DIALYSIS SYSTEM WITH CONTINUOUS GLUCOSE MONITORING

Abstract

The invention relates to a system for carrying out dialysis treatment with a dialysis machine, a control unit and a sensor, the sensor being signal-connected to the control unit, and the control unit being designed to measure a patient's blood sugar level or interstitial glucose value during dialysis treatment using the sensor, to record a curve over time of the blood sugar level or interstitial glucose values on the basis of the measured values, and to adapt one or more treatment parameters of the dialysis machine automatically taking the curve into account, or to output an instruction for adaptation of a treatment parameter by a user or for another action by a user.

Claims

1. A system for carrying out a dialysis treatment using a dialysis machine, a control unit, and a sensor, wherein the sensor is in signal communication with the control unit, characterized in that the control unit is configured to measure the blood glucose level or the interstitial glucose value of a patient using the sensor during a dialysis treatment, to record a time progression of the blood glucose level or of the interstitial glucose values on the basis of the measurement values, and to automatically adapt one or more treatment parameters of the dialysis machine while taking the progression into account or to output instructions for a user-side adaptation of a treatment parameter or to output another user-side behavior.

2. A system in accordance with claim 1, characterized in that the dialysis machine is a peritoneal dialysis machine.

3. A system in accordance with claim 1, characterized in that the dialysis machine is a hemodialysis unit.

4. A system in accordance with claim 1, characterized in that the control unit is configured to obtain information on the body composition of the patient and to have this information enter into the automatic adaptation of the treatment parameters or into the output of corresponding information.

5. A system in accordance with claim 1, characterized in that the adaptation of the treatment parameters comprises an adaptation of the glucose concentration of a dialysis solution administered to the patient.

6. A system in accordance with claim 1, characterized in that the adaptation of the treatment parameters comprises an adaptation of the treatment performance.

7. A system in accordance with claim 1, characterized in that the system furthermore comprises an apparatus for administering active ingredients to the patient; and in that the adaptation of the treatment parameters comprises an administration of active ingredients to the patient.

8. A system in accordance with claim 3, characterized in that the control unit is configured to obtain information on the plasma volume of the patient and to have this information enter into the automatic adaptation of the treatment parameters or into the output of corresponding information.

9. A system in accordance with claim 3, characterized in that the adaptation of the treatment parameters comprises an adaptation of the ultrafiltration rate

10. A system in accordance with claim 1, characterized in that the control unit is configured to display the instructions for a user-side adaptation at a user interface or to transmit them to an external device.

Description

[0022] Further details and advantages of the invention result from the embodiments described in the following with reference to the Figures. There are shown in the Figures:

[0023] FIG. 1: a schematic representation of a workflow in the application of the invention to a peritoneal dialysis treatment; and

[0024] FIG. 2: a diagram of exemplary progressions of the blood glucose level and the blood pressure during a hemodialysis treatment.

[0025] FIG. 1 relates to an application of the concept in accordance with the invention to peritoneal dialysis.

[0026] In a first step 100, a plurality of treatments 110, 120, and 130 are first carried out, with the treatment progressions 111, 121, and 131 corresponding to specified prescriptions 112, 122, and 132 and comprising a plurality of cycles each having an inflow phase, a dwell phase, and an outflow phase. The composition of the administered dialysis solution is likewise specified and can differ between cycles. Provision is made in agreement with the invention that the respective progressions 113, 123, and 133 of the blood glucose level or of the interstitial glucose values of the patient are determined during these treatments. In the exemplary case shown, hypoglycemic episodes HGE occur in all three treatments.

[0027] If, as in the exemplary case shown, it is found over a plurality of treatments 110, 120, and 130 by means of a continuous determination of the glucose level in the blood of the patient that said patient tends to hypoglycemic episodes HGE at regular intervals, the control unit of the machine lays down measures in a second step 200 to avoid such episodes HGE or to at least curb their occurrence and intensity to counteract them.

[0028] One measure 210 can be the adaptation of the prescription or treatment. The glucose concentration in the dialysis solution for one cycle (inflow-dwell-outflow) during which a hypoglycemic episode is to be expected on the basis of the data can, for example, be automatically increased to, for example, 4.25% glucose and/or the dwell time can be automatically reduced. A signal can, for example, also be output at a user interface of the device, said signal indicating to the user that a dialysis solution having a higher glucose concentration should be used or that the dwell time should be extended for the cycle in question.

[0029] The machine can furthermore take account of the fluid status 221, that is the extent of the water retention levels of the patient, in the adaptation of the treatment or a corresponding signal output as part of a possible measure 220. For example, in a patient having a comparatively low body water content or fluid status that is often accompanied by hypoglycemia, the therapy can be adapted such that two short cycles are carried out with a dialysis solution having a low glucose content and one following cycle is carried out with a dialysis solution having a higher glucose content. The adaptation can take place automatically or corresponding instructions can be output to the user. Alternatively, the dwell time can also be adapted.

[0030] If a patient tends to regular hyperglycemic episodes and correspondingly has a comparatively high body water content or fluid status, provision can be made as part of a further conceivable measure 230 to adapt the glucose content of the administered dialysis solutions on the basis of a continuous determination of the glucose content in the blood or of the interstitial glucose value and while additionally taking account of the fluid status such that hyperglycemic episodes are avoided. In addition to a decrease or increase of the glucose content of the dialysis solution, there is also the possibility of a partial or complete replacement of the glucose with icodextrin or other osmotica.

[0031] Instead of an adaptation of a treatment parameter such as a glucose content of the solution administered, instructions 240 can also be given to the patient that relate to his behavior before or during the therapy. The patient can, for example, be prompted to eat a snack prior to the start of the therapy.

[0032] If said measures are not sufficient or are predicted as insufficient to avoid a hyperglycemic episode, the control unit can be configured to initiate an insulin dose 250 by means of an insulin pump. Alternatively, the glucose can be replaced with icodextrin if an excessive increase of the fat content is observed.

[0033] In addition, the body fat content and the muscle mass as well as ultimately the lean tissue index (LTI) or the lean tissue mass (LTM) can be determined at regular intervals on the basis of a determination of the body composition of the patient (BCM—body composition measurement) to inter alia determine the dietary status of the patient. If it is found in this process that these parameters drop over time, a higher glucose concentration can be provided, optionally in combination with the dose of insulin, to support the buildup of body fat.

[0034] FIG. 2 relates to an application of the concept in accordance with the invention to hemodialysis.

[0035] The treatment parameters can also be adapted to avoid glycemic episodes in the patient in hemodialysis. In addition to the progression of the blood glucose level or of the interstitial glucose value and of the fluid status of the patient, in particular the plasma volume of the patient can here be used to adapt the treatment parameters, with the adaptation of the treatment parameters here in particular also being able to comprise an adaptation of the ultrafiltration rate.

[0036] A drop in blood pressure can, for example, occur during hemodialysis. The curve 310 of FIG. 2 shows an exemplary progression of the blood pressure. A drop 311 of the blood pressure is a typical symptom for the presence of a hypoglycemic episode HGE, with the blood pressure drop naturally also being able to have different causes such as a great reduction in plasma volume. The curve 320 of FIG. 2 shows an exemplary progression of the blood glucose level that in this case accompanies the drop of the blood pressure. Conclusions can at least be drawn on whether a drop of the blood glucose level could be the cause of the blood pressure drop or not using the continuous determination of the blood glucose level.