WO2013175896A1

WO2013175896A1 - Dialysis unit

Info

Publication number: WO2013175896A1
Application number: PCT/JP2013/061264
Authority: WO
Inventors: 佐野　嘉彦; 満隆上田
Original assignee: ニプロ株式会社
Priority date: 2012-05-25
Filing date: 2013-04-16
Publication date: 2013-11-28
Also published as: JPWO2013175896A1

Abstract

This dialysis unit (20) has a bypass line (600) which, by having one end coupled to an intermediate area (C1) of a downstream-side dialysate line (400), and another end coupled to an intermediate area (C2) of an upstream-side dialysate line (300), is capable of introducing a portion of treated dialysate passing through the downstream-side dialysate line (400) to the upstream-side dialysate line (300). On the bypass line (600) is provided a shut-off device (700) which performs opening and closing of the bypass line (600). By way of the configuration, it is possible to mitigate the burden upon a dialysis patient at a time of hemodialysis for the dialysis patient.

Description

Dialysis unit

The present invention relates to a dialysis unit constituting an extracorporeal circuit such as hemodialysis, blood filtration, blood exchange and the like.

Conventionally, as an extracorporeal circuit for hemodialysis, a dialysis unit and a dialysis apparatus including a hemodialyzer have been used. Waste products, moisture, and other solute-removing solutes in the blood are dialyzed into fresh dialysate delivered from the dialyzer in a hemodialyzer. The treated dialysate is collected in a dialysis machine. A dialysis unit including such a hemodialyzer is disclosed in JP-A-01-62167 (Patent Document 1), JP-A-01-62168 (Patent Document 2), and JP-A-01-227763 (Patent Document 3). Is disclosed.

Typical solute-removing solutes in blood include low molecular weight solutes urea (molecular weight: 60), creatinine (molecular weight: 113.12), phosphorus (molecular weight: 98), and medium molecular weight solute vitamin B12 (molecular weight: 1355.38), myoglobin (molecular weight: about 17,200), which is a high molecular weight solute, and the like.

FIG. 5 shows the relationship between the removal rate of the solute removal solute by the hemodialyzer and the time. As shown in FIG. 5, the removal rate of the low molecular weight solute among the solute removal solutes greatly changes in about 30 minutes after the start of dialysis. This indicates that the low molecular weight solute is efficiently removed from the blood by the hemodialyzer compared to the medium molecular weight solute and the high molecular weight solute within about 30 minutes after the start of dialysis.

Japanese Patent Laid-Open No. 01-62167 Japanese Patent Laid-Open No. 01-62168 Japanese Patent Laid-Open No. 01-227763

However, if the low molecular weight solute is rapidly removed from the blood, the body fluid balance will be lost, and a large burden will be placed on the dialysis patient. In particular, among the low molecular weight solutes, various amino acids belonging to the medium molecular weight solute are also removed from the low molecular weight solute that is not originally required to be removed, which places a heavy burden on dialysis patients.

The present invention has been made in view of the above problems, and an object of the present invention is to provide a dialysis unit that makes it possible to reduce the burden on the dialysis patient during hemodialysis for the dialysis patient.

In the dialysis unit according to the present invention, a hemodialyzer having a blood inlet and a blood outlet, a dialysate inlet and a dialysate outlet, an upstream blood line connected to the blood inlet, and connected to the blood outlet A downstream blood line that is connected to the dialysate inlet and through which the fresh dialysate passes; a downstream dialysate line that is connected to the dialysate outlet and through which the treated dialysate passes; , One end is connected to an intermediate region of the downstream dialysate line, and the other end is connected to an intermediate region of the upstream dialysate line, thereby allowing the treated dialysate to pass through the downstream dialysate line. A bypass line that allows part of the gas to be introduced into the upstream dialysate line; and an opening / closing device that is provided in the bypass line and opens and closes the bypass line.

In another embodiment, the bypass line is provided with a filter that captures a solute having a predetermined molecular weight or more in the treated dialysate.

In another embodiment, the opening / closing device is a pump.
In another embodiment, the amount of the treated dialysate introduced into the upstream dialysate line is controlled by controlling the rotation speed of the pump.

According to the dialysis unit based on the present invention, it is possible to provide a dialysis unit that makes it possible to reduce the burden on the dialysis patient during hemodialysis on the dialysis patient.

It is a figure which shows the extracorporeal circuit which employ | adopted the dialysis unit in embodiment. It is a figure which shows the relationship between the removal rate at the time of using the extracorporeal circuit which employ | adopted the dialysis unit in embodiment, and time. It is a figure which shows the extracorporeal circuit which employ | adopted the other dialysis unit in embodiment. It is a figure which shows the relationship between the removal rate at the time of using the extracorporeal circuit which employ | adopted the other dialysis unit in embodiment, and time. It is a figure which shows the relationship between the removal rate at the time of using the dialysis unit in background art, and time.

Hereinafter, in each embodiment, a dialysis unit and an extracorporeal circuit according to the present invention will be described with reference to the drawings. In each embodiment described below, when referring to the number, amount, and the like, the scope of the present invention is not necessarily limited to the number, amount, and the like unless otherwise specified. It is planned from the beginning to use a combination of the configurations appearing in each embodiment as appropriate.

(Embodiment 1)
Hereinafter, the extracorporeal circuit 10 used for hemodialysis in the present embodiment will be described with reference to FIG. FIG. 1 is a diagram showing an extracorporeal circuit using the dialysis unit in the present embodiment.

The extracorporeal circuit 10 in this embodiment includes a dialysis unit 20 and a dialysis device 30. The dialysis unit 20 includes a hemodialyzer 100, a blood circuit having an upstream blood line 140 and a downstream blood line 150, and a dialysate circuit having an upstream dialysate line 300 and a downstream dialysate line 400.

The hemodialyzer 100 has a blood inlet BF1 and a blood outlet BF2, and a dialysate inlet DF1 and a dialysate outlet DF2. Inside the hemodialyzer 100, a filter 130 using a hollow fiber filter or the like is attached, and a blood flow channel region 110 and a dialysate flow channel region 120 are formed.

In the hemodialyzer 100, when a hollow fiber filter is used as the filter 130, blood flows inside the hollow fiber filter, and fresh dialysate flows outside the hollow fiber filter in the direction opposite to the blood flow. . Dialysis is performed between blood and fresh dialysate using this hollow fiber filter.

One end of the upstream blood line 140 is connected to the blood inlet BF1 of the hemodialyzer 100. An arterial puncture needle (not shown) is provided at the other end of the upstream blood line 140. The arterial puncture needle is punctured into an arteriovenous shunt of a dialysis patient.

One end of the downstream blood line 150 is connected to the blood outlet BF2 of the hemodialyzer 100. A vein puncture needle (not shown) is provided at the other end of the downstream blood line 150. The venous puncture needle is punctured into a vein of a dialysis patient.

In the blood circuit, the upstream blood line 140 or the downstream blood line 150 is provided with a blood pump (not shown).

One end of the upstream dialysate line 300 is connected to the dialysate inlet DF1 of the hemodialyzer 100. The other end of the upstream dialysate line 300 is connected to the dialysate outlet DM1 of the dialyzer 30. Fresh dialysate is led out from the dialyzer 30 to the upstream dialysate line 300.

One end of the downstream dialysate line 400 is connected to the dialysate outlet DF2 of the hemodialyzer 100. The other end of the downstream dialysate line 400 is connected to the dialysate inlet DM2 of the dialyzer 30. The treated dialysate is introduced into the dialyzer 30 from the downstream dialysate line 400.

In the dialysate circuit, in this embodiment, a roller pump 500 is provided in the downstream dialysate line 400. The position where the roller pump 500 is provided is not limited to the downstream dialysate line 400, and may be inside the upstream dialysate line 300 or the dialyzer 30.

In the dialysis unit 20 according to the present embodiment, a bypass line 600 is provided in which one end is connected to the middle region C1 of the downstream dialysate line 400 and the other end is connected to the middle region C2 of the upstream dialysate line 300. ing. This bypass line 600 allows a part of the treated dialysate passing through the downstream dialysate line 400 to be introduced into the upstream dialysate line 300.

The bypass line 600 is provided with an opening / closing device 700 that controls the introduction of the treated dialysate into the upstream dialysate line 300 by opening and closing the bypass line 600. As an example of the opening / closing device 700, a roller pump is provided in the present embodiment. The opening / closing device 700 is not limited to the roller pump 700 but may be an opening / closing device having a clamp mechanism.

FIG. 2 shows the relationship between the removal rate and time when the extracorporeal circuit 10 having the above configuration is used. Consider a case where a 550 ml / min dialysate is allowed to flow through the dialysate channel region 120 of the hemodialyzer 100. A control device 900 is used to control the bypass line 600 so that a 50 ml / min treated dialysate is sent from the downstream dialysate line 400 to the upstream dialysate line 300 by the switch 700.

Therefore, the amount of fresh dialysate drawn from the dialyzer 30 to the upstream dialysate line 300 and the amount of treated dialysate introduced from the downstream dialysate line 400 to the dialyzer 30 are each 500 ml / min. It becomes.

In this way, by returning a part of the treated dialysate once derived from the hemodialyzer 100 to the upstream dialysate line 300, as shown in FIG. 2, the solute removal solute removal rate in the blood is lowered. It becomes possible to make it. Thereby, the collapse of the body fluid balance of the dialysis patient is relieved.
Thereby, it becomes possible to reduce the burden given to a dialysis patient.

Line L1p, line L2P, and line L3P in FIG. 2 remove low molecular weight solute, medium molecular weight solute, and high molecular weight solute when a portion of the treated dialysate is not returned to the upstream dialysate line 300. This is a line indicating the relationship between rate and time, and is the same as the line shown in FIG. On the other hand, the line L1a, the line L2a, and the line L3a in FIG. 2 are low molecular weight solute, medium molecular weight solute, and high molecular weight solute when a part of the treated dialysate is returned to the upstream dialysate line 300. It is a line which shows the relationship between the removal rate of time and time.

The amount of the treated dialysate introduced from the downstream dialysate line 400 into the dialyzer 30 can be controlled by the opening / closing device 700 using the control device 900. As a result, it is possible to flexibly cope with the condition of the dialysis patient, and hemodialysis can be performed while taking into consideration the physical condition of the dialysis patient.

For example, in order to reduce the removal rate for the first 30 minutes, the amount of the treated dialysate introduced into the dialyzer 30 from the downstream dialysate line 400 is increased. Thereby, the collapse of the body fluid balance is alleviated and the burden on the dialysis patient is reduced. Next, after the change in the removal rate of the molecular weight solute, the medium molecular weight solute, and the high molecular weight solute is stabilized, the treated dialysis introduced from the downstream dialysate line 400 to the dialyzer 30 to increase the removal rate. Control of the opening / closing device 700 for reducing the amount of liquid is performed using the control device 900.

Such control of the opening / closing device 700 can be easily performed by executing programming by storing the control flow in the control device 900 in advance. For example, there is a method in which the treatment time is plotted on the horizontal axis and the rotation speed or flow rate of the roller pump (opening / closing device 700) is plotted on the vertical axis so that the rotation speed or flow rate of the roller pump at the elapsed time can be set in advance.

(An extracorporeal circuit 10A having another configuration)
In the dialysis unit 20 used in the extracorporeal circuit 10 in the above embodiment, the removal rate is reduced in all of the low molecular weight solute, the medium molecular weight solute, and the high molecular weight solute as shown in FIG. The reason for suddenly losing the balance of body fluid is that the removal rate of low molecular weight solutes is larger than that of medium molecular weight solutes and high molecular weight solutes within a fixed time from the start of hemodialysis.

In an extracorporeal circuit 10A employing an extracorporeal circuit 10A having another configuration shown in FIG. 3, in the extracorporeal circuit 10A, a filter 800 that captures a solute having a predetermined molecular weight or more in the treated dialysate in the bypass line 600. Is used. In the present embodiment, a filter 800 that passes a low molecular weight solute and captures a medium molecular weight solute and a high molecular weight solute is used. For example, as the filter 800, there is a CTA (cellulose triacetate) membrane manufactured by Nipro Corporation used for hemodialyzers, or a Nipro precision ultrafiltration filter CF-609 used for cleaning dialysate.

As shown in FIG. 4, it is possible to reduce only the removal rate of low molecular weight solutes and increase the removal rate of high molecular weight solutes and medium molecular weight solutes. Thereby, the collapse of the body fluid balance is alleviated. As a result, it is possible to suppress an increase in dialysis time while reducing the burden on the dialysis patient.

As mentioned above, although embodiment of this invention was described, it should be thought that embodiment disclosed this time is an illustration and restrictive at no points. The scope of the present invention is defined by the terms of the claims, and is intended to include any modifications within the scope and meaning equivalent to the terms of the claims.

10, 10A extracorporeal circuit, 20 dialysis unit, 30 dialysis machine, 100 hemodialyzer, 110 blood channel region, 120 dialysate channel region, 130,800 filter, 140 upstream blood line, 150 downstream blood line, 300 upstream dialysate line, 400 downstream dialysate line, 500,700 roller pump (opening / closing device), 600 bypass line, 900 control device, BF1 blood inlet, BF2 blood outlet, C1, C2 halfway region, DF1 dialysate inlet , DF2 dialysate outlet, DM1 dialysate outlet, DM2 dialysate inlet.

Claims

A hemodialyzer having a blood inlet and a blood outlet, and a dialysate inlet and a dialysate outlet;
An upstream blood line connected to the blood inlet;
A downstream blood line connected to the blood outlet;
An upstream dialysate line connected to the dialysate inlet and through which fresh dialysate passes;
A downstream dialysate line connected to the dialysate outlet and through which the treated dialysate passes;
One end of the treated dialysate passing through the downstream dialysate line is connected to one end of the downstream dialysate line and the other end is connected to the midrange of the upstream dialysate line. A bypass line that allows introduction of a part into the upstream dialysate line;
A dialysis unit comprising: an opening / closing device provided in the bypass line, for opening and closing the bypass line.
The dialysis unit according to claim 1, wherein the bypass line is provided with a filter for capturing a solute having a predetermined molecular weight or more in the treated dialysate.
The dialysis unit according to claim 1 or 2, wherein the opening / closing device is a pump.
The dialysis unit according to claim 3, wherein an amount of the treated dialysate introduced into the upstream dialysate line is controlled by controlling a rotation speed of the pump.