WO2023008294A1 - 透析条件設定支援装置及びプログラム - Google Patents

透析条件設定支援装置及びプログラム Download PDF

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Publication number
WO2023008294A1
WO2023008294A1 PCT/JP2022/028295 JP2022028295W WO2023008294A1 WO 2023008294 A1 WO2023008294 A1 WO 2023008294A1 JP 2022028295 W JP2022028295 W JP 2022028295W WO 2023008294 A1 WO2023008294 A1 WO 2023008294A1
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Prior art keywords
dialysis
value
conditions
support device
condition setting
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PCT/JP2022/028295
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English (en)
French (fr)
Japanese (ja)
Inventor
高広 長岡
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Medical Corp Satoni Denen Clinic
JMS Co Ltd
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Medical Corp Satoni Denen Clinic
JMS Co Ltd
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Priority to CN202280052767.1A priority Critical patent/CN117715667A/zh
Priority to JP2023538474A priority patent/JPWO2023008294A1/ja
Publication of WO2023008294A1 publication Critical patent/WO2023008294A1/ja
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
    • A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes

Definitions

  • the present invention relates to a dialysis condition setting support device and program.
  • hemodialysis treatment for dialysis patients is performed using a dialysis machine installed at the dialysis patient's bedside. Before starting dialysis treatment, it is necessary to set the dialysis conditions in the dialysis machine.
  • the dialysis conditions include the weight of the dialysis patient measured before the dialysis treatment and the values of substances contained in the blood from blood tests. It is determined based on inspection values and the like. While the dialysis treatment is being performed, the dialysis patient does not continue to receive the dialysis treatment under the same conditions, and the dialysis conditions are required to be changed according to the test values and the like each time.
  • dialysis conditions include a decrease in urine output due to a decrease in residual renal function, an increase or decrease in food intake, the state of a shunt, which is a blood vessel for dialysis that shunts arteries and veins, infection, This is because it is affected by various dynamics such as nutritional status. Dialysis conditions have been determined based on the experiences and feelings of doctors and other medical personnel for the reasons described above.
  • the body fluid volume which is the total amount of water in the patient's body
  • a mathematical model related to urea dynamics A technique related to a hemodialysis apparatus that obtains the blood velocity required to achieve a target dialysis volume by analyzing a model has been disclosed (see, for example, Patent Document 1).
  • an object of the present invention is to provide a dialysis condition setting support device and a program that takes into account individual differences among dialysis patients.
  • the present invention comprises a measured value acquiring means for acquiring a measured value, which is a post-dialysis test value obtained as a result of performing dialysis treatment on a patient under dialysis conditions set based on the first pre-dialysis test value; A theoretical value calculating means for calculating a theoretical value, which is a theoretical post-dialysis test value when dialysis treatment is performed on the patient under dialysis conditions, and calculating a difference between the theoretical value and the actual measurement value,
  • the present invention relates to a dialysis condition setting support apparatus comprising correction value storage means for storing the calculated difference as a correction value for the patient.
  • the theoretical value calculation means changes the dialysis conditions based on the second pre-dialysis test value performed after the dialysis treatment at the time of the first pre-dialysis test value.
  • a post-change theoretical value which is the theoretical value when dialysis treatment is performed on the patient under the post-change dialysis conditions, is calculated, and the calculated post-change theoretical value and the patient stored by the correction value storage means
  • Corrected predicted value calculation means for calculating a predicted value that is a post-dialysis test value when dialysis treatment is performed under the post-change dialysis conditions using the corrected value of and the corrected predicted value calculated by the corrected predicted value calculation means It is preferable to include predicted value presenting means for presenting the predicted value and the post-change dialysis conditions.
  • the test value includes a value related to a small molecular weight substance
  • the dialysis conditions are blood flow rate, total dialysate flow rate, filtration flow rate, dialysis membrane, and dialysis time.
  • Post-dialysis conditions preferably include changing the dialysis membrane.
  • the actual measurement value obtaining means obtains a post-change actual measurement obtained as a result of performing dialysis treatment on the patient under the post-change dialysis conditions based on the second pre-dialysis test value.
  • inspection value comparison means for acquiring a value and comparing the predicted value calculated by the corrected predicted value calculation means with the changed actual measurement value acquired by the actual measurement value acquisition means; and a comparison result by the inspection value comparison means.
  • factor presentation means for presenting a factor different from the dialysis conditions when the difference between the predicted value and the post-change actual measurement value is outside a predetermined range.
  • the correction value storage means stores the post-change theoretical It is preferable to calculate the difference between the value and the post-change actual measurement value, and store the calculated difference as the correction value.
  • the theoretical value calculation means calculates the theoretical value by taking into consideration the value caused by the device related to the dialysis treatment.
  • the theoretical value calculation means uses a mathematical model for the pre-dialysis test value and body weight of the patient, the overall mass transfer area coefficient, and the dialysis conditions to calculate the dialysis conditions. It is preferable to calculate the theoretical value under the conditions.
  • target value receiving means for receiving an input of target values for post-dialysis test values, the target values received by the target value receiving means, and the patient stored by the correction value storage means Based on the correction target value calculation means for calculating the correction target value using the correction value of and the second pre-dialysis test value performed after the dialysis treatment at the time of the first pre-dialysis test value, It is preferable to include condition search means for searching for a dialysis condition that achieves the correction target value calculated by the correction target value calculation means, and dialysis condition presentation means for presenting the dialysis conditions searched by the condition search means. .
  • the dialysis conditions include items related to blood flow rate, total dialysate flow rate, filtration flow rate, dialysis membrane, and dialysis time, and the setting range of each item of the dialysis conditions is stored.
  • a setting range storage unit is provided, and the condition searching unit searches for a dialysis condition that achieves the correction target value calculated by the correction target value calculation unit by changing the setting range of the setting range storage unit. is preferred.
  • the dialysis condition setting support device includes priority order acquisition means for acquiring a priority order related to the change of the dialysis conditions, and the condition search means achieves the correction target value calculated by the correction target value calculation means. It is preferable to change the dialysis conditions to be searched according to the priority order acquired by the priority order acquiring means.
  • a measured value registering means for registering the measured value acquired by the measured value acquisition means in a measured value storage unit; and reporting means for reporting.
  • the notifying means indicates that at least part of the measured values are outside the threshold range, or that the actual measured values fall continuously for a predetermined number of times or more corresponding to the items of the measured values. Alternatively, it is preferable to notify when there is an upward trend.
  • the present invention also relates to a program for causing a computer to function as a dialysis condition setting support device.
  • FIG. 1 is a diagram showing functional blocks of a dialysis condition setting support device according to a first embodiment
  • FIG. 4 is a diagram showing an example of a patient dialysis information storage unit of the dialysis condition setting support device according to the first embodiment
  • FIG. 4 is a diagram showing an example of a factor storage unit of the dialysis condition setting support device according to the first embodiment
  • FIG. 4 is a diagram for explaining an example of data related to dialysis treatment
  • FIG. 4 is a diagram for explaining an example of data related to dialysis treatment
  • FIG. 4 is a diagram for explaining an example of data related to dialysis treatment
  • FIG. 4 is a diagram for explaining an example of data related to dialysis treatment; 4 is a flowchart showing main processing of the dialysis condition setting support device according to the first embodiment; 4 is a flow chart showing correction value calculation processing of the dialysis condition setting support device according to the first embodiment. 4 is a flow chart showing predicted value presentation processing of the dialysis condition setting support device according to the first embodiment. 4 is a flow chart showing post-dialysis processing of the dialysis condition setting support device according to the first embodiment.
  • FIG. 4 is a diagram showing an example of processing in the dialysis condition setting support device according to the first embodiment;
  • FIG. 5 is a diagram showing an example of test values and factor presentations in the dialysis condition setting support device according to the first embodiment; FIG.
  • FIG. 3 is a diagram showing the relationship between the dialysis membrane, the removal rate of ⁇ 1MG, and the amount of leaked albumin.
  • FIG. 5 is a diagram showing functional blocks of a dialysis condition setting support device according to a second embodiment;
  • FIG. 10 is a diagram showing an example of a setting range storage unit of a dialysis condition setting support device according to the second embodiment;
  • FIG. 10 is a diagram showing an example of a notification target storage unit of a dialysis condition setting support device according to the second embodiment;
  • FIG. 9 is a flow chart showing main processing of the dialysis condition setting support device according to the second embodiment;
  • FIG. 11 is a flowchart showing dialysis condition presentation processing of the dialysis condition setting support device according to the second embodiment;
  • FIG. 10 is a diagram showing an example of searching for dialysis conditions in the dialysis condition presentation process;
  • FIG. 10 is a diagram showing a specific example using a search example of dialysis conditions;
  • FIG. 10 is a diagram showing a specific example using a search example of dialysis conditions;
  • FIG. 1 is a diagram showing functional blocks of a dialysis condition setting support device 1 according to the first embodiment.
  • FIG. 2 is a diagram showing an example of the patient dialysis information storage unit 32 of the dialysis condition setting support device 1 according to the first embodiment.
  • FIG. 3 is a diagram showing an example of the factor storage unit 35 of the dialysis condition setting support device 1 according to the first embodiment.
  • the dialysis condition setting support device 1 acquires test values of a patient (dialysis patient) before dialysis treatment, and obtains theoretical values, which are theoretical test values when dialysis treatment is performed under predetermined dialysis conditions, from the obtained test. calculated from the values. Then, the dialysis condition setting support device 1 acquires the actual measurement value, which is the test value of the patient after the dialysis treatment, calculates the difference from the acquired actual measurement value and the theoretical value, and uses the calculated difference as the individual difference of the patient. is a correction value for correcting In addition, when the correction value of the patient is stored, the dialysis condition setting support device 1 acquires the test value before the dialysis treatment, and then predicts when the dialysis treatment is performed under the dialysis conditions.
  • the dialysis condition setting support device 1 includes a control section 10 , a storage section 30 , an input section 41 , a display section 42 and a communication IF (interface) section 49 .
  • the control unit 10 is a central processing unit (CPU) that controls the entire dialysis condition setting support device 1 .
  • the control unit 10 reads and executes an operating system (OS) and application programs stored in the storage unit 30 as appropriate, thereby cooperating with the above-described hardware and executing various functions.
  • OS operating system
  • the control unit 10 includes an inspection value processing unit 11 and an information presentation unit 21 .
  • the test value processing unit 11 acquires test values output from a dialysis machine, a device for testing blood components (devices related to dialysis treatment, not shown), and uses the acquired test values. process.
  • the test value processing unit 11 includes a pre-dialysis test value acquisition unit 12, a dialysis condition acquisition unit 13, an actual measurement value acquisition unit 14 (actual value acquisition means), a theoretical value calculation unit 15 (theoretical value calculation means), and a correction and a value calculation processing unit 16 (correction value storage means).
  • the pre-dialysis test value acquisition unit 12 acquires the test values related to the patient's blood components, which are output from the dialysis machine, blood component test equipment, etc., before dialysis treatment.
  • the pre-dialysis test value acquisition unit 12 may acquire, for example, the test values displayed on the dialysis machine or the like by inputting them via the input unit.
  • the dialysis condition setting support device 1 may be communicably connected to, for example, a dialysis machine, and the pre-dialysis test value acquisition unit 12 may acquire test values sent by the dialysis machine or the like.
  • test values include various blood components, but here, the values of small-molecular-weight substances, low-protein substances, and albumin (Alb), which are substances to be removed by dialysis treatment, are particularly focused.
  • Small molecular weight substances are substances with a molecular weight of less than 1,000, with urea nitrogen (BUN) and creatinine (Cr) being common low molecular weight substances.
  • BUN urea nitrogen
  • Cr creatinine
  • Urea nitrogen and creatinine are substances called uremic toxins.
  • a low-protein substance is a substance with a molecular weight of about 30,000 with ⁇ 1MG (alpha-one microglobulin) as a main marker.
  • Albumin has a molecular weight of approximately 69,000.
  • the dialysis condition acquisition unit 13 acquires dialysis conditions, which are treatment conditions when performing dialysis treatment on a patient.
  • the dialysis conditions are set in the dialysis machine when performing dialysis treatment.
  • a designated dialysis membrane is set in the filtration device of the dialyzer.
  • the dialysis conditions are set in the dialysis machine or the like by a medical worker or the like according to, for example, the status of albumin, which is one of the test values related to the blood components of the patient.
  • the dialysis condition acquisition unit 13 may acquire the dialysis conditions by displaying the dialysis conditions on a dialysis machine or the like and inputting them via the input unit 41, for example.
  • the dialysis condition setting support device 1 may be communicably connected to, for example, a dialysis machine, and the dialysis condition acquisition unit 13 may acquire the dialysis conditions sent by the dialysis machine via the communication IF 49 .
  • Dialysis conditions include blood flow (QB), total dialysate flow, filtered flow (QS), dialysis time, and overall mass transfer area coefficient (KOA).
  • the overall mass transfer area coefficient is a coefficient that indicates the membrane efficiency of a dialysis membrane, and is related to the membrane area and the strength of the membrane. Therefore, dialysis conditions also include the selection of dialysis membranes.
  • the measured value acquisition unit 14 acquires test values related to the blood components of the patient after dialysis treatment under the dialysis conditions acquired by the dialysis condition acquisition unit 13 .
  • the theoretical value calculation unit 15 calculates a mathematical model based on the patient's weight before dialysis, the pre-dialysis test value acquired by the pre-dialysis test value acquisition unit 12, and the dialysis conditions acquired by the dialysis condition acquisition unit 13.
  • the theoretical value calculation unit 15 calculates the dialysis amount loss caused by a dialysis device such as a dialysis device or a blood component inspection device (due to the membrane area of the dialysis membrane, the thickness of the needle that punctures the patient's blood vessel, etc.) Correction is performed to calculate the theoretical value, which takes into account the value due to the equipment involved in the dialysis treatment. Factors caused by the dialysis device include loss of blood flow and increase/decrease in clearance due to increase/decrease in membrane area.
  • the blood flow rate is defined by the drive speed of a blood pump that is arranged and controlled in the dialysis machine.
  • the actual blood flow in the blood circuit does not equal the driving speed of the blood pump, and the actual blood flow loses about 10% or more of the set blood flow due to the driving characteristics of the blood pump. Especially at a high flow rate, this tendency becomes remarkable.
  • Another factor affecting the blood flow rate is the thickness (gauge) of the puncture needle.
  • the gauge of the puncture needle is usually determined according to the patient's shunt condition, and the finer the gauge, the greater the deviation between the blood flow rate and the actual blood flow rate.
  • the treatment efficiency of dialysis is often evaluated using the value KT/V, and the membrane area of the dialyzer is a factor that affects the dialysis efficiency.
  • small-molecule solutes including low-molecular-weight proteins
  • the amount of uremic toxins removed per unit time is small, and the target KT/V value may not be reached.
  • the correction value calculation processing unit 16 calculates the difference between the measured value obtained by the measured value obtaining unit 14 and the theoretical value calculated by the theoretical value calculating unit 15.
  • the difference may be a value obtained by subtracting the predicted value from the measured value, or may be the ratio of the difference between the measured value and the predicted value to the measured value.
  • the correction value calculation processing unit 16 stores the calculated difference in the correction value storage unit 34 as a correction value.
  • the information presenting unit 21 presents the dialysis conditions, and when there is a discrepancy between the predicted test values and the actually measured values, the information presenting unit 21 presents items considered to be factors.
  • the information presenting unit 21 includes a corrected predicted value calculating unit 22 (corrected predicted value calculating means), a predicted value presenting unit 23 (predicted value presenting means), an inspection value comparing unit 24 (inspection value comparing means), and a factor presenting unit. 25 (factor presenting means).
  • the corrected predicted value calculation unit 22 uses the theoretical value calculated by the theoretical value calculation unit 15 and the correction value calculated by the correction value calculation processing unit 16 to calculate the dialysis treatment for the patient under the dialysis conditions.
  • a predicted value which is a post-dialysis test value, is calculated.
  • the theoretical value here is the test value (theoretical value after change) when the dialysis conditions are changed, and the theoretical values are calculated according to the dialysis conditions that have various variations. Also, the predicted values are obtained by applying correction values to various theoretical values.
  • the corrected predicted value calculator 22 can calculate predicted values under various variations of dialysis conditions.
  • the dialysis conditions with various variations include not only single changes such as increase/decrease in blood flow rate, but also conditions in which multiple changes such as needle thickness, membrane area, filtration flow rate, etc. are performed simultaneously.
  • the predicted value presentation unit 23 outputs the predicted value calculated by the corrected predicted value calculation unit 22 and the dialysis conditions to the display unit 42, for example.
  • the dialysis conditions output here are the dialysis conditions that can achieve the target value, and the target value is, for example, a dialysis efficiency index (KT/V, removal rate, post-dialysis value ).
  • the dialysis conditions may include selection of a dialysis membrane and adjustment of the filtration flow rate according to the status of albumin among test values related to the patient's blood components, for example.
  • the predicted value presenting unit 23 transmits the predicted value and the dialysis conditions to the dialysis machine via the communication IF 49. may be sent.
  • the test value comparison unit 24 compares the actual measurement value (post-change actual measurement value), which is the test value after dialysis when dialysis treatment is performed under the dialysis conditions corresponding to the predicted value output by the predicted value presentation unit 23, and the predicted value. compare.
  • the factor presenting unit 25 outputs the factor stored in the factor storage unit 35 to the display unit 42 when the difference is out of the predetermined range as a result of the comparison. If the difference is outside the predetermined range, it deviates above or below the predetermined range, so an appropriate factor is presented depending on whether the comparison result is above or below the predetermined range. do.
  • the storage unit 30 is a storage area such as a hard disk or a semiconductor memory device for storing programs, data, etc. necessary for the control unit 10 to execute various processes.
  • the storage unit 30 includes a program storage unit 31 , a patient dialysis information storage unit 32 (actual measurement value storage unit), a correction value storage unit 34 and a factor storage unit 35 .
  • the program storage unit 31 is a storage area for storing various programs such as programs for executing various functions of the control unit 10 .
  • the program stored in the program storage unit 31 may be a separate program for each functional unit of the control unit 10 or a plurality of functional units, or may be a single program.
  • the patient dialysis information storage unit 32 is a storage area that stores information on patient dialysis treatment.
  • FIG. 2 exemplifies item names stored in the patient dialysis information storage unit 32 .
  • the patient dialysis information storage unit 32 stores, for example, a dialysis date, body weight, pre-dialysis test values, dialysis conditions, and post-dialysis test values as one record.
  • the dialysis date is the date on which dialysis treatment is performed.
  • Body weight is the patient's weight before dialysis.
  • the pre-dialysis test value is the test value of the patient before dialysis treatment acquired by the pre-dialysis test value acquiring unit 12 .
  • the dialysis conditions are conditions for dialysis treatment when performing dialysis treatment.
  • a post-dialysis test value is a test value of a patient after dialysis treatment according to dialysis conditions. Note that the test values described in this example are only examples, and other values such as values related to renal anemia may also be stored. Also, DW (dry weight) and the like may be stored in addition to body weight.
  • the correction value storage unit 34 in FIG. 1 is a storage area that stores the correction values calculated by the correction value calculation processing unit 16 .
  • the correction value storage unit 34 stores, for example, a dialysis date, a patient ID (IDentification), and a correction value in association with each other.
  • the factor storage unit 35 is a storage area that stores various factor information.
  • FIG. 3 shows an example of the factor storage unit 35.
  • the factor storage unit 35 stores results and factors in association with each other. There are two patterns of results: one in which the prediction failed to remove the other, and the other in the prediction. Factors are things that can happen for each outcome.
  • the input unit 41 in FIG. 1 is, for example, an input device such as a keyboard or a mouse.
  • the display unit 42 is, for example, a display device such as an LCD (Liquid Crystal Display).
  • the communication IF unit 49 is an interface for communicating with, for example, a dialysis machine or the like via a communication network or the like as necessary.
  • the computer is an information processing device having a control unit, a storage device, etc.
  • the dialysis condition setting support device 1 is an information processing device having a control unit, a storage device, etc., and is included in the concept of a computer. .
  • FIG. 4 shows dialysis conditions 50 for a certain patient (referred to as patient A).
  • the dialysis conditions 50 change the blood flow rate to perform dialysis treatment in the second month, change the dialysis membrane, blood flow rate, and filtration flow rate in the third month, and change the dialysis membrane and blood flow rate in the fourth month. was changed, and in the 5th month, dialysis treatment was performed by changing the dialysis time.
  • FIG. 5 shows laboratory values 51 for patient A.
  • the test values 51 exemplify a graph G11 of urea nitrogen (BUN) before dialysis, a graph G12 of urea nitrogen after dialysis under the dialysis conditions shown in FIG. 4, and a graph G13 of albumin (Alb).
  • FIG. 6 shows the dialysis index value 52 after patient A's dialysis treatment.
  • the dialysis index value 52 exemplifies a graph G21 of KT/V values using test values after dialysis and a graph G22 of TACBUN values.
  • the KT/V value is an index showing how much urea nitrogen has been removed from the patient's body fluid volume.
  • the TACBUN value is an index showing the average concentration of urea nitrogen (BUN).
  • the dialysis condition setting support device 1 sets the test values before dialysis at the time of dialysis treatment in the next elapsed month (the elapsed month is the 6th month) after the elapsed months shown in FIGS. For example, when the conditions are changed to increase the membrane area of the dialysis membrane, the values in the sixth month such as the graphs G12 and G13 in FIG. 5 and the graph G21 in FIG. Taking into account the dialysis amount loss characteristics associated with the deterioration of the dialysis device due to the influence and condition change, it is possible to make more accurate predictions and propose conditions that enable the goal to be achieved.
  • FIG. 7 is a flowchart showing main processing of the dialysis condition setting support device 1 according to the first embodiment.
  • FIG. 8 is a flowchart showing correction value calculation processing of the dialysis condition setting support device 1 according to the first embodiment.
  • FIG. 9 is a flowchart showing predicted value presentation processing of the dialysis condition setting support device 1 according to the first embodiment.
  • FIG. 10 is a flow chart showing post-dialysis processing of the dialysis condition setting support device 1 according to the first embodiment.
  • step S when performing dialysis treatment for a certain patient, in step S (hereinafter, "step S” is simply referred to as "S") 11 in FIG. It is checked whether or not the correction value for the patient is stored in the unit 34 . If the patient's correction value is stored (S11: YES), the control unit 10 moves the process to S13. On the other hand, if the patient's correction value is not stored (S11: NO), the control unit 10 moves the process to S12. In S12, the control unit 10 performs correction value calculation processing.
  • the control unit 10 acquires the patient's pre-dialysis test value and stores the pre-dialysis test value in the patient dialysis information storage unit 32.
  • FIG. The control unit 10 similarly acquires the weight of the patient and stores it in the patient dialysis information storage unit 32 .
  • the control unit 10 (dialysis condition acquisition unit 13 ) acquires the dialysis conditions of the patient and stores the dialysis conditions in the patient dialysis information storage unit 32 .
  • the dialysis conditions here are set by the medical staff based on their experiences and senses. At the time of the first dialysis treatment, the dialysis condition setting support device 1 does not have information regarding the patient's dialysis. Therefore, the medical staff sets the dialysis conditions based on their experiences and senses.
  • the control unit 10 calculates a theoretical value, which is a test value after dialysis, using a mathematical model.
  • the control unit 10 acquires the measured value, which is the test value after the patient has undergone dialysis treatment according to the dialysis conditions, and stores the measured value in the patient dialysis information storage unit 32.
  • the control unit 10 calculates the difference from the theoretical value and the actual measurement value, associates the calculated difference with the patient, and stores it in the correction value storage unit . After that, the control unit 10 terminates this process.
  • the control unit 10 performs a predicted value presentation process.
  • the predicted value presentation process will be described with reference to FIG.
  • the control unit 10 pre-dialysis test value acquiring unit 12
  • the control unit 10 acquires the patient's pre-dialysis test value.
  • the control unit 10 (dialysis condition acquisition unit 13 ) acquires from the patient dialysis information storage unit 32 the previous dialysis condition, which is the most recent dialysis treatment performed by the patient.
  • control unit 10 uses a mathematical model to calculate a theoretical value, which is a post-dialysis test value, using the current pre-dialysis test value and the previous dialysis conditions. .
  • the control unit 10 (correction predicted value calculation unit 22) extracts the correction value of the patient from the correction value storage unit 34, and uses the extracted correction value and the theoretical value to calculate the test value after dialysis. Calculate some prediction value.
  • the control unit 10 (predicted value presenting unit 23 ) presents the dialysis conditions and the predicted values by outputting them to the display unit 42 . At that time, the control unit 10 displays the past test values and dialysis conditions of the patient, and the current dialysis conditions and predicted values in tables and graphs, as shown in FIGS. is desirable. Moreover, it is desirable to arrange the elapsed months vertically on a single screen to make them easier to see.
  • the control unit 10 changes the dialysis conditions and determines whether or not to perform a simulation for other dialysis conditions. For example, the controller 10 determines to change the dialysis conditions by receiving an operation for making predictions under other dialysis conditions. If the dialysis conditions are to be changed (S36: YES), the controller 10 moves the process to S37. On the other hand, if the dialysis conditions are not to be changed (S36: NO), the controller 10 shifts the process to S14 of FIG.
  • the case where the dialysis conditions are not changed means, for example, the case where the dialysis treatment is performed under the presented dialysis conditions, and the medical staff performs dialysis treatment on the patient under the dialysis conditions.
  • the control unit 10 (dialysis condition acquisition unit 13) changes the currently set dialysis conditions according to the operation. After that, the control unit 10 shifts the process to S33 and makes a prediction under the changed dialysis conditions.
  • control unit 10 acquires actual measurement values, which are inspection values after the patient has undergone dialysis treatment according to the determined dialysis conditions, and stores the actual measurement values in the patient dialysis information storage unit 32. store the value.
  • control unit 10 performs post-dialysis treatment.
  • the control unit 10 compares the predicted value and the actual measurement value.
  • the control unit 10 determines whether the difference between the predicted value and the actual measurement value is within a predetermined range.
  • the predetermined range is, for example, a range in which the error rate between the predicted value and the measured value is ⁇ 20%. If the difference between the predicted value and the measured value is within the predetermined range (S42: YES), the control section 10 moves the process to S44. On the other hand, if the difference between the predicted value and the measured value is not within the predetermined range (S42: NO), the control section 10 moves the process to S43.
  • the control unit 10 (factor presentation unit 25 ) presents the factor information in the factor storage unit 35 by outputting it to the display unit 42 based on the relationship between the predicted value and the actual measurement value. After that, the control unit 10 terminates this process.
  • the control unit 10 (correction value calculation processing unit 16) calculates the difference between the theoretical value and the actual measurement value, and stores the difference as a correction value in the correction value storage unit 34 in association with the patient. After that, the control unit 10 terminates this process.
  • FIG. 11 is a diagram showing an example of processing in the dialysis condition setting support device 1 according to the first embodiment.
  • FIG. 11A shows the dialysis membrane conditions, which are part of the dialysis conditions at the time of initial dialysis, and the urea nitrogen (BUN) value, which is one of the test values.
  • the control unit 10 calculates a theoretical value from the dialysis conditions and the urea nitrogen value (test value) before dialysis.
  • the test value before dialysis is 65.3 and the calculated theoretical value is 14.1.
  • the theoretical values calculated by this calculation are merely calculated using a mathematical model, and are theoretical values that do not consider individual differences and the like.
  • the control unit 10 sets the difference between the theoretical value and the actual value as the correction value.
  • the correction value is 2.4, which is the difference between 16.5 and 14.1.
  • the correction value calculated here is stored in the correction value storage unit 34 . Note that the correction value may be a ratio.
  • FIG. 11(B) shows dialysis conditions and urea nitrogen (BUN) values during the second dialysis.
  • the dialysis conditions in this example, are changes in the dialysis membrane.
  • the control unit 10 calculates the theoretical value from the dialysis conditions and the urea nitrogen value (test value) before dialysis. In this example, the test value before dialysis is 67.3 and the calculated theoretical value is 12.8. Also, the control unit 10 (corrected predicted value calculator 22) calculates a predicted value from the theoretical value and the corrected value. The predicted value is the theoretical value with the corrected value taken into account, and is 15.2, which is the theoretical value of 12.8 plus the corrected value of 2.4.
  • the control unit 10 compares the predicted value and the actual measured value.
  • the predicted value is 15.2 and the measured value is 16.8, so the error (difference) is 1.6.
  • the error rate is -10%, which is within the predetermined range, so no factor is presented.
  • the control unit 10 uses the difference between the theoretical value and the actual measurement value as the correction value.
  • the correction value is 4.0, which is the difference between 12.8 and 16.8.
  • the correction values calculated here are accumulated and stored in the correction value storage unit 34 .
  • FIG. 12 is a diagram showing an example of test values and factor presentations in the dialysis condition setting support device 1 according to the first embodiment.
  • the test values 60 shown in FIG. 12 include a post-dialysis urea nitrogen (BUN) graph G31 up to March and a predicted value P32 for the fourth month.
  • BUN post-dialysis urea nitrogen
  • the control unit 10 determines that the actual measurement value is included outside the predetermined range. Then, the control unit 10 (factor presenting unit 25 ) outputs the factor information corresponding to the result from the factor storage unit 35 to the display unit 42 .
  • the actual measurement value is included in the region A1
  • the region A3 contains the actual measurement value it means that the urea nitrogen is removed more than expected.
  • FIG. 13 is a diagram showing the relationship between the dialysis membrane, the removal rate of ⁇ 1MG, and the amount of leaked albumin.
  • Various marks in the graph 70 of FIG. 13 indicate the performance of each dialysis membrane product.
  • a frame 71 is a dialysis difficulty improvement area
  • a frame 72 is an pruritus improvement area and a preliminary area for various symptoms
  • a frame 73 is a fingertip pinch force and a shoulder joint pain improvement area
  • a frame 74 is: Finger numbness, RLS improvement area.
  • the medical staff can determine the dialysis membrane based on the graph 70 shown in FIG. 13 as well as the dialysis conditions based on the predicted values.
  • an actual measurement value which is a post-dialysis test value obtained as a result of performing dialysis treatment on the patient under the dialysis conditions set based on the first pre-dialysis test value, is acquired, and the patient under the dialysis condition is obtained.
  • the first embodiment based on the second pre-dialysis test value performed during dialysis treatment performed a predetermined number of days after the first pre-dialysis test value, it is adjusted to the patient's condition on that day. or after changing the dialysis conditions to make the difference during dialysis treatment smaller in the case of the first pre-dialysis test value.
  • Calculate the theoretical value calculate the predicted value, which is the post-dialysis test value when dialysis treatment is performed under the changed dialysis conditions, using the calculated theoretical value after change and the patient's corrected value, and calculate the predicted value Values and post-change dialysis conditions are presented.
  • the correction value which is the difference between the theoretical value and the actual measurement value, can be used as the individual difference of the patient. Therefore, it is possible to make a prediction that considers individual differences and the like.
  • the predicted value is presented along with the dialysis conditions, it is possible to simulate the predicted value under various variations of dialysis conditions.
  • the test values include values related to small molecular weight substances
  • the dialysis conditions relate to blood flow rate, total dialysate flow rate, filtration flow rate, dialysis membrane, and dialysis time.
  • Post-dialysis conditions include changing the dialysis membrane. Therefore, when the dialysis membrane is changed, it is possible to predict the removal rate and blood concentration of small-molecular-weight substances that should be considered first in dialysis treatment.
  • the post-change actual measurement value obtained as a result of performing dialysis treatment on the patient under the post-change dialysis condition based on the second pre-dialysis test value is acquired, and the predicted value and the post-change actual measurement value are acquired. If the comparison result shows that the difference between the predicted value and the post-change measured value is outside a predetermined range, a factor different from the dialysis conditions is presented. This makes it possible to present factors different from the dialysis conditions, and prompt the medical staff to search for the etiology and to take clinical measures.
  • the difference between the predicted value and the post-change actual measurement value when the difference between the predicted value and the post-change actual measurement value is within a predetermined range, the difference between the predicted value and the post-change actual measurement value is within a predetermined range.
  • the difference from the measured value after the change is calculated, and the calculated difference is stored.
  • the correction values can be accumulated, and the accumulated correction values can be used for calculating the predicted value.
  • the theoretical value is calculated in consideration of the elements/factors caused by the equipment related to the dialysis treatment.
  • the theoretical value which is the post-dialysis test value when dialysis treatment is performed under the dialysis conditions, from the pre-dialysis test value, taking into account not only the individual difference of the patient but also the dialysis amount loss caused by the dialysis device, etc. .
  • a theoretical value under dialysis conditions is calculated using a mathematical model for the pre-dialysis test values and body weight of the patient, the overall mass transfer area coefficient, and the dialysis conditions. .
  • a theoretical value which is a post-dialysis test value when dialysis treatment is performed under dialysis conditions, can be calculated from the pre-dialysis test value.
  • FIG. 14 is a diagram showing functional blocks of a dialysis condition setting support device 201 according to the second embodiment.
  • FIG. 15 is a diagram showing an example of the setting range storage unit 236 of the dialysis condition setting support device 201 according to the second embodiment.
  • FIG. 16 is a diagram showing an example of the notification target storage unit 237 of the dialysis condition setting support device 201 according to the second embodiment.
  • the dialysis condition setting support device 201 acquires test values of the patient before dialysis treatment, and calculates theoretical values, which are theoretical test values when dialysis treatment is performed under predetermined dialysis conditions, from the obtained test values. . Then, the dialysis condition setting support device 201 acquires the actual measurement value, which is the test value of the patient after the dialysis treatment, calculates the difference from the acquired actual measurement value and the theoretical value, and uses the calculated difference as the individual difference of the patient. is a correction value for correcting In addition, when the correction value for the patient is calculated and stored, the dialysis condition setting support device 201 accepts the target value for the current dialysis treatment, acquires the test value before the dialysis treatment, and determines the correction value. is used to present dialysis conditions that achieve target values. Furthermore, the dialysis condition setting support device 201 notifies the actual measurement value, which is the test value of the patient after the dialysis treatment, according to the transition from the past.
  • the control unit 210 includes an inspection value processing unit 211 and an information presentation unit 221 .
  • the test value processing unit 211 includes a pre-dialysis test value acquisition unit 12, a dialysis condition acquisition unit 13, an actual measurement value acquisition unit 214 (measurement value acquisition means, actual measurement value registration means), a theoretical value calculation unit 15, and a correction value. and a calculation processing unit 16 .
  • the measured value acquisition unit 214 acquires measured values, which are test values related to the blood components of the patient after dialysis treatment under the dialysis conditions acquired by the dialysis condition acquisition unit 13 . Then, the measured value acquisition unit 214 registers the acquired measured values in the patient dialysis information storage unit 32 .
  • the information presenting unit 221 performs processing of presenting dialysis conditions that can achieve the received target values, and notifying actual measurement values according to the state of transition from the past.
  • the information presentation unit 221 includes a target value reception unit 226a (target value reception means), a correction target value calculation unit 226b (correction target value calculation means), a priority order acquisition unit 226c (priority order acquisition means), and a condition search unit. 226d (condition searching means), a dialysis condition presenting section 226e (dialysis condition presenting means), and a measured value notifying section 227 (notifying means).
  • the target value receiving unit 226a receives an input of a target value related to the patient's post-dialysis test value via the input unit 41, for example, before the current dialysis treatment.
  • the correction target value calculation unit 226b uses the target value received by the target value reception unit 226a and the correction value of the patient stored in the correction value storage unit 34 to calculate the correction target value.
  • the correction target value is, for example, a value obtained by subtracting the correction value from the received target value.
  • the priority order acquiring unit 226c acquires, for example, via the input unit 41, the priority order for changing the dialysis conditions.
  • the dialysis conditions include blood flow rate (QB), total dialysate flow rate (QD), filtration flow rate (QS), dialysis membrane, and dialysis time.
  • the priority order acquisition unit 226c acquires information about which item among these dialysis conditions is preferentially changed.
  • the condition searching unit 226d searches for a dialysis condition that achieves the corrected target value calculated by the corrected target value calculating unit 226b, based on the current pre-dialysis test value (second pre-dialysis test value) of the patient undergoing dialysis treatment. .
  • the condition search unit 226d searches for a dialysis condition that achieves the correction target value by changing within the setting range of the setting range storage unit 236, which will be described later.
  • the condition searching unit 226d searches for the dialysis conditions that achieve the correction target value while changing the order of priority acquired by the priority order acquiring unit 226c.
  • the dialysis condition presentation unit 226e presents the dialysis conditions searched by the condition search unit 226d by outputting them to the display unit 42, for example.
  • the actual measurement value notification unit 227 notifies via the display unit 42, for example, according to the transition status of the actual measurement value stored in the patient dialysis information storage unit 32 from the past.
  • the measured value notification unit 227 refers to the notification target stored in the notification target storage unit 237 and issues a notification. More specifically, the actual measurement value notification unit 227 determines whether at least a part of the actual measurement values are outside the threshold range of the marker in the notification target storage unit 237, or a predetermined number of times or more ( For example, when there is a downward or upward trend three times or more in succession, the transition status of the notification target may be notified.
  • the storage unit 230 includes a program storage unit 231 , a patient dialysis information storage unit 32 , a correction value storage unit 34 , a setting range storage unit 236 and a notification target storage unit 237 .
  • the program storage unit 231 is a storage area for storing various programs such as programs for executing various functions of the control unit 210 .
  • the setting range storage unit 236 is a storage area that stores the setting range of each item of the dialysis conditions.
  • FIG. 15 shows an example of the setting range storage unit 236. As shown in FIG.
  • the setting range storage unit 236 stores the number, the dialysis condition, and the setting range in association with each other. Numbers are assigned in order starting from 1 and uniquely correspond to dialysis conditions.
  • the dialysis conditions in this example are dialysis time, dialysis membrane, blood flow (QB), total dialysate flow (QD) and filtration flow (QS).
  • the setting range is a range that can be changed under each dialysis condition.
  • the dialysis time can be set within a range from 2 hours to 5 hours.
  • the setting range storage unit 236 may have information on the change width as another.
  • the range of change is, for example, that the dialysis time can be changed in units of one hour.
  • each dialysis condition corresponding to numbers 1 to 4 increases the dialysis efficiency (KT/V) as the value increases. More specifically, urea nitrogen (BUN) values are lower and dialysis efficiency (KT/V) is higher. Also, the dialysis condition corresponding to the number 5, the filtration flow rate (QS), divides from the total dialysate flow rate (QD), and increasing the value of the filtration flow rate decreases the value of the total dialysate flow rate. Therefore, dialysis efficiency (KT/V) decreases. More specifically, the urea nitrogen (BUN) value does not decrease significantly, and the dialysis efficiency (KT/V) does not increase.
  • the notification target storage unit 237 is a storage area that stores each item of the performance values to be notified.
  • FIG. 16 shows an example of the notification target storage unit 237.
  • the notification target storage unit 237 stores targets and markers in association with each other.
  • the target is a large item whose transition status should be checked as a notification target.
  • a marker is an actual value item.
  • the notification target storage unit 237 may store a threshold value to be a notification target, whether the marker is rising or falling, and the like, for each marker. Alternatively, the threshold to be notified for each marker and whether it is rising or falling may be stored in another storage area and associated with the marker in the notification target storage unit 237 .
  • FIG. 17 is a flowchart showing main processing of the dialysis condition setting support device 201 according to the second embodiment.
  • FIG. 18 is a flowchart showing dialysis condition presentation processing of the dialysis condition setting support device 201 according to the second embodiment.
  • the processing of S211 and S212 in FIG. 17 is the same as the processing of S11 and S12 in the first embodiment (FIG. 7).
  • the control unit 210 determines whether or not the change in the patient's actual value stored in the patient dialysis information storage unit 32 is to be reported. to determine. If the transition of the actual value is to be notified (S213: YES), the control unit 210 shifts the process to S214. On the other hand, if the transition of the actual value is not subject to notification (S213: NO), the control unit 210 shifts the process to S215. Note that when the number of actual measurement values stored is small (for example, two times or less), the control unit 210 may determine that the process is NO. In S214, the control unit 210 (actual value notification unit 227) performs notification processing. The control unit 210 notifies the actual measurement value to be notified by outputting it to the display unit 42 . Note that the control unit 210 may output a notification sound from an audio output unit such as a speaker (not shown), for example.
  • the control unit 210 (information presentation unit 221) performs a dialysis condition presentation process.
  • the dialysis condition presentation process will be described based on FIG.
  • the control unit 210 pre-dialysis test value acquiring unit 12 acquires the patient's pre-dialysis test value. Then, the control unit 210 stores the acquired pre-dialysis test values in the patient dialysis information storage unit 32 .
  • the control unit 210 (dialysis condition acquisition unit 13 ) acquires from the patient dialysis information storage unit 32 the previous dialysis condition, which is the most recent dialysis treatment performed by the patient.
  • the control unit 210 receives the target value of the post-dialysis test value in the current dialysis via the input unit 41.
  • the control unit 210 (correction target value calculation unit 226b) calculates the correction target value using the target value of the post-dialysis test value and the correction value of the patient stored in the correction value storage unit 34. do.
  • the control unit 210 (priority order acquisition unit 226c) acquires the priority order for changing the dialysis conditions via the input unit 41.
  • control unit 210 (condition search unit 226d) searches for a dialysis condition that achieves the correction target value.
  • the control unit 210 (the dialysis condition presenting unit 226e) presents the searched dialysis conditions by outputting them to the display unit .
  • the control unit 210 determines whether or not to decide on dialysis under the presented dialysis conditions. For example, by accepting an operation for proposing other dialysis conditions, the control unit 210 determines that a request for dialysis conditions different from the presented dialysis conditions has been made. When determining dialysis under the presented dialysis conditions (S237: YES), the control unit 210 shifts the process to S216 of FIG. On the other hand, if dialysis under the presented dialysis conditions is not decided (S237: NO), control unit 210 shifts the process to S235 to search for other dialysis conditions. It should be noted that the control unit 210 may receive, for example, through the input unit 41, information on which of the presented dialysis conditions is to be changed, or information on individual conditions such as within which range the conditions should be changed. good.
  • control unit 210 stores the determined dialysis conditions in the patient dialysis information storage unit 32.
  • control unit 210 (actual value acquiring unit 214) acquires actual measured values, which are test values after the patient has undergone dialysis treatment according to the determined dialysis conditions, and stores the actual measured values in the patient dialysis information storage unit 32. . After that, the control unit 210 terminates this process.
  • FIG. 19 is a diagram showing an example of searching for dialysis conditions in the dialysis condition presentation process.
  • 20 and 21 are diagrams showing a specific example using a search example of dialysis conditions.
  • the search example shown in FIG. 19 is a specific example of the process of S235 in FIG. 18, and
  • FIG. 19A shows a first search example 241 as an example.
  • the control unit 210 acquires the priority order of the dialysis conditions numbered 1 to 5 in the setting range storage unit 236 as the processing order 1 .
  • the control unit 210 determines whether or not the correction target value can be achieved by changing the dialysis conditions with priority 1 within the setting range. If it can be achieved, the control unit 210 proceeds to the processing order N, and if it cannot be achieved, the control unit 210 sets the dialysis conditions with the priority order of 1 to the maximum value within the set range, and then changes the processing order. Proceed to 3. As processing order 3, the control unit 210 determines whether or not the correction target value can be achieved by changing the dialysis conditions with the priority order of 2 within the setting range.
  • control unit 210 proceeds to the processing order N, and if it cannot be achieved, the control unit 210 sets the dialysis conditions with the priority order of 2 to the maximum value within the set range, and then changes the processing order. Proceed to 4. After that, the control unit 210 changes the dialysis conditions with lower priority until the condition is achieved that can achieve the correction target value. As the processing order N, the control unit 210 determines the dialysis conditions that achieve the correction target value.
  • the control unit 210 acquires the priority order of the dialysis conditions.
  • priority 1 is QB
  • priority 2 is dialysis membrane.
  • the control unit 210 changes the value of QB from 250, which is the value of QB of the most recent dialysis conditions, to 400, which is the maximum value.
  • the control unit 210 calculates the theoretical value under the changed dialysis conditions, but the correction target value is not reached.
  • the dialysis membrane value is changed from 1.5, which is the most recent dialysis membrane value, to 2.2. That is, the conditions are changed so as to increase the membrane area of the dialysis membrane.
  • the control unit 210 determines to change the QB value to 400 and the dialysis membrane value to 2.2.
  • the correction target value was achieved in the processing order 3. However, for example, if the correction target value was achieved in the processing order 2, the control unit 210 decides to change only the value of QB. do. Further, if the correction target value is not reached even if the value of the dialysis membrane is changed to 2.2 in the processing order 3, the control unit 210 increases the value of the dialysis membrane to 3.0, which is the maximum value. It is determined whether or not the correction target value is achieved by changing according to the change width. If the target value is still not reached, the control unit 210 next changes the dialysis time with priority 3 and determines whether or not the corrected target value is achieved.
  • FIG. 19B shows a second search example 242, which is an example.
  • the control unit 210 acquires the priority order of dialysis conditions numbered 1 to 5 in the setting range storage unit 236, including the type of dialysis membrane.
  • Processing order 2 and subsequent steps are the same as in the first search example 241 (FIG. 19A).
  • the control unit 210 acquires the priority order of the dialysis conditions.
  • priority 1 is film selection
  • priority 2 is QS.
  • the control unit 210 changes the membrane type from the leaky type, which is the membrane type of the most recent dialysis conditions, to the non-leaky type.
  • control unit 210 calculates the theoretical value under the changed dialysis conditions, but the correction target value is not reached.
  • the QS value is changed from 200, which is the latest QS value, to 100.
  • the control unit 210 determines to change the film type to the non-leakage type and change the value of QS to 100.
  • the dialysis condition setting support device 201 the following effects are achieved.
  • the input of the target value of the post-dialysis test value is received, and the corrected target value is calculated using the received target value and the patient's correction value, and the dialysis at the time of the first pre-dialysis test value
  • a dialysis condition that achieves the calculated corrected target value is searched based on the second pre-dialysis test value performed during the dialysis treatment that is performed after a predetermined number of days from the treatment, and the searched dialysis condition is presented. This makes it possible to present new dialysis conditions under which the patient's test values to be achieved after dialysis treatment can achieve the target values.
  • the dialysis conditions include those related to each item of blood flow rate, total dialysate flow rate, filtration flow rate, dialysis membrane, and dialysis time.
  • the setting range of the setting range storage unit that stores the setting range of each item is changed and searched. As a result, new dialysis conditions under which the target value can be achieved can be presented as dialysis conditions within an appropriate range.
  • the order of priority for changing the dialysis conditions is acquired, and the dialysis conditions for achieving the calculated correction target value are changed according to the acquired order of priority and searched.
  • the dialysis conditions can be changed according to the order of priority among the many dialysis conditions, and new dialysis conditions that can achieve the target value can be presented.
  • the measured value after the dialysis treatment is stored in the patient dialysis information storage unit 32, and a notification is given according to the transition of the stored measured value from the patient's past. Then, when at least part of the measured values are out of the threshold range, or when there is a continuous downward or upward trend, a notification is given. As a result, it is possible to inform the user that the dialysis conditions should be improved.
  • the factor information is presented based on the relationship between the predicted value and the measured value during the second and subsequent dialysis, that is, when the correction value for the patient is stored in the correction value storage unit. , but it is not limited to this.
  • the factor information may be presented based on the relationship between the theoretical value and the actual measurement value. .
  • the dialysis conditions and predicted values are presented as an example when the correction values for the patient are stored in the correction value storage unit during the second and subsequent dialysis sessions. , but not limited to. For example, it is also possible to monitor changes in past measured values and propose dialysis conditions that restore target values when an arbitrary value or rate of change is reached.
  • the dialysis conditions are changed according to the priority order, and the dialysis conditions that achieve the target value are searched for and presented. It is not limited to this.
  • the dialysis conditions may be randomly changed within a set range to search for and present dialysis conditions that achieve the target value. Then, when a plurality of dialysis conditions that achieve the target value can be presented, the dialysis conditions to be actually used may be determined from among them.
  • each patient may have a setting range storage unit.
  • the dialysis condition setting support device has been described as being a single computer, but it is not limited to this.
  • the dialysis condition setting support device may be communicably connected to the dialysis machine, for example.

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Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2011110349A (ja) * 2009-11-30 2011-06-09 Nipro Corp 血液透析装置
JP2016535644A (ja) * 2013-08-16 2016-11-17 バクスター・インターナショナル・インコーポレイテッドＢａｘｔｅｒ Ｉｎｔｅｒｎａｔｉｏｎａｌ Ｉｎｃｏｒｐ０Ｒａｔｅｄ 腎不全血液療法、特に在宅血液透析のための血清カリウムの療法予測及び最適化

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2011110349A (ja) * 2009-11-30 2011-06-09 Nipro Corp 血液透析装置
JP2016535644A (ja) * 2013-08-16 2016-11-17 バクスター・インターナショナル・インコーポレイテッドＢａｘｔｅｒ Ｉｎｔｅｒｎａｔｉｏｎａｌ Ｉｎｃｏｒｐ０Ｒａｔｅｄ 腎不全血液療法、特に在宅血液透析のための血清カリウムの療法予測及び最適化

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