WO2012053942A1 - Растворы для бикарбонатного гемодиализа - Google Patents
Растворы для бикарбонатного гемодиализа Download PDFInfo
- Publication number
- WO2012053942A1 WO2012053942A1 PCT/RU2011/000822 RU2011000822W WO2012053942A1 WO 2012053942 A1 WO2012053942 A1 WO 2012053942A1 RU 2011000822 W RU2011000822 W RU 2011000822W WO 2012053942 A1 WO2012053942 A1 WO 2012053942A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- acid
- component
- bicarbonate
- hemodialysis
- chloride
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/08—Solutions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
- A61K31/19—Carboxylic acids, e.g. valproic acid
- A61K31/194—Carboxylic acids, e.g. valproic acid having two or more carboxyl groups, e.g. succinic, maleic or phthalic acid
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K33/00—Medicinal preparations containing inorganic active ingredients
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
- A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P7/00—Drugs for disorders of the blood or the extracellular fluid
- A61P7/08—Plasma substitutes; Perfusion solutions; Dialytics or haemodialytics; Drugs for electrolytic or acid-base disorders, e.g. hypovolemic shock
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
- A61K47/02—Inorganic compounds
Definitions
- the invention relates to medicine and relates to dialysis solutions used in acute and chronic renal failure.
- the main function of the dialysis solution is the correction of the main indicators of the biochemical composition of the blood of a patient with uremia to normal physiological values. This means not only the removal of uremic metabolic products and excess electrolytes, but also the replenishment of the buffer components of the blood to restore the acid-base balance.
- the dialysis solution is formulated in such a way that its chemical composition corresponds to normal plasma with some certain deviations.
- a dialysis solution there are usually sodium, potassium, calcium, magnesium, chlorine ions, as well as a buffer component.
- acetate As a buffer component, acetate can be used, which is metabolized in the body and converted to bicarbonate, which is a natural key component of the main buffer system of the mammalian body.
- the disadvantage of using acetate in a dialysis solution is the overload of the body with acetate ions during dialysis and an increase in acidosis.
- Bicarbonate can also be used directly as a buffering component. Bicarbonate buffer base does not require intermediate metabolism.
- bicarbonate dialysis solution In a standard bicarbonate dialysis solution, the content of bicarbonate ions in the range of 30-40 mmol / L and calcium ions up to 3.5 mmol / L is allowed. It is calculated that to reduce the risk of precipitation of calcium carbonate, the pH of this solution should not exceed 7.3. For this purpose, acid is introduced into the acid component, which, when two solutions are mixed, allows you to set the required pH of the dialysis solution.
- acetic acid is used in the acidic component for bicarbonate hemodialysis.
- the plasma acetate level during such bicarbonate hemodialysis is usually not more than 0.1 mmol / L, which is much less than during acetate hemodialysis, but still higher than normal.
- the present invention provides a concentrated acidic component for bicarbonate hemodialysis containing a pH regulatory component, wherein the pH regulatory component contains hydrochloric and succinic acids.
- the ratio of hydrochloric and succinic acid can be from 3: 1 to 1: 3, for example from 2: 1 to 1: 1, in particular 2: 1.
- the concentrated acid component of the invention may also contain an acid selected from the group consisting of citric, malic, lactic and ⁇ -ketoglutaric acids, or any combination thereof.
- the concentrated acid component of the invention may further comprise glucose.
- a dilute acidic component for bicarbonate hemodialysis comprising a pH regulatory component, wherein the pH regulatory component contains hydrochloric and succinic acids.
- Such a dilute acid component can be obtained by diluting the concentrated acid component of the invention.
- the pH regulatory component may be in an amount of 3 mmol / L, with hydrochloric acid ranging from 0.1 to 2.9 mmol / L, and succinic acid ranging from 0.1 to 2, 9 mmol / l.
- a dialysis solution for bicarbonate hemodialysis is also provided, containing a pH regulatory component, where the pH regulatory component contains hydrochloric and succinic acids.
- the dialysis solution of the invention can be prepared by diluting the concentrated acid component of the invention and mixing it with bicarbonate.
- the dialysate solution according to the invention in the particular case of execution may have the following composition, mmol / l:
- a kit for bicarbonate hemodialysis is also proposed, containing electrolytes, including a pH-regulating component, where the pH-regulating component contains hydrochloric and succinic acids, and the electrolytes can be presented in dry and (or) liquid form.
- hydrochloric acid is presented in liquid form, and all other components are in dry form.
- the kit according to the invention preferably includes the following chemicals: sodium chloride NaCI, calcium chloride CaCl 2 -2H 2 0, magnesium chloride MgCl 2 -6H 2 0, potassium chloride KCI, hydrochloric acid HCI, succinic acid C 4 H 6 04 And possibly glucose.
- the kit of the invention may further comprise an acid selected from the group consisting of citric, malic, lactic and aketoglutaric acids, or any combination thereof.
- a method for producing a concentrated acid component for bicarbonate hemodialysis is also provided, in which dry chemical reagents for the acid component from the kit of the invention are dissolved in water and liquid reagents are added.
- a method for producing a dialysis solution is also provided in which the concentrated acid component for bicarbonate hemodialysis according to the invention is fed to a hemodialysis apparatus, where it is diluted and mixed with the bicarbonate component.
- the method of obtaining a dialysis solution leads to a solution of the following composition, mmol / l:
- Hemodialysis apparatuses include blood supply devices, devices for preparing and supplying a dialysis solution and a dialyzer.
- the dialysis fluid is supplied to the dialyzer from a reservoir or dispensers in which the solution is prepared immediately before use.
- the dialysis solution for bicarbonate hemodialysis is prepared from two components, each of which can be stored either as a concentrate or as a dry substance.
- composition of hemodialysis solutions corresponds to human blood in terms of osmolality, the concentration of basic ions and the value of the concentration of hydrogen ions (pH). These indicators are taken into account when drawing up the solution.
- the composition of the dialysis solution includes electrolytes, ensuring the presence of the following ions, in mmol / l:
- Sodium is usually supplied in the form of sodium chloride (NaCI), calcium in the form of calcium chloride (CaCl 2 2H 2 0), magnesium in the form of magnesium chloride (MgCl 2 -6H 2 0), potassium in the form of potassium chloride (KCI), these the salts provide the presence of a chlorine ion, and bicarbonate is supplied in the form of sodium bicarbonate (NaHCO3).
- NaCI sodium chloride
- CaCl 2 2 2H 2 0 calcium in the form of calcium chloride
- MgCl 2 -6H 2 0 magnesium in the form of magnesium chloride
- KCI potassium in the form of potassium chloride
- Such substances are standard, although, theoretically, other salts can be used as components of a solution for bicarbonate hemodialysis, and the specialist is clear what replacement can be made.
- the content of each of the components can vary, and the content of each of them has a definite effect on the progress of the hemodialysis procedure.
- Dialysis solution may also contain glucose. However, glucose-free solutions are equally applicable. An increase in the osmolarity of the dialysate due to glucose contributes to ultrafiltration. The use of dialysis solution without glucose helps to remove potassium ions from the blood of patients and reduces insulin levels. If glucose enters, then its concentration can be from 0 to 12 g / l, and is usually 11, 2 mmol / l.
- the necessary component of the dialysis solution is acid.
- this component of the dialysis solution is referred to as a “pH-regulating component”, since its purpose is to neutralize the bicarbonate ions to such a level as to prevent precipitation when mixing the components to obtain a dialysis solution before its direct use.
- the dialysis solution before its direct use is obtained by mixing the "acid component” and the "bicarbonate component”.
- the acid component includes all electrolytes except sodium bicarbonate. Sodium bicarbonate is a separate component.
- the “acidic component” and the “bicarbonate component” from which the dialysis solution for bicarbonate hemodialysis is obtained can be in the form of concentrates (referred to as “acidic component concentrate” and “bicarbonate component concentrate”, respectively). After diluting the acid concentrate with water, a “diluted acid component” is obtained.
- bicarbonate hemodialysis usually uses an acid concentrate with such an amount of acetic acid (pH-regulating component) that its concentration in the final dialysis solution is 3-4 mmol / L.
- a smaller amount of acid brings the concentration of calcium carbonate closer to the precipitation point, and even a small additional increase in pH can cause precipitation of calcium carbonate. Precipitation can also be triggered by the use of old bicarbonate concentrate or excessive loss of carbon dioxide from it.
- the central distribution systems of the dialysis solution the situation is complicated by the fact that the finished bicarbonate dialysis solution must be transported at sufficiently large distances between the central distribution point at which it is prepared and the dialysis places.
- the concentration of such a component can be up to 5 mmol / L.
- composition of the pH-regulating component may include not only acid, but also, for example, sodium acetate, which acts as a buffer and stabilizes the pH of the solution.
- the acid concentration can be reduced to 2 mmol / L.
- concentration of bicarbonate which is usually indicated by the concentrate manufacturer on the canister label, is its final concentration in the dialysis solution prepared with a specific combination of acid and bicarbonate concentrates. This means that the calculation takes into account the neutralization reaction between hydrogen ions from the acid component and the corresponding amount of bicarbonate ions from the bicarbonate component of the concentrate.
- Devices for preparing the dialysate solution concentrate are containers of various volumes, in which chemically pure water (from the water treatment system) is mixed and salt samples in a given proportion and volume.
- Dialysis water is used for dilution.
- the mixing of the acid concentrate and bicarbonate with water and the formation of a dialysis solution takes place in a hemodialysis apparatus (dialysis machine).
- kidney can be applied both to the hemodialysis apparatus itself and directly to the dialyzer, which is a part of it, in this description it is established that by “artificial kidney” is meant the whole hemodialysis apparatus.
- Standard dilution involves 1.0 L of liquid acid concentrate, 1.225 L of 8.4% sodium bicarbonate solution and 32.775 L of purified water. Although another breeding is possible.
- Modern dialysis machines have a device for connecting a dry bicarbonate cartridge instead of liquid bicarbonate concentrate.
- the hydraulic system of the dialysis machine dissolves the bicarbonate cartridge with purified water and feeds it into the mixing system instead of bicarbonate from the canister.
- the acid component concentrate
- the “artificial kidney” apparatus allows for a controlled process of blood purification from uremic toxins, regulation of water-electrolyte balance and acid-base state.
- the controllability of the blood purification procedure is achieved by choosing the parameters of blood and dialysate perfusion in the dialyzer, the speed and volume of ultrafiltration, the proportionality of mixing purified water and concentrate, dialysis temperature, etc.
- the inventors of the present invention unexpectedly found that replacing acetic acid with a mixture of hydrochloric and succinic can remove many of these problems.
- the acetic acid used earlier has the properties of a buffer, which made it possible to maintain the concentration of hydrogen ions during the hemodialysis procedure, while hydrochloric acid does not have buffer properties.
- hydrochloric acid does not have buffer properties.
- the applicant found that if in the part of the pH-regulating component that is represented by the organic acid, several different organic acids are used, tissue respiration improves. Without being limited by any theory, it can be assumed that the tricarboxylic acid cycle is stimulated, the energy output required for ATP synthesis increases, and tissue oxygen consumption increases due to increased electron transport in mitochondria.
- Obtaining a hemodialysis solution for bicarbonate hemodialysis includes the formation of a set of dry salts, their subsequent dissolution, for example at room temperature, in purified water to obtain a concentrated acid component for bicarbonate hemodialysis, this component is fed to a hemodialysis apparatus, which automatically dilutes concentrated acid and bicarbonate components in accordance with a predetermined ratio.
- Each stage of this method can be carried out separately without regard to the remaining stages.
- the concentrated acid component can be obtained from such a set in appropriate apparatuses, poured into cans, and stored or sold in a retail network.
- Salts from a set of dry salts were loaded into a tank filled with purified water for hemodialysis, a stirrer was turned on, the solution was stirred until the salts were completely dissolved, and hydrochloric acid was added. Then the volume of the resulting solution was adjusted to 100 l to obtain a concentrated solution of the acid component. In the resulting solution, the content of ions Na + , Ca ++ , Md ++ , K *, SG, C 2 H 4 (COO " ) 2 , acidity, pH, osmolarity were monitored. Before feeding the prepared acid component to the" Artificial kidney "apparatus filtering it through a filter with a pore size of 100 ⁇ m.
- the dialysis regimen was the same in both groups (3 times a week for 4.5 hours), and hemodialysis sessions were carried out according to standard methods.
- the urea level decreased from 34 mmol / l before dialysis to 25 mmol / l in the experimental group compared with the control;
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- Health & Medical Sciences (AREA)
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- Veterinary Medicine (AREA)
- Medicinal Chemistry (AREA)
- Pharmacology & Pharmacy (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Epidemiology (AREA)
- Inorganic Chemistry (AREA)
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Abstract
Description
Claims
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP11834707.9A EP2630958A4 (en) | 2010-10-18 | 2011-10-17 | SOLUTIONS FOR BICARBONATE HEMODIALYSIS |
EA201390406A EA201390406A1 (ru) | 2010-10-18 | 2011-10-17 | Растворы для бикарбонатного гемодиализа |
PCT/RU2012/000295 WO2013058674A1 (ru) | 2011-10-17 | 2012-04-17 | Раствор для бикарбонатного гемодиализа |
EA201490617A EA201490617A1 (ru) | 2010-10-18 | 2012-04-17 | Раствор для бикарбонатного гемодиализа |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
RU2010143339/15A RU2438663C1 (ru) | 2010-10-18 | 2010-10-18 | Способ получения гемодиализирующего раствора для бикарбонатного гемодиализа |
RU2010143339 | 2010-10-18 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2012053942A1 true WO2012053942A1 (ru) | 2012-04-26 |
Family
ID=45783848
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/RU2011/000822 WO2012053942A1 (ru) | 2010-10-18 | 2011-10-17 | Растворы для бикарбонатного гемодиализа |
Country Status (4)
Country | Link |
---|---|
EP (1) | EP2630958A4 (ru) |
EA (2) | EA201390406A1 (ru) |
RU (1) | RU2438663C1 (ru) |
WO (1) | WO2012053942A1 (ru) |
Families Citing this family (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
RU2536994C1 (ru) * | 2013-05-17 | 2014-12-27 | Общество С Ограниченной Ответственностью "Нпо "Нефрон" | Концентрированный кислотный компонент, набор для его получения, концентрированный раствор кислотного компонента для получения гемодиализирующего раствора и способ его получения |
Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2000023086A2 (en) | 1998-10-20 | 2000-04-27 | Advanced Renal Technologies | Buffered compositions for dialysis |
CN1634614A (zh) * | 2004-09-30 | 2005-07-06 | 广州明兴制药有限公司 | 一种无醋酸的碳酸氢盐血液透析剂 |
RU2311202C1 (ru) * | 2006-02-08 | 2007-11-27 | Общество С Ограниченной Ответственностью "Нпо "Нефрон" | Способ получения кислотного компонента для бикарбонатного гемодиализа |
JP2010042124A (ja) | 2008-08-12 | 2010-02-25 | Fuso Pharmaceutical Industries Ltd | 透析用製剤 |
WO2010055963A1 (en) * | 2008-11-17 | 2010-05-20 | Lee, Jin Tae | Manufacturing method of acetate-free dialysate composition |
-
2010
- 2010-10-18 RU RU2010143339/15A patent/RU2438663C1/ru active
-
2011
- 2011-10-17 EP EP11834707.9A patent/EP2630958A4/en not_active Withdrawn
- 2011-10-17 EA EA201390406A patent/EA201390406A1/ru unknown
- 2011-10-17 WO PCT/RU2011/000822 patent/WO2012053942A1/ru active Application Filing
-
2012
- 2012-04-17 EA EA201490617A patent/EA201490617A1/ru unknown
Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2000023086A2 (en) | 1998-10-20 | 2000-04-27 | Advanced Renal Technologies | Buffered compositions for dialysis |
CN1634614A (zh) * | 2004-09-30 | 2005-07-06 | 广州明兴制药有限公司 | 一种无醋酸的碳酸氢盐血液透析剂 |
RU2311202C1 (ru) * | 2006-02-08 | 2007-11-27 | Общество С Ограниченной Ответственностью "Нпо "Нефрон" | Способ получения кислотного компонента для бикарбонатного гемодиализа |
JP2010042124A (ja) | 2008-08-12 | 2010-02-25 | Fuso Pharmaceutical Industries Ltd | 透析用製剤 |
WO2010055963A1 (en) * | 2008-11-17 | 2010-05-20 | Lee, Jin Tae | Manufacturing method of acetate-free dialysate composition |
Non-Patent Citations (2)
Title |
---|
FOURNIER G. ET AL.: "Zamena uksusnoy kisloty na solyanuyu v bikarbonatom bufernom dializate.", ARTIFICAL ORGANS, vol. 22, no. 7, 1998, pages 608 - 613, XP055087674, Retrieved from the Internet <URL:http://www.hdl3.ru/article/1410> [retrieved on 20100827] * |
See also references of EP2630958A4 * |
Also Published As
Publication number | Publication date |
---|---|
EA201390406A1 (ru) | 2013-11-29 |
RU2438663C1 (ru) | 2012-01-10 |
EP2630958A1 (en) | 2013-08-28 |
EP2630958A4 (en) | 2014-06-18 |
EA201490617A1 (ru) | 2014-07-30 |
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