysis apparatus can operate stably and normally.
[Brief description of the drawings]
FIG. 1 is an equipment system diagram of a hemodialysis apparatus according to an embodiment of the present invention.
FIG. 2 is an operation characteristic diagram showing a normal operation state in the apparatus of FIG. 1;
3 is an operation characteristic diagram showing an abnormal operation state in the apparatus of FIG. 1. FIG.
4 is an operation characteristic diagram showing another abnormal operation state in the apparatus of FIG. 1; FIG.
5 is an operation characteristic diagram showing still another abnormal operation state in the apparatus of FIG. 1. FIG.
FIG. 6 is an equipment system diagram of a conventional hemodialysis apparatus.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Hemodialysis apparatus 2 Hemodialysis element 3 Blood flow path 4 Dialysate flow path 5 Dialysis membrane 6 Artery 7 Blood circuit 8 Blood pump 9 Vein 10 Dialysate circulation path 10a Dialysate circulation path 10b Dialysate return path 11 Circulation pumps 12a and 12b Dialysis Fluid supply / reception elements 13a, 13b Dialysate supply chambers 14a, 14b Dialysate reception chambers 15a, 15b Elastic membranes 16a, 16b, 17a, 17b, 18a, 18b Switching valve 19 Dialysate supply paths 20a, 20b Switching valve 21 Used Dialysate discharge path 22 Water removal path 23 Water removal pumps 24, 25 On-off valve 26 Flow control valve 27 Flow meter 28 Temperature sensor 29 Bypass valve 30 Bypass path 31 Dialysate pressure sensor 32 Gas-liquid separator 33 Air vent line 34 Atmospheric release Valve 35 Negative pressure release valve 36 Branch path 37 Filter 38 Pressure switch 39 Pressure reducing valve 40 Shut-off valve 41 Deaeration pump 4 2 Heater 43 Temperature sensor 44 Deaeration tank 45 Air vent line 51 Hemodialysis device 52 First flow meter 53 Second flow meter

Claims (3)

A hemodialysis element having a dialysis membrane between the blood flow path and the dialysate flow path, a dialysate circulation path substantially consisting of a closed circuit and communicating with the dialysate flow path of the hemodialysis element, and the dialysate A dialysis fluid supply chamber connected to the dialysate forward path to the dialysate flow path of the circulation path and a dialysate reception chamber connected to a dialysate return path from the dialysate flow path of the dialysate circulation path; At least two dialysate supply / reception elements that can be switched for dialysis alternately via a switching valve provided in the liquid circulation path, a circulation pump provided in the dialysate circulation path, and each dialysate A dialysate supply path connected to each dialysate supply chamber of the supply / reception element and alternately supplying unused dialysate to each dialysate supply chamber of each dialysate supply / reception element via a switching valve, and each dialysis Each dialysate receiving chamber is connected to each dialysate receiving chamber, and each dialysate is connected via a switching valve. And used dialysis liquid discharge path for discharging the used dialysate alternately outside dialysate circulation path consisting of the closed circuit from the dialysate receiving chamber of the sheet-receiving element, the dialysate return of the dialysis fluid circulation path A hemodialysis apparatus having a water removal path having a water removal pump connected and capable of removing water from the dialysate return path, wherein the dialysate supply path is positioned upstream of the switching valve in the dialysate supply path Provided with a first flow meter or a flow switch, and a second flow meter or a flow switch at a position downstream of the switching valve in the used dialysate discharge path of the used dialysate discharge path. The hemodialyzer is characterized in that the second flow meter or the flow switch is disposed at a position unrelated to the water removal amount in the water removal path. At least one branch path is connected to the dialysate return path of the dialysate circulation path via an opening / closing valve, and the branch path is located downstream of the opening / closing valve when viewed from the dialysate return path side. The hemodialysis apparatus according to claim 1, wherein the hemodialysis apparatus is connected to a position upstream of the second flow meter or the flow switch in the spent dialysate discharge path. The hemodialysis apparatus according to claim 1 or 2, wherein the first flow meter and the second flow meter are composed of a flow meter with a flow switch.

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