JPH04189364A - Peritodialysis apparatus - Google Patents

Abstract

PURPOSE:To allow the continuous execution of peritodialysis by coupling the 1st chamber of a 1st dialyzer segmented by a 1st dialysis, membrane and the 3rd chamber of a 2nd dialyzer internally segmented by a 2nd dialysis membrane and connecting these chambers respectively to the 2nd chamber and 4th chambers on the filtrate side of the 1st dialyzer and the 2nd dialyzer. CONSTITUTION:This apparatus is segmented to the 1st chamber and the 2nd chamber by the 1st dialysis membrane 9. The 1st chamber is connected to a 1st conduit 11 which supplies the dialyzate in the peritoneum 1 and a 2nd conduit 12 to allow the passage of the dialyzate and discharges the same. On the other hand, the 2nd chamber 6 is connected to a fresh dialyzate supply conduit 14 into which the fresh dialyzate is admitted from a fresh dialyzate container 4 by a pump 21 and a cleaned dialyzate discharge conduit 16 which discharges the cleaned dialyzate formed by permeating a part of the metabolite in the peritodialyzate through the 1st dialysis membrane 9 to incorporate the same into the fresh dialyzate by a pump 23. The pore size of the 1st dialysis membrane 9 is specified to 20 to 1000Angstrom and the pore size of the 2nd dialysis membrane 5 to 10 to 300Angstrom smaller than the pore size of the 1st dialysis membrane 9.

Description

[Detailed description of the invention] [Industrial application field]

The present invention relates to a peritoneal dialysis device, and more specifically, the present invention relates to a peritoneal dialysis device that supplies peritoneal dialysate to at least two dialyzers with different membrane pore diameters, returns the dialysate to the peritoneal cavity, and is capable of performing dialysis even while stationary at night. Concerning continuous recirculation peritoneal dialysis equipment.

[Conventional technology]

Continuous peritoneal dialysis (CAPD) is a continuous artificial kidney treatment.
) and continuous hemofiltration (C) for patients with acute renal failure.
HF) etc. are known. Their daily clearance of low molecular weight substances, such as urea, is 1
The dialysis fluid is changed 2 times a day, and the amount of water removed is 2 times! However, the maximum rate is 10ρ/day. In addition, in CIIF using a replacement fluid, the blood concentration of urea is reduced to 1
00mg/Vl! The amount of replacement fluid required to maintain the following is at least 10! /day is required. Furthermore, in hemodialysis (HD), which is an intermittent treatment, blood urea nitrogen (IIIJN)
Clearance of 150 mf/min, 3 times a week, 4 times a day
Calculating the daily clearance from the cumulative clearance for one week during time dialysis results in an equivalent of 15.4 g/day. In other words, the performance of current artificial kidneys is at most 10 to 15 ρ/
This is far below the daily clearance of urea in the kidneys of a living body, which is said to be 1,701 days. This corresponds to a state in which one kidney has been abolished and more than 415 organs in the remaining kidney have ceased to function, and there has been a demand for the development of an artificial kidney that approaches the performance of a living kidney as much as possible. On the other hand, in hemodialysis (IID), one week 3 in Figure 5
The human body's blood urea nitrogen (BU) after dialysis for 4 hours a day
As shown in the diagram showing the change in N), the IIUN value is large (fluctuating), and this fluctuation is the cause of all complications.

[Problems to be Solved by the Invention] In order to solve the problems of the current artificial kidneys, it is essential to develop an artificial kidney system with continuous treatment. To this end, it is essential to have an artificial kidney that can be used to treat patients while they are active during the day, and dialysis can be performed while the patient is asleep at night. As a result of intensive research in order to solve this problem, the present inventors used a small and portable peritoneal filtration device that combines continuous recirculation peritoneal dialysis and a filter during the daytime, and at night, the peritoneal filtration device used during the day was used. He discovered that by flowing dialysate into the filtrate side of the membrane and using it as a dialyzer, treatment could be performed intermittently day and night, and he has already filed a patent application for a small peritoneal filtration device for daytime use. The present invention relates to a peritoneal dialysis device used during rest at night or for home dialysis. JP-A-60-150758 is known as a peritoneal dialysis device that combines peritoneal dialysis and a dialyzer. This device performs dialysis by adding an osmotic substance such as glucose to the dialysate so as not to apply negative pressure to the patient, but glucose irritates the abdominal cavity and risks causing diabetes. An object of the present invention is to provide a peritoneal dialysis device that allows continuous peritoneal dialysis without adding such an osmotic substance to the dialysate. Still another object of the present invention is to provide a cartridge-type peritoneal dialysis device that can be easily changed intermittently to be a compact and portable peritoneal filtration device that can perform artificial kidney treatment during the daytime. [Means for Solving the Problems] That is, the present invention provides a peritoneal dialysis device comprising a peritoneal cavity, at least two dialyzers, and a conduit connecting them. A first chamber of a first dialyzer is divided by a first dialysis membrane, and a second chamber of a second dialyzer is internally divided by a second dialysis membrane, which is a microporous membrane having a smaller pore diameter than the first dialysis membrane. a closed circuit formed by a third chamber and a conduit connecting them; and a dialysate conditioning device connected to the second and fourth chambers, which are filtrate sides of the first dialyzer and second dialyzer, respectively. This is a lIx membrane dialysis device consisting of: Further, in the peritoneal dialysis apparatus of the present invention, the dialysate adjusting device includes respective conduits for supplying fresh dialysate from the fresh dialysate container to the second chamber and the fourth chamber, and
This is a peritoneal dialysis device consisting of conduits through which the dialysate that has passed through each chamber is discharged. Furthermore, the present invention provides the peritoneal dialysis apparatus, in which the dialysate adjustment device includes a first dialysate container and a second dialysate container that contain dialysate, a second chamber and a fourth chamber, and a first dialysate container and a second dialysate container. 2 conduits for discharging the dialysate from the dialysate containers to the second and fourth chambers, respectively, and dialysate that has passed through the second and fourth chambers, respectively, is connected to the first dialysate container and the second dialysate. A peritoneal dialysis device consisting of a closed circuit formed by a reservoir conduit that flows into a container. Furthermore, in the peritoneal dialysis apparatus of the present invention, the first dialysis membrane has a pore diameter of 20 to 1,000 pores, and the second dialysis membrane has a pore diameter of 10 to 300 pores! It is a membrane dialysis device.

[Effect]

In the present invention, fresh dialysate supplied into the peritoneal cavity comes into contact with blood through the peritoneum, and the peritoneum acts as a permeable membrane to allow metabolic products in the blood to permeate into the peritoneal cavity, thereby converting the peritoneal dialysate into peritoneal dialysate. Become. The peritoneal dialysate is supplied to the first chamber of the first dialyzer, and a portion of the metabolic products are permeated through the dialysate and the first dialysis membrane. The peritoneal dialysate that has passed through the first dialyzer is then supplied to the third chamber of the second dialyzer, and is contained in the peritoneal dialysate via the dialysate that passes through the fourth chamber and the second dialysis membrane. It allows some of the metabolic products that are present to pass through. The peritoneal dialysate that has passed through the third chamber of the second dialyzer then returns to the peritoneal cavity. Dialysis is performed while the dialysate is circulated in the second and fourth chambers, which are the filtrate sides of the first dialyzer and the second dialyzer, respectively.

【Example】

An example of the present invention will be described below with reference to Examples. FIGS. 1 and 2 are explanatory diagrams showing an example of the peritoneal dialysis device of the present invention, and FIG. 3 is an explanatory diagram showing an example of the peritoneal filtration device used during the day when the peritoneal dialysis device of the present invention is used at night. FIG. 4 is a diagram showing the state in which the peritoneal filtration device of FIG. 3 is carried on a human body, and FIG. It is. In the figure, 1 is the peritoneal cavity, 2 is the first dialyzer, 3 is the second dialyzer, 4 is the new dialysate container, 5 is the first chamber, 6 is the second chamber, 7 is the third chamber, and 8 is the fourth chamber. chamber, 9 is the first dialysis membrane, 10 is the second dialysis membrane, 1
1 is a first conduit, 12 is a second conduit, 13 is a third conduit, 14
and 15 are fresh dialysate supply conduits, 16 and 17 are purified dialysate discharge conduits, 18-25 are pumps, 26-29 are valves, 31 is a first dialysate container, 32 is a second dialysate container, 33 and 34 denotes a purified dialysate discharge conduit pipe, 35 and 36 a purified dialysate partial discharge conduit, and > indicates a discharged fluid storage bag. In FIG. 1, a predetermined amount of sterilized fresh dialysate =7- or peritoneal dialysate that has been peritoneally filtered during the day is accommodated in the peritoneal cavity 1. In the peritoneal cavity 1, the dialysate comes into contact with blood through the peritoneum, and metabolic products in the blood permeate into the peritoneal cavity to become a peritoneal dialysate. Although a predetermined amount of an osmotically active substance such as glucose may be added to the dialysate in advance to prevent negative pressure in the peritoneal cavity, the peritoneal dialysis apparatus of the present invention allows peritoneal dialysis to be performed without adding glucose. This causes less irritation to the peritoneum and eliminates the cause of diabetes. In FIG. 1, the peritoneal cavity 1 has two conduits, a first conduit 11 for outflowing the peritoneal dialysate and a third conduit 13 for inflowing the returned dialysate returned from the second dialyzer 3. Although shown connected, the conduit connection to the peritoneal cavity is preferably a single conduit connection to prevent entry of external bacteria into the peritoneal cavity. That is, the dialysate inlet and outlet are double lumen separated from the peritoneal cavity.
A conduit formed from a catheter or the like is preferred. Peritoneal dialysate is supplied to the first chamber 5 of the first dialyzer 2 via the first conduit 11 by the pump 18 . The pump used in the wood-invented peritoneal dialysis machine is a mini-pump or roller clamp. The first dialyzer 2 is divided into a first chamber and a second chamber by a first dialysis membrane 9, and the first chamber has a first conduit 11 through which peritoneal dialysate is supplied, and a first conduit 11 through which the dialysate passes. It is connected to the second conduit 12 to be delivered. On the other hand, the second chamber 6 has a fresh dialysate supply conduit 14 into which fresh dialysate flows from the fresh dialysate container 4 by a pump 21, and a part of the metabolic products in the peritoneal dialysate through the first dialysis membrane 9. A purified dialysate discharge conduit 16 is connected to the pump 23 for discharging the purified dialysate which has been permeated and is contained in the fresh dialysate. As the first dialysis membrane 9 and the second dialysis membrane 10, flat membrane filters, plate-shaped, coil-shaped, or hollow fiber-shaped membranes are used. The first dialysis membrane 9 has a pore size of 20 to 1000 pores, preferably 100 to 200 pores. If the pore size is less than 20, the dialysis efficiency tends to decrease, and if it exceeds 1,000, albumin tends to be lost and hypoproteinemia occurs. The peritoneal dialysate, which has passed through the first dialysis membrane 9 in the first chamber 5 of the first dialyzer 2 and removes the filtrate containing a portion of metabolic products, is passed through the second conduit 12 by a pump 19 to the second dialyzer 3. the third
Moved to room 7. The second dialyzer 3 is divided into a third chamber and a fourth chamber by a second dialysis tube 10. The third chamber 7 is connected to a second conduit 12 through which the peritoneal dialysate flows from the first chamber 5 of the first dialyzer, and a third conduit 13 through which the dialysate flows out. On the other hand, the fourth chamber 8 has a fresh dialysate supply conduit 15 into which fresh dialysate flows from the fresh dialysate container 4 by a pump 22, and a part of the metabolic products in the peritoneal dialysate through the second dialysis membrane 10. A purified dialysate discharge conduit 1 that discharges the purified dialysate that has been permeated and is contained in the fresh dialysate by a pump 24
7 are joined. The pore diameter of the second dialysis membrane 5 is smaller than that of the first dialysis membrane 9, 10 to 3
00 people, preferably 30 to 100 people. Pore diameter is 10
If it is less than 30 people, dialysis efficiency tends to decrease, and
When it exceeds 0, large and medium molecular weight substances such as β2-microglobulin tend to pass through. The peritoneal dialysate flowing out of the third chamber 7 of the second dialyzer 3 is returned to the peritoneal cavity 1 via the third conduit 13 by the pump 20 . Since the peritoneal dialysis apparatus of the present invention can easily inject medicinal fluid into the circulating dialysate, it can be applied to various medical treatments. For example, the glucose concentration of the circulating dialysate can be measured and insulin can be injected into the pipe of the circulating dialysate to treat diabetic patients, acting as an artificial pancreas. It can be installed in the second conduit 12 between the dialyzer 2 and the second dialyzer 3 to adsorb bilirubin, bile acids, etc. in the circulating dialysate, and play a role in supporting the liver. These applications involve injecting and dispensing medicinal solutions into the dialysate, rather than directly injecting or dispensing them into the blood. It is possible to safely and quickly respond by replacing the module. In this example, the peritoneal dialysis apparatus of the present invention was explained by combining peritoneal dialysis and two dialyzers. = 11- separation of metabolic products can be made even more rigorous. FIG. 2 is an explanatory diagram showing another embodiment of the peritoneal dialysis apparatus of the present invention, in which a fresh dialysate supply device is provided on the filtrate side of the first dialyzer 2 and the second dialyzer 3 in the peritoneal dialysis apparatus of FIG. This is a peritoneal dialysis device that uses a cycler for dialysis. That is, the first dialyzer 2 is placed in the second chamber 6 on the filtrate side of the first dialyzer 2.
The dialysate is pumped from the dialysate container 31 to the conduit 3 by the pump 24.
The purified dialysate flows into the conduit 38 after dialysis.
The dialysate is then returned to the dialysate storage container 31. Part of the purified dialysate may be discharged from the conduit 35 if necessary, but most of the purified dialysate is discharged from the second chamber 6 of the first dialyzer 2 and the first dialysate container 3.
It circulates in a closed circuit formed by 1 and 1. The volume ratio at which the purified dialysate is discharged at that time is adjusted by the degree of opening of the valve 27 and hole valve 26 provided in the conduit 35 and the conduit 38. The same applies to the dialysate flowing into the fourth chamber 8 on the filtrate side of the second dialyzer 32, and the second dialysate container 32 and the fourth chamber 8
The conduits 39 and 40 connecting the two form a closed circuit in which purified dialysate circulates. Then, if necessary, a partially purified dialysate is discharged from the conduit 36 by adjusting the apertures of the valves 28 and 29. The peritoneal dialysis apparatus of the present invention is generally used during rest at night or for home dialysis, but when performing treatment while active during the day, for example, the peritoneal filtration apparatus shown in FIG. 3 is used. FIG. 3 is an explanatory diagram of a small, portable peritoneal filtration device that can be used for treatment while active during the day. The sterilized fresh dialysate supplied from the conduit 65 into the peritoneal cavity 50 permeates metabolic products in the blood through the peritoneum and becomes a peritoneal dialysate. Peritoneal dialysate is supplied by a pump 66 to the first chamber 56 of the first dialyzer 52 through the first conduit. The first filter 52 is the first
It is divided into a first chamber and a second chamber by a filtration membrane 54,
The first chamber is connected with a first conduit barb, through which the peritoneal dialysate is supplied, and with a second conduit 61, through which the dialysate flows out. On the other hand, the second chamber is a chamber in which the first filtrate obtained by filtering the peritoneal dialysate through the first filtration membrane 54 is stored, and the third chamber 58 of the second filter 53 and the third chamber 58 of the second filter 53 to which the first filtrate is transferred. 4 conduits 63. As the first filter 52 and the second filter 53, the first dialyzer 2 and the second dialyzer 3 shown in FIG. 1 can be used as they are. A peritoneal filtration device can be easily formed by fitting or screwing predetermined conduits to these dialyzers. The first filtration membrane 54 and the second filtration membrane 55 are flat membrane filters, plate-shaped, coil-shaped, or hollow fiber-shaped membranes, and the first filtration membrane 54 has a pore diameter of 20 to 1000, preferably 100 to 100. There are 200 people. The peritoneal dialysate, which has been filtered through the first filter membrane 54 in the first chamber 56 of the first filter 52 and removes the filtrate containing metabolic products, is transferred to the second chamber 56 of the first filter 52.
It is transferred to the fourth chamber 59 of the second filter 53 via the conduit 61. On the other hand, the first filtrate in the second chamber 57 of the first filter 52 is supplied to the third chamber 58 of the second filter 53 via the fourth conduit 63 by a pump 68. The 1st a liquid passes through the 2nd i1 5
5 to become a second filtrate. The 2'm filter 53 is divided into a third chamber and a fourth chamber by a second filter membrane 55. The third chamber 58 includes a fourth conduit 63 into which the first filtrate from the second chamber 57 of the first filter flows, and a first filtrate discharge conduit 6 through which a portion of the first filtrate that has flowed in is discharged.
It is joined with 4. The volume of the first filtrate discharged is the amount of metabolic products in the blood that have permeated through the peritoneum in the abdominal cavity 50,
For example, the capacity is equal to or greater than the capacity of the component. The volume of circulating peritoneal dialysate is maintained approximately constant by first discharging a portion of the filtrate (within the peritoneal cavity).
Blood and dialysis are performed through a 1M membrane, and metabolic products in the blood are mixed with intraperitoneal dialysis overnight. A portion of the first filtrate is discharged from the discharge conduit 64 by the pump 69, but if necessary, the discharged fluid may be accommodated in a discharged fluid storage housing 37 as shown in FIG. The fourth chamber 59 has a second conduit 61 into which the peritoneal dialysate from the first chamber 56 of the first filter 52 flows, and a first conduit 61 in the third chamber 58.
A third conduit 62 is connected to a third conduit 62 through which a mixed liquid of the second filtrate obtained by filtering the filtrate through the second filtration membrane 55 and the 11M intraluminal dialysate that has flowed into the fourth chamber 59 flows out. . The second filtration membrane 55 has a pore size of 10 to 300 pores, preferably 30 to 100 pores. The mixed liquid of the peritoneal dialysate and the second filtration fluid flowing out from the fourth chamber 59 of the second filter 53 is returned to the peritoneal cavity 50 via the third conduit 62 by the pump 67 . FIG. 4 shows the abdominal llU filtration device of FIG. 3 carried on the human body, and the present invention I
l! By carrying the membrane filtration device and attaching the effluent-containing bathogummy to the thigh, the patient can perform peritoneal dialysis while being active during the day. The recorder attached to the main body allows the patient to easily see the cumulative amount of water removed, allowing the patient to adjust the amount of water removed based on experience and intuition. By continuously using the peritoneal dialysis apparatus of the present invention while the peritoneal dialysis apparatus of the present invention is stationary at night and the peritoneal filtration apparatus shown in FIG. 3 during daytime activities, dialysis can be performed continuously day and night. Dialyzer replacement is preferably carried out periodically, for example every day when transitioning from night to day. The peritoneal dialysis device of the present invention used at night removes low molecular weight substances such as urea, and the peritoneal filtration device as shown in FIG. 3 used during the day removes medium and high molecular weight substances such as β2-microglobulin. Tend. Example 1 In the peritoneal dialysis apparatus shown in FIG. 1, 2p of fresh dialysate was injected into the peritoneal cavity. The pore size of the dialysis membrane of the first dialyzer is 14
For 0 people, the membrane area is 0.2 + r. The second dialyzer
The pore size of the dialysis membrane was 35, and the membrane area was 0.2 n (dialysis).The circulating dialysate flow rate was 100 mρ/min, and the fresh dialysate flow rate was 100 m1/min for 8 hours. The peritoneal filtration device shown in Figure 3 was used.
As the filter and the second filter, the first dialyzer and the second dialyzer used at night were used. The filtrate flow rate of the first filter is 40
Filtration was carried out for 16 hours a day at a mQ of 1 minute, a filtrate flow rate of 3 FJm1/min, and a water removal flow rate of 2 mβ/min. The clearances of urea and β2-microglobulin (hereinafter referred to as BMG) obtained are shown in Table 1. As Comparative Example 1, when current hemodialysis was performed at a blood flow rate of 150 s/min, 3 times a week for 4 hours each time, the clearance of the metabolic product was calculated by converting the cumulative clearance of one week to the daily clearance. did. Since most of the urea in Table 1 is removed by the peritoneal dialysis device of the present invention that performs peritoneal dialysis during rest at night, even if the dialysis time in the peritoneal filtration device of FIG. The dialysis machine has about four times the performance compared to current hemodialysis (110).

【effect】

The peritoneal dialysis apparatus of the present invention can remove a large amount of low molecular weight substances such as urea and can easily adjust electrolytes. Furthermore, dialysis can be performed without adding an osmotic substance such as glucose to the peritoneal dialysis device, and there is less irritation to the peritoneum and diabetes can be prevented. By using it in conjunction with a small, portable peritoneal filtration device that is used during the day, continuous artificial kidney treatment has become possible. Complications caused by intermittent hemodialysis can be prevented.

[Brief explanation of the drawing]

FIGS. 1 and 2 are explanatory diagrams showing an example of the peritoneal dialysis device of the present invention, and FIG. 3 is an explanatory diagram showing an example of the peritoneal filtration device used during the day when the peritoneal dialysis device of the present invention is used at night. Fig. 4 is a diagram showing the peritoneal filtration device of Fig. 3 carried on a human body, and Fig. 5 is a graph showing changes in BUN over time when intermittent hemodialysis is performed for one week. be. In the figure, 1 is the peritoneal cavity, 2 is the first dialyzer, 3 is the second dialyzer, 4 is the fresh dialysate container, 5 is the first chamber, 6 is the second chamber, 7 is the third chamber, and 8 is the fourth chamber , 9 is the first dialysis membrane, 10 is the second dialysis membrane, 1
1 is the first conduit, 12 is the second conduit, 13 is the third conduit, ]4
and 15 are fresh dialysate supply conduits 16 and 17 are purified dialysate discharge conduits, 18-25 are pumps, 26-29 are valves, 31 is a first dialysate container, 32 is a second dialysate container,
33 and 34 are purified dialysate return conduits, 35 and 36
indicates a purified dialysate partial discharge conduit, and < indicates a drained fluid storage bag.

Claims (4)

[Claims] (1) A peritoneal dialysis device consisting of a peritoneal cavity, at least two dialyzers, and a conduit connecting them;
A first chamber of a first dialyzer divided by a dialysis membrane, and a second chamber consisting of a microporous membrane having a smaller pore diameter than the first dialysis membrane.
a closed circuit formed by a third chamber of the second dialyzer whose interior is divided by a dialysis membrane and a conduit connecting them; a second chamber on the filtrate side of the first dialyzer and the second dialyzer; A peritoneal dialysis device consisting of a dialysate adjusting device connected to each fourth chamber. (2) Conduits for the dialysate adjustment device to supply fresh dialysate from the fresh dialysate container to the second and fourth chambers, respectively, and discharge the dialysate that has passed through the second and fourth chambers, respectively. 2. A peritoneal dialysis device according to claim 1, comprising a respective conduit for said peritoneal dialysis. (3) The dialysate adjustment device has a first dialysate container and a second dialysate container that contain dialysate, a second chamber and a fourth chamber, and a dialysate from the first dialysate container and the second dialysate container. Each conduit for draining the dialysate into the second chamber and the fourth chamber, respectively, and the second
2. The peritoneal dialysis apparatus according to claim 1, comprising closed circuits formed by respective conduits through which the dialysate that has passed through the first dialysate chamber and the fourth chamber flows into the first dialysate container and the second dialysate container. (4) The peritoneal dialysis apparatus according to any one of claims 1 to 3, wherein the first dialysis membrane has a pore diameter of 20 to 1000 Å, and the second dialysis membrane has a pore diameter of 10 to 300 Å.