Vessel Analysis-Based Medical System for Specifying Adjustable Values of a Blood Treatment Apparatus

Abstract

The present disclosure relates to a medical system for specifying adjustable setting of a blood treatment apparatus having a calculation device with an input interface for entering and/or reading in the results determined by a diagnostic device for executing a retinal vessel analysis of a patent, respectively; an output interface for outputting at least one technical parameter value for the treatment of the patient and/or outputting at least one target treatment parameter value for a treatment of the patent using the blood treatment apparatus, and/or for outputting suggested changes of existing pre-set or pre-settings for the technical parameter value and/or for the target treatment parameter value.

Claims

1-18. (canceled)

19. A medical system for specifying adjustable values of a blood treatment apparatus, the medical system comprising: a calculation device with an input interface for an input and/or for reading in results respectively determined by a diagnostic device for performing a retinal vessel analysis of a patient; an output interface for outputting at least one technical parameter value for treatment of the patient and/or at least one target treatment parameter value for treatment of the patient by the blood treatment apparatus, and/or for outputting suggested changes to existing pre-set specifications or pre-settings for the at least one technical parameter value and/or the at least one target treatment parameter value; wherein the calculation device is programmed to: determine, based on results being entered or read in via the input interface, the at least one target treatment parameter value or the at least one technical parameter value, and/or a suggested or advised change from the pre-set specifications, for controlling or regulating the blood treatment apparatus for the treatment of the patient; and output the at least one technical parameter value and/or the at least one target treatment parameter value, or a change in the at least one technical parameter value and/or the at least one target treatment parameter value, via the output interface.

20. The medical system according to claim 19, wherein the results are, build upon, or encompass venous and/or arterial dilatation.

21. The medical system according to claim 19, further comprising a display device configured or programmed to display the results and/or the at least one technical parameter value and/or the at least one target treatment parameter value, or a change in the at least one technical parameter value and/or the at least one target treatment parameter value.

22. The medical system according to claim 19, wherein the output interface comprises a visual or graphical interface for the user or is connected to a graphical display device.

23. The medical system according to claim 19, wherein the output interface comprises an interface with a control device or closed-loop control device of the blood treatment apparatus.

24. The medical system according to claim 19, wherein the output interface comprises an interface with a server, a network protocol, and/or a data storage.

25. The medical system according to claim 19, wherein the medical system comprises a mobile device, handheld device, cell phone, smartphone, tablet, and/or an application suitable therefor.

26. The medical system according to claim 19, further comprising a diagnostic device for executing a retinal vessel analysis of the patient.

27. The medical system according to claim 19, wherein the at least one technical parameter value or at least one target treatment parameter value determined by the calculation device relate to, or comprise, an ultrafiltration volume for the current or the upcoming treatment session, a treatment duration thereof, a treatment type, a sodium management and/or liquid management, or changes thereof.

28. The medical system according to claim 19, wherein the medical system is a control device or closed-loop control device of the blood treatment apparatus or part thereof, encompasses the control device or closed-loop control device, or is in signal communication therewith.

29. The medical system according to claim 28, wherein the control device or closed-loop control device is programmed to control or regulate the blood treatment apparatus, which comprises a conveying device for a liquid on the basis of the calculated at least one technical parameter value or the at least one target treatment parameter value.

30. The medical system according to claim 29, wherein the conveying device comprises an ultrafiltration pump, a blood pump and/or a dialysis liquid pump.

31. A blood treatment apparatus, embodied as a dialysis apparatus, comprising, or connected to, the medical system according to claim 19.

32. The blood treatment apparatus according to claim 31, embodied as a hemodialysis apparatus, hemofiltration apparatus or hemodiafiltration apparatus, an apparatus for acute renal replacement therapy, for chronic renal replacement therapy, or for continuous renal replacement therapy (CRRT).

33. A treatment system comprising: one or several blood treatment apparatuses, each embodied as a dialysis apparatus; and a medical system according to claim 19; wherein at least one or more of the blood treatment apparatuses and the medical system are present separately from each other.

34. A method for preparing for an upcoming treatment or treatment session of a patient, which is to be carried out by using a blood treatment apparatus, said method comprising: providing a medical system according to claim 19; entering at least one result determined by the diagnostic device into the input interface of the calculation device; reading, from the output interface, the at least one technical parameter value and/or the at least one target treatment parameter value, or at least one change of the at least one technical parameter value and/or the at least one target treatment parameter value, for a treatment of the patient using the blood treatment apparatus; and entering the at least one technical parameter value and/or the at least one target treatment parameter value, or the at least one change of the at least one technical parameter value and/or the at least one target treatment parameter value, as a set value into an input interface of the blood treatment apparatus.

35. A digital storage medium, with electronically readable control signals, designed to interact with a programmable computer system such that a conventional calculation device is reprogrammed into a calculation device of a medical system according to claim 19.

36. The digital storage medium of claim 35, in the form of a floppy disk, CD or DVD, EPROM, FRAM or SSD.

37. A computer program product, as a signal wave or having a program code stored on a machine-readable carrier, for interacting with a programmable computer system such that a conventional calculation device is reprogrammed into a calculation device of a medical system according to claim 19.

38. A computer program with a program code to reprogram a conventional calculation device into a calculation device of a medical system according to claim 19, when the computer program runs on a computer.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0129] In the following, the present disclosure is exemplarily described based on the accompanying drawing in which same reference numerals designate identical or similar components. The following applies in the figures:

[0130] FIG. 1 shows a highly simplified representation of a medical system in addition to a blood treatment apparatus;

[0131] FIG. 2 shows the treatment system described herein in a first embodiment;

[0132] FIG. 3 shows the possible specification of a technical parameter value (here the ultrafiltration rate) when using the present systems, methods, and devices over time;

[0133] FIG. 4 shows the dependence of the withdrawn ultrafiltration volume on venous dilatation in an embodiment; and

[0134] FIG. 5 shows the dependence of the duration of a treatment session on venous dilatation in an embodiment.

DETAILED DESCRIPTION

[0135] FIG. 1 shows, in a highly simplified representation, a medical system 1 in a first embodiment in addition to a blood treatment apparatus 100, which is optionally connected to an extracorporeal blood circuit 300. FIG. 1 thus shows a treatment system of an exemplary embodiment.

[0136] The extracorporeal blood circuit 300 comprises a first line 301, here in the form of an arterial line section.

[0137] The first line 301 is in fluid communication with a blood treatment device, here for example a blood filter or dialyzer 303. The blood filter 303 comprises a dialysis liquid chamber 303a and a blood chamber 303b, which are separated from each other by a mostly semi-permeable membrane 303c.

[0138] The extracorporeal blood circuit 300 further comprises at least one second line 305, here in the form of a venous line section. Both the first line 301 and the second line 305 may be used to connect them to the vascular system of the patient P, not shown.

[0139] The first line 301 is optionally connected to a (first) tube clamp 302 for blocking or closing the line 301. The second line 305 is optionally connected to a (second) tube clamp 306 for blocking or closing the line 305.

[0140] The blood treatment apparatus 100 represented in FIG. 1 schematically and only by some of its devices, comprises a blood pump 101. During the treatment of the patient P (see FIG. 2) the blood pump 101 conveys blood through sections of the extracorporeal blood circuit 300 and in the direction of the blood filter or dialyzer 303 as shown by the small arrows, which generally indicate in each of the figures the direction of flow.

[0141] Using a pump for dialysis liquid 121, that may be embodied as a roller pump or as any otherwise occluding pump, fresh dialysis liquid is pumped out of a source 200 along the dialysis liquid inlet line 104 into the dialysis liquid chamber 303a. The dialysis liquid leaves the dialysis liquid chamber 303a as dialysate, possibly enriched with filtrate, towards an optional effluent bag 400 and will be referred to herein as effluent.

[0142] The source 200 may for example be a bag or a container. The source 200 may further be a fluid line, for example, a hydraulic outlet or hydraulic port of the blood treatment apparatus 100, from which liquid is provided that is on-line and/or continuously generated or mixed.

[0143] A further source 201 with substitute fluid may optionally be provided. It may correspond to the source 200 or be a separate source.

[0144] An only outlined control device or closed-loop control device 150 can be configured to control or regulate the blood treatment session.

[0145] Where the effluent bag 400 is connected to the blood treatment apparatus 100 is indicated in the bottom right within the blood treatment apparatus 100 of FIG. 1.

[0146] In addition to the aforementioned blood pump 101 and the aforementioned pump 121 for dialysis liquid, the arrangement shown in FIG. 1 further comprises, purely optionally, a number of other optional pumps, namely the pump 111 for substitute fluid and the pump 131 for the effluent. The pump 131 may optionally be used in terms of ultrafiltration for establishing an underpressure

[0147] The pump 121 is provided to supply dialysis liquid to the blood filter 303, out of a source 200, for example a bag, through an optional available bag heater H2 having a heater bag, using the dialysis liquid inlet line 104.

[0148] The thus supplied dialysis liquid exits from the blood filter 303 via a dialysate outlet line 102 (also: effluent inlet line), supported by the optional pump 131, and may be discarded.

[0149] An optional arterial sensor PS1 is provided upstream of the blood pump 101. It measures the pressure in the arterial line during a treatment of the patient P (not shown here).

[0150] A further optional pressure sensor PS2 is provided downstream of the blood pump 101, but upstream of the blood filter 303 and if provided, upstream of an optional addition point 25 for Heparin. It measures the pressure upstream of the blood filter 303 (pre-hemofilter).

[0151] To measure the filtrate pressure of the blood filter 303 a further pressure sensor may be provided as PS4 downstream of the blood filter 303, however, preferably upstream of the pump 131 in the dialysate outlet line 102.

[0152] Blood, which leaves the blood filter 303, passes through an optional venous blood chamber 29, which may comprise a de-aeration device 31 and/or a further pressure sensor PS3.

[0153] The control device or closed-loop control device 150 shown in FIG. 1 may be in cable or wireless signal communication to any of the components referred to herein especially or in particular to the blood pump 101in order to control or regulate the blood treatment apparatus 100.

[0154] The optional pump 111 is provided to supply substitute fluid from the optional source 201, for example a bag, via an optional available bag heater H1 having a heater bag, to the second line 305.

[0155] In some embodiments, a citrate solution is delivered, if necessary by a citrate pump 15, into line 301 from an optionally provided source for citrate solution, designed here, e.g., as a citrate bag 9. For example, 4% Na.sub.3 citrate is supplied from the source for citrate solution.

[0156] An optional addition device, designed here as a calcium pump 12, is provided in order to deliver a calcium solution into the line 305 from an optional source for calcium solution in FIG. 1, designed for example as a calcium bag 13. For example, a CaCl.sub.2 solution is supplied from the source for calcium solution. This may have a calcium concentration of 91 mmol/l, 100 mmol/l or another suitable calcium concentration.

[0157] To the right of the blood treatment apparatus 100, FIG. 1 shows a medical system 1 with a calculation device 5 The calculation device 5 comprises an input interface 51 for manually inputting or automatically reading in results which have been determined by a diagnostic device 700 (also: examination device) for performing a retinal vessel analysis of a patient P (see FIG. 2).

[0158] The medical system 1 comprises an output interface 53 for outputting at least one technical parameter value for the blood treatment apparatus 100 for treating the patient P (not shown in FIG. 1) or at least one target treatment parameter value for a treatment of the patient P using the blood treatment apparatus 100.

[0159] The calculation device 5 is programmed to determine, based on results entered or read in by the input interface 51, the target treatment parameter value or its level or the technical parameter value or its level, or their respective suggested or advised change with respect to a pre-set specification on the blood treatment apparatus 100 or with respect to a specification for the control or regulation of the blood treatment apparatus 100 for the treatment of the patient P. In this, the change may be or may encompass, for example, a change with respect to a value previously used for treatment, an entry in the patient file or in patient history, etc.

[0160] Further, the calculation device 5 is programmed to output the determined technical parameter value and/or the determined target treatment parameter value, or their respective change for the operation of the blood treatment apparatus 100, by an output interface 53.

[0161] Such an output may be carried out for example at a display device 500. This may be configured or programmed to display the results of the examination being performed by or using the diagnostic device 700, the determined parameter values and/or the determined target treatment parameter values or their respective changes.

[0162] The display device 500 may optionally be a printer.

[0163] A storage device for storing or providing results of the examination being performed by the diagnostic device, or storing such results, is provided by the present disclosure in several embodiments.

[0164] Alternatively or additionally, the present system comprises at least one device which enables data (in particular results of the examination being performed by the diagnostic device, parameter values and/or target treatment parameter values) to be stored, provided and/or displayed over time (i.e., as a patient history). The storage, providing and/or display of data, for example as mentioned herein, relating to patient collectives, are also encompassed by the present disclosure.

[0165] Blood treatment apparatus 100 and medical system 1 together represent an embodiment of a treatment system.

[0166] The medical system 1 may be provided on a mobile handheld device, e.g., cell phone or tablet, spatially separated from the blood treatment apparatus 100.

[0167] In certain embodiments, the medical system 1 and the blood treatment apparatus 100 are separate from each other. The term separate from each other may encompass herein, for example, a spatial separation, a physical separation, and/or a separation such that there is no signal communication between the blood treatment apparatus 100 and the medical system 1. Alternatively or additionally, this may be understood to mean that one component (e.g., the medical system 1) is not part of the other component (e.g., the blood treatment apparatus 100).

[0168] In the embodiment shown in FIG. 1, the output interface 53 of the medical system 1 comprises an interface with the control device or closed-loop control device 150 of the blood treatment apparatus 100 or is connected to it in signal communication and/or physically or is part thereof.

[0169] In the latter cases, however, the devices thus connected are no longer a treatment system, but a blood treatment apparatus 100.

[0170] The medical system 1 may be or may comprise a server-based solution, i.e., comprise an interface to a server, a network protocol, and/or a data storage or be in signal communication therewith. In this, the user may access, for example via a website, a program running on the server in order to run or initiate a portion of the method described herein. The medical system 1 may thus comprise a server. It may comprise user interfaces and/or user terminals such as computer, cell phone or tablet, which are set up to communicate with the server.

[0171] It is further encompassed by the present disclosure that, other than as shown herein, the medical system 1 is identical to or comprised by the control device or closed-loop control device 150.

[0172] FIG. 2 shows the treatment system in a first embodiment with a medical system 1 interacting with a blood treatment apparatus 100 or with its control device or closed-loop control device 150 while the attending physician or medical staff D and a patient P are involved.

[0173] The diagnostic device 700, for example the Retinal Vessel Analyzer from the company Imedos, which can operate as an independent device and is already available on the market, is set up or arranged as an independent device, for example in a dialysis station. Patients may be examined therewith or using it, preferably non-invasively. An average examination takes only a few minutes. This may be done in different cycles and does not have to take place before each treatment. An examination at intervals of 2 to 4 weeks seems appropriate.

[0174] Thus, in the example of FIG. 2, the diagnostic device 700 determines the values of the ratio of the maximum venous dilatation to the base diameter of the vessel in percent (also: vMax) and the values of the ratio of the maximum arterial dilatation to the base diameter of the vessel in percent aMax (not shown in FIG. 2) and transmits them, for example via a suitable network protocol, to the server that preferably stores the treatment data and patient data. In this, the course of the values of aMax and vMax may also be stored over several examinations or treatment sessions.

[0175] In some embodiments, when the respective patient P is logged on to a blood treatment apparatus 100, the blood treatment apparatus 100 sends a request to the server and receives in response the treatment data of the respective patient P. Preferably, a display device 500, which may be part of the blood treatment apparatus 100, may display the measured values for aMax and vMax in a suitable view. Resulting from the measured values, for example, suggested technical parameter values, target treatment parameter values or further treatment modifications may be displayed and suggested or proposed to the attending physician.

[0176] After the suggested and determined parameter values or target treatment parameter values have been checked and confirmed by the doctor or by other medical personnel qualified for this purpose, these values may be adopted by the blood treatment apparatus 100 for the upcoming (or ongoing) treatment of the patient P, in particular by the control device or closed-loop control device 150 of the blood treatment apparatus 100; and the blood treatment apparatus 100, in particular its pumps 101, 111, 121, are controlled or regulated individually adapted to the patient P on the basis of the determined parameter values or target treatment parameter values.

[0177] FIG. 3 shows the specification of the ultrafiltration rate, denoted in FIG. 3 as UF (in [ml/h]), over the time duration t.sub.1, t.sub.2, t.sub.3 (in [sec]) as an example of ahere changing over timetechnical parameter value.

[0178] The values of vMax and aMax as results of the retinal vessel analysis may be classified or subdivided in a variety of ways, and different values for the technical parameters or target treatment parameter values relevant in the treatment of patient P may be assigned to them according to their class or characteristic, and wherein such an assignment may be stored for example in data memories.

[0179] A possible subdivision may be carried out as follows, for example in tertiles:

TABLE-US-00001 lower tertile of vMax <2.44% middle tertile of vMax 2.44% bis 4.46% upper tertile of vMax >4.46%
and/or

TABLE-US-00002 lower tertile of aMax <0.71% middle textile of aMax 0.71% bis 2.80% upper tertile of aMax >2.80 %

[0180] These figures are purely exemplary and not to be understood as limiting. These values may serve as standard pre-settings, other values and other subdivisions are also provided.

[0181] Depending on vMax, parameter values or target treatment parameter values or changes thereof are suggested. If vMax is below the upper tertile in the present example, a high volume HDF treatment is activated. This is understood here to be a contribution to a cardioprotective dialysis.

[0182] Furthermore, in this example, the course of the UF rate is changed over time depending on the results of the retinal vessel analysis. The curve forms shown in FIG. 3 are exemplary. An application to other curve forms is possible; equation (1) should apply to extract the desired ultrafiltration volume U.sub.g.

[00003]$\begin{array}{cc}{U}_g=\underset{t_0}{\overset{t_1}{}}{u}_1\left(t\right)\mathrm{dt}=\underset{t_0}{\overset{t_1}{}}{u}_2\left(t,\mathrm{vMax}\right)\mathrm{dt}=\underset{t_0}{\overset{t_2}{}}{u}_3\left(t,\mathrm{vMax}\right)\mathrm{dt},& \left(1\right)\end{array}$

[0183] If vMax is within the upper tertile, for example a constant UF rate is applied, see the top curve in FIG. 3.

[0184] The ultrafiltration volume U.sub.g to be withdrawn is specified, for example, by the attending physician or results from the measurement by a body composition monitor (BCM), if available, etc.

[0185] For U.sub.a the following results

[00004]$\begin{array}{cc}{U}_a=\frac{U_g}{t_1-t_0}& \left(2\right)\end{array}$

[0186] The following applies

u.sub.1(t)=U.sub.a(3)

[0187] If vMax is in the middle tertile, the UF rate is thus given here as a function u.sub.2(t,vMax), see the middle curve u.sub.2(t,vMax) in FIG. 3. As a result, more volume is withdrawn per time at the beginning compared with the above-mentioned UF rate of the top representation in FIG. 3 (there: 1000 ml/h) (now: around 1200 ml/h), but the UF rate curve should flatten out again quickly. As a result, the same ultrafiltration volume is initially withdrawn faster than in the uppermost representation, but later more slowly than there.

[0188] The following applies by way of example:

[00005]$\begin{array}{cc}{u}_2\left(t,\mathrm{vMax}\right)=\frac{U_{0m}\left(\mathrm{vMax}\right)-U_1\left(\mathrm{vMax}\right)}{1+e^{-k\left(-t+t_w\right)}}+U_1\left(\mathrm{vMax}\right)& \left(4\right)\end{array}$

[0189] In this, the following applies: [0190] U.sub.g the total ultrafiltration volume withdrawn over the duration of the treatment session [0191] U.sub.a is the constant UF rate in the standard case (without modification based on the results of the retinal vessel analysis) [0192] U.sub.0 the standard UF rate at the beginning of the treatment session U.sub.0m(vMax) is the UF rate modified by the results of the retinal vessel analysis at the beginning of treatment [0193] U.sub.max is the maximum allowed UF rate [0194] U.sub.1(vMax) is the UF rate at the end of treatment (modified by the result of retinal vessel analysis) [0195] k is a factor that influences the curvature of the function [0196] t.sub.w is the inflection point at which the change of direction of the curvature occurs [0197] t.sub.0 is the time at which the treatment session starts (at t=0) [0198] t.sub.1 is the time at which the treatment session ends [0199] t.sub.2(vMax) is the time, being modified based on the results of the retinal vessel analysis, at which the treatment session ends

[0200] If vMax is in the lower tertile, the middle curve u.sub.2(t,vMax) of FIG. 3 can be exemplarily modified to u.sub.3(t,vMax). For this purpose, in addition to the modifications of u.sub.2(t,vMax), the duration of the treatment session (dialysis time) is extended, as shown by the lowest curve u.sub.3(t,vMax) of FIG. 3. FIG. 3 thus shows different UF rates over time, as well as the modification of the treatment duration, which for u.sub.3 in FIG. 3 was increased from 4 hours (4 h) to e.g. 4 hours and 33 minutes (4.55 h).

[0201] All parameters can be modified as needed, e.g., by the attending physician.

[0202] FIG. 4 shows an exemplary procedure when proposing a change U [in %] from an existing pre-set specification U.sub.0 as a specification for the technical parameter value of the UF rate depending on the venous, maximum dilatation vMax [in %].

[0203] The parameter U.sub.0, which is understood here as the standard value or pre-set specification for the UF rate, is influenced or changed by the results from the retinal vessel analysis plotted along the x-axis, for example as follows:

[0204] Based on the measured value of vMax, U.sub.0, a constant starting value or standard value of, for example, 1000 ml/h, is increased by, for example, a maximum of 50% of U.sub.0.

[0205] This is done, for example by interpolation using a straight line, as shown in FIG. 4.

U.sub.0m(vMax)=U.sub.0*(1+U(vMax))(5)

[0206] This curve course and the values used are purely exemplary and are not to be understood as limiting. Any modifications are possible.

[0207] The following should preferably apply:

U(vMax)0 and U.sub.0m(VMax)U.sub.max

[0208] To keep the withdrawn UF volume unchanged, U.sub.1(vMax)) can be calculated as follows by inserting (3), (4) and (5) into (1) and solving it for U.sub.1(vMax):

[00006]$\begin{array}{cc}{U}_1\left(\mathrm{vMax}\right)=\frac{\mathrm{kt}\left(U_a-U_{0m}\left(\mathrm{vMax}\right)\right)}{{\log }_e\left(e^{k\left(t-t_w\right)}+1\right)}+U_{0m}\left(\mathrm{vMax}\right)\mathrm{for}t=t_1& \left(6\right)\end{array}$

[0209] FIG. 5 shows the dependence of the change t (in [sec]) in the duration of the treatment session (as an example of a target treatment parameter) on the venous maximal dilatation vMax (in [%]).

[0210] If vMax is in the lower tertile, then, as stated above, the middle curve u.sub.2(t,vMax) of FIG. 3 can be changed exemplarily to u.sub.3(t,vMax). For this purpose, in addition to the modifications of u.sub.2(t,vMax), the duration of the treatment session (dialysis time) is extended (see also the lowest curve u.sub.3(t,vMax) of FIG. 3). With an unfavorable calcium/phosphate balance, calcification leads to increased stenoses in the vascular system. Prolonged dialysis time may improve the reduction or breaking down of excess phosphate, which may be an advantage in the treatment of some patients that can be identified by the present systems, methods, and devices.

[0211] For this purpose, as with u.sub.2(t,vMax), see above or the middle curve in FIG. 3, the change U for modifying the pre-set specification U.sub.0 for the UF rate is first determined in dependance of the venous maximum dilatation vMax at the beginning of the treatment session or the dialysis.

[0212] Furthermore, a modified end time or duration of the treatment session or the dialysis time is calculated as a change t to modify the pre-set specification t.sub.1 for duration as an example of a target treatment parameter. This is done, for example, by interpolation using a straight line as shown in FIG. 5.

t.sub.2(vMax)=t.sub.1+t(vMax)(7)

[0213] This curve progression and the values used are purely exemplary and are not to be understood as limiting. Any modifications are possible.

[0214] The following should apply:

t(vMax)0

[0215] There are hardly any restrictions on extending the duration of dialysis. The longer dialysis lasts, the milder it is for the patient. A reduction in blood flow seems appropriate here, which may lead to a further change in the specification of a technical parameter value (in this case, the preset blood pump rate). In practice, however, dialysis duration may also be limited by economic and patient-related factors.

[0216] To ensure that the total withdrawn ultrafiltration volume remains unchanged, U.sub.1(vMax) may be calculated by inserting (3), (4) and (5) in (1) and solving it for U.sub.1(vMax):

[00007]$\begin{array}{cc}{U}_1\left(\mathrm{vMax}\right)=\frac{\mathrm{kt}\left(U_a-U_{0m}\left(\mathrm{vMax}\right)\right)}{{\log }_e\left(e^{k\left(t-t_w\right)}+1\right)}+U_{0m}\left(\mathrm{vMax}\right)& \left(8\right)\end{array}$$\mathrm{for}t=t_2\left(\mathrm{vMax}\right)$

[0217] If the dialysis machine has the option of sodium management, then, when vMax is below the upper tertile, sodium management is further activated with a 0 balance, which may correspond to a possible value of the sodium balance or of the target sodium level as a possible target treatment parameter.

[0218] The attending physician may respectively modify the target sodium level in in order to achieve a positive effect on the intravascular volume. If the sodium balance is zero, the patient's sodium level is the same before and after treatment.

[0219] In addition, if vMax is below the upper tertile, then for example the use of the Body Composition Monitor (in short: BCM, which may optionally also be part of the treatment system) is recommended. If the BCM option is switched on, the treatment system or the treatment apparatus may request a new measured value at regular intervals, e.g., every 4 weeks, if such a value will not be, or has not been, transmitted automatically, e.g., by SmartCard or the like.

[0220] The determined values of vMax and aMax may be displayed as a graphic in some embodiments. Thus, a long-term history may be presented to the attending physician. In the case of increasing values of vMax and aMax, dialysis treatment that is as cardioprotective as possible may be indicated.

[0221] In some embodiments, some or all of the changes to the parameter values or target treatment parameter values are given as suggestions to the attending personnel. In certain embodiments, these suggestions must be explicitly accepted before the changes are activated or made active, i.e., transmitted to the control device or closed-loop control device 150 of the blood treatment apparatus 100 (see FIG. 1 and FIG. 2).

[0222] The disclosure of the figures and the explanation thereof are only exemplary. In particular, the curves shown do not have to be linear. The respective curve progression, as well as the absolute values, could be determined differently or modified by the attending physician.

LIST OF REFERENCE NUMERALS

[0223] 1 medical system [0224] 5 calculation device [0225] 9 source for citrate solution, here exemplarily [0226] 10 as a citrate bag [0227] 12 calcium pump [0228] 13 source for calcium solution, calcium bag [0229] 15 citrate pump [0230] 25 addition site for Heparin (optional) [0231] 29 venous blood chamber (optional) [0232] 31 de-aeration device [0233] 51 input interface [0234] 53 output interface [0235] 100 blood treatment apparatus [0236] 101 blood pump [0237] 102 dialysate outlet line [0238] 104 dialysis liquid inlet line [0239] 111 pump for substitute fluid [0240] 121 pump for dialysis liquid, dialysis liquid pump [0241] 131 pump for dialysate or effluent in effluent inlet line; pump for ultrafiltration, ultrafiltration pump [0242] 150 control device or closed-loop control device [0243] 200 source with dialysis liquid [0244] 201 source with substitute fluid, optional [0245] 300 extracorporeal blood circuit [0246] 301 first line (arterial line section) [0247] 302 (first) tube clamp [0248] 303 blood filter or dialyzer [0249] 303a dialysis liquid chamber [0250] 303b blood chamber [0251] 303c semipermeable membrane [0252] 305 second line (venous line section) [0253] 306 (second) tube clamp [0254] 400 effluent bag [0255] 500 display device [0256] 700 diagnostic device [0257] D attending doctor, medical staff [0258] H1 bag heater [0259] H2 bag heater [0260] P patient [0261] PS1 arterial sensor [0262] PS2 pressure sensor (optional, pre-hemofilter) [0263] PS3 pressure sensor [0264] PS4 pressure sensor [0265] t.sub.1, t.sub.2, t.sub.3 time duration [sec] [0266] t change in time duration [0267] UF ultrafiltration rate [ml/h] [0268] U change in the ultrafiltration rate [0269] aMax arterial dilatation; ratio of maximum arterial dilatation to the base diameter of the vessel as a percentage [0270] vMax venous dilatation ration of maximum venous dilatation to base diameter of the vessel as a percentage