Dialysis equipment for peritoneal dialysis

Abstract

The invention relates to a device for performing a peritoneal dialysis treatment, comprising a reservoir for fresh dialysis fluid, an interface for connecting to a patient's peritoneal catheter, an outlet for used dialysis fluid, and a control unit connected to an actuator, wherein the device is designed to perform a plurality of successive inflow-dwell-outflow cycles for the treatment based on a prescription stored in the control unit, in which inflow-dwell-outflow cycles dialysis fluid is supplied from the reservoir to the patient and is discharged again through the outlet after a specific dwell time in the patient's peritoneum, and wherein the device is also designed to replace a portion of the dialysis fluid in the patient's peritoneum with fresh dialysis fluid from the reservoir before the dwell time has expired in at least one cycle if the volume of fresh dialysis fluid prescribed for a previous cycle according to the prescription was not fully consumed in at least one previous cycle.

Description

Technical Field

[0001] The present invention relates to a dialysis apparatus for performing an automated peritoneal dialysis (APD) treatment. Background Art

[0002] In the implementation of an automated peritoneal dialysis treatment, it is known from WO 2013 / 000569 A1 that the treatment is optimized with respect to compliance with preset tolerances and times and with respect to the volume of dialysis fluid administered. Within the scope of this concept, it is important to define a permitted shortening of the dwell time, a permitted reduction of the inflow volume, a permitted residual volume and a permitted patient volume.

[0003] The potential use and administration of unused dialysis solution is not taken into account. If fresh dialysis fluid remains at the end of the treatment, it is delivered to the drainage device when the solution bag is emptied. However, in practice it often happens that the total inflow volume prescribed for the treatment cannot be completely administered to the patient. The reason for this lies in particular in the different value ranges of the allowed residual volume and the allowed patient volume. The allowed residual volume is usually set relatively high relative to the allowed patient volume, so that the patient is not disturbed by outflow disturbance notifications while sleeping.

[0004] The facts are indicative of Figure 1 . The permitted patient volume in the example shown there is 120%, while the permitted residual volume is determined to be 50%. The total inflow volume prescribed is 5000 ml (5 cycles of 1000 ml). However, due to the automatic switching in the residual range, only 4700 ml of solution can be administered. That is, when 50% of the outflow volume is reached, switching to the next inflow is permitted, while due to the upper limit of the permitted inflow volume, only the other 20% of the inflow volume can be administered. Therefore, the dialysis solution remains unused, which can lead to inappropriate treatment results on the one hand and is also uneconomical on the other hand.

[0005] In order to avoid discarding the remaining liquid, that is, the difference between the volume of the dialysate connected and the volume actually required for the treatment, a prescription for tidal treatment can be considered, in which tidal outflow is applied in a volume-controlled manner. Thus, the loss of the dialysis solution can be minimized by the preset allowed residual volume. However, because the patient cannot be emptied according to standard treatment as by pressure-controlled outflow, the efficiency of the treatment is reduced to a minimum. Therefore, tidal treatment is usually not prescribed for therapeutic reasons, but only for minimizing the interference and loss of the dialysis liquid. In this regard, the method described in WO2010 / 088360 A1 is mentioned, in which, in the case of incomplete outflow, the remaining treatment is replaced by tidal treatment so as to implement the total volume to achieve the target UF rate. The remaining inflow volume as a prescription is evenly distributed on the tidal cycle here so that the total treatment time is followed.

[0006] It is also conceivable to edit the prescription during the treatment. If, during the treatment, the limit of the permitted residual volume is usually switched to start the next inflow phase, then there is the possibility that the user increases the subsequent inflow volume with the aid of an editor. However, the possibility of editing is linked to user rights, the user must set an alarm at night, and the adjustment is relatively complex.

[0007] It is also conceivable to reduce the limit of the permissible residual volume. However, this may result in the patient being woken up more frequently during the treatment due to interruptions. The parameter value of the permissible residual volume is usually set high precisely for the purpose of avoiding this.

[0008] However, due to the disadvantages described, none of the concepts described has resulted in a satisfactory concept. Furthermore, it is problematic to implement these concepts in an apparatus for modeling a specific prescription, wherein an individual volume of dialysis solution adjusted individually is administered to the patient in each cycle, as in Figure 2 As schematically shown in . Summary of the invention

[0009] The object of the present invention is to provide an improved concept for utilizing residual liquid.

[0010] Against this background, the invention relates to an apparatus for performing a peritoneal dialysis treatment, comprising a reservoir for fresh dialysis fluid, an interface for connecting to a patient's peritoneal catheter, an outlet for used dialysis fluid, and a control unit connected to an actuator, wherein the apparatus is designed to perform a plurality of successive inflow-dwelling-outflow cycles for the treatment based on a prescription stored in the control unit, in which dialysis fluid is supplied from the reservoir to the patient and is discharged again via the outlet after a specific dwell time in the patient's peritoneum, and wherein the apparatus is also designed to replace a portion of the dialysis fluid in the patient's peritoneum before the end of the dwell time in at least one cycle with fresh dialysis fluid from the reservoir if the volume of fresh dialysis fluid prescribed for a previous cycle according to the prescription was not fully consumed in at least one previous cycle.

[0011] That is to say, according to the invention, it is proposed to use fresh dialysis solution, which may no longer be used according to the prescription, to renew the dialysis solution present in the patient's peritoneum during the dwell phase.

[0012] In the context of the partial replacement carried out in advance, in one embodiment, a maximum of 50%, preferably a maximum of 30% and more preferably a maximum of 20% of the volume of the dialysis fluid located in the peritoneum as a whole is replaced. This means that within the scope of the invention, it is not about actually setting up a further complete outflow and inflow phase, but rather about replacing only a small partial amount of the dialysis fluid located in the peritoneum in order to slightly renew the dialysis fluid.

[0013] Preferably, the dwell time, i.e. the duration of the dwell phase of the respective cycle, is not extended or shortened by the partial replacement carried out in advance. In other words, the dwell time remains constant. If dwell time is mentioned in this context, it is meant to be the dwell time including the partial replacement process. Therefore, the total treatment duration remains unchanged.

[0014] In this embodiment, the total volume of the dialysis fluid in the peritoneum of the patient is not changed by the partial replacement performed previously. In other words, it is provided that the total volume of the dialysis fluid in the peritoneum of the patient after the partial replacement process corresponds to the total volume of the dialysis fluid in the peritoneum of the patient before the partial replacement process. During the partial replacement process, no deviations occur.

[0015] Alternatively, provision can also be made for the volume to change slightly, for example, in particular when a partial replacement process begins with a step of introducing fresh dialysis solution.

[0016] The partial replacement process can be started not only with the entry step but also with the outflow step, wherein, in particular when the total volume in the patient's peritoneum is close to the determined maximum volume, starting with the outflow step can be preferred. On the other hand, when starting with the entry step, possible outflow problems can be reduced, because the outflow pressure can then be higher.

[0017] Preferably, the partial replacement carried out in advance is realized in a plurality of preferably directly following inflow and outflow steps. By dividing the outflow and inflow of the dialysis liquid necessary for the partial replacement into a plurality of steps, the total volume of the liquid in the peritoneum can be kept approximately constant. A plurality of smaller partial replacement volumes also minimize the risk of outflow problems. If problematic outflow or inflow events nevertheless occur, the partial replacement method can be interrupted and continued at a later point in time if necessary. Alternatively, in the event of outflow problems, an attempt is made to continue the partial replacement cycle with the inflow so that a possibly sucked catheter can be flushed open.

[0018] In this regard, for example, three or more, five or more, etc. inflow steps and / or a maximum of 200 ml delivered with each inflow step can be provided. The effective partial replacement volume can be increased by a high number of small-volume inflow and outflow steps during the partial replacement process.

[0019] It is preferably provided that the early replacement is carried out only after at least 50% of the prescribed dwell time has expired and / or that the early replacement is terminated before a maximum of 80% of the prescribed dwell time has expired. After half of the dwell time has expired, the dialysis fluid in the peritoneum is generally no longer as effective as at the beginning of the dwell time, so that a significant increase in efficiency can be achieved by partial replacement. A late replacement has only a small effect on the quality of the treatment, since the renewed solution is then no longer able to exert its effect within the flushable range.

[0020] In one embodiment, the device is designed to replace part of the dialysis fluid in the patient's peritoneum with fresh dialysis fluid from the reservoir in a plurality of cycles before the end of the dwell time during the treatment. This is for efficiency reasons, but also because the situation with respect to the existing residual volume may change during the treatment. Thus, for example, the dialysis solution may have to be discarded if a disturbance occurs or the pump is repositioned.

[0021] In one embodiment, the device is designed to start a partial replacement cycle only when the residence time specified for the corresponding cycle according to the recipe exceeds a minimum time. For cycles with short residence times, it may not make sense to generate a partial replacement cycle due to the short residence time. A suitable minimum time can be determined, for example, at 45 minutes or 60 minutes.

[0022] The decision whether to carry out a partial replacement is usually made by the device at the beginning of the dwell phase, because the available and required inflow volume can be determined at this time point. In addition, the dwell phase can be changed. For example, the preset dwell time can be shortened. Subsequently, one or more outflows and inflows with small volumes are applied. After the partial replacement, another final dwell phase follows. The time points planned for the subsequent outflow should also be followed, so that no treatment extension occurs.

[0023] In the context of partial replacement, it is also conceivable in principle to administer a solution having a different glucose concentration than the solution originally provided for the circulation, depending on availability, since the overall concentration changes only slightly due to the relatively small amounts.

[0024] As an additional effect, it is conceivable that the dialysis solution is renewed by partial replacement in the peritoneum. Additional beneficial effects are achieved in terms of treatment efficiency.

[0025] The inflow and outflow rates during the partial replacement cycle can usually be determined corresponding to the inflow and outflow rates for the cycle, or smaller or larger. In this regard, a very small flow rate can be set to carry out a nearly continuous partial replacement.

[0026] If necessary, for the selection of the partial replacement volume, it is not necessary to observe any minimum volume applicable to the prescription, since the partial replacement does not involve the prescription parameters. Rather, the corresponding patient parameters apply across the board to all prescriptions.

[0027] The invention also relates to a device for performing a peritoneal dialysis treatment, comprising a reservoir for fresh dialysis fluid, an interface for connecting to a patient's peritoneal catheter, an outlet for used dialysis fluid, and a control unit connected to an actuator, wherein the device is designed to perform a plurality of successive cycles, typically inflow-dwelling-outflow cycles, for the treatment based on a prescription stored in the control unit, in which dialysis fluid is conveyed from the reservoir to the patient and, after a specific residence time in the patient's peritoneum, is discharged again via the outlet, and wherein the device is also designed to increase the total inflow volume in at least one cycle if the volume of fresh dialysis fluid prescribed for the preceding cycle according to the prescription was not fully consumed in at least one preceding cycle.

[0028] According to this variant of the invention, it is therefore proposed to use fresh dialysis solution that may no longer be used according to the prescription in order to increase the subsequent circulation. This variant of the method control can be advantageous for adapted prescriptions, because in the treatment mode, circulations with small and large inflow volumes are alternated. The circulation with small inflow volume can be increased within preset limits of, for example, 10%.

[0029] These two variants of controlling the method according to the invention can be combined.

[0030] It can generally be proposed that the maximum volume of dialysis fluid that is allowed to be in the peritoneum of the patient is determined in the control unit, and that insufficient consumption of the volume of fresh dialysis fluid specified for the previous cycle is caused by the fact that sufficient consumption may lead to exceeding the maximum volume. Determining the maximum volume contributes to patient reliability. The prescription is of course designed in principle so that the maximum volume is not exceeded, but it is not always possible to fully take into account that the peritoneum is only incompletely emptied during the upstream outflow phase and the inflow volume determined in the prescription is added to the unpredictable residual volume to form a total volume, which can then potentially be higher than the maximum value. The residual volume is caused by the fact that the outflow, especially during the patient's rest at night, cannot always be achieved under ideal conditions, but a certain residual volume is tolerated so that the patient is not disturbed by outflow disturbance notifications while sleeping.

[0031] In one embodiment, the device is designed to deliver the total amount of dialysis fluid prescribed to the patient during the treatment, wherein any differential amount that is not delivered during the conventional inflow phase, in particular due to consideration of the maximum volume, is completely delivered during at least one or more cycles during the replacement carried out in advance. Thus, the dialysis solution that is available or determined according to the prescription for administration is used in an overall meaningful manner, which is desirable both from a medical and an economic point of view. BRIEF DESCRIPTION OF THE DRAWINGS

[0032] Further details and advantages of the present invention are obtained from the tests and examples described below with reference to the figures. In the figures:

[0033] Figure 1 A schematic diagram shows the sequence of an automated peritoneal dialysis treatment, in which the permitted residual volume is set relatively high relative to the permitted patient volume, so that the dialysis solution is not consumed sufficiently;

[0034] Figure 2Schematic diagram showing the sequence of an automated peritoneal dialysis treatment with specific prescriptions, wherein solution A is prescribed for inflow 1, solution B is prescribed for inflow 2 and solution C is prescribed for the last inflow (specific solution), and wherein the inflow volume and the residence time are also varied for both cycles (specific volume and specific residence time);

[0035] Figure 3 Schematic diagram showing the convergence of existing residual solution and fresh solution in the patient's peritoneum during inflow;

[0036] Figure 4 Schematic diagram showing mixing of remaining solution and fresh solution;

[0037] Figure 5 Schematic diagram showing absorption profiles for solutes exchanged during peritoneal dialysis treatment;

[0038] Figure 6 Different absorption curves for different solutes are shown;

[0039] Figure 7 shows a filling volume-time diagram for method control during a peritoneal dialysis treatment with the aid of the device according to the invention;

[0040] Figure 8 Shown are graphs showing the effect of UF generation for solutions having glucose concentrations of 3.86%, 2.27% and 1.50%;

[0041] Fig. 9 A graphical illustration showing the effect of a mixed solution consisting of fresh and used dialysis solution;

[0042] Fig.10 shows a filling volume-time diagram for an alternative method control during a peritoneal dialysis treatment with the aid of the device according to the invention;

[0043] Fig.11 An exemplary diagram showing the portion of the partial replacement volume in the peritoneum;

[0044] Fig.12 shows a filling volume-time diagram for a further method control during a peritoneal dialysis treatment with the aid of the device according to the invention; and

[0045] Fig.13 A filling volume-time diagram is shown for a further method control during a peritoneal dialysis treatment using the device according to the invention. DETAILED DESCRIPTION

[0046] The advantages of the present invention can be best explained based on the following considerations. Figure 3 As can be seen, during the inflow (English: Inflow) of fresh dialysis solution 10 at each new cycle, the existing residual solution 20 and the fresh solution 10 in the peritoneum 2 of the patient 1 converge. The residual solution 20 is formed by the residual liquid of the previous circulation and consists of the previously administered dialysis and ultrafiltration liquid. The material transport properties of the residual solution 20 are different from those of the fresh solution 10. It is even conceivable in an independent manner that the residual solution 20 ensures absorption. The question is how quickly the two solutions 10 and 20 mix with each other in the peritoneal cavity and what properties the mixed solution has. During the inflow, part of the fresh dialysis solution 10 mixes with the residual solution 20 due to the inflow. The diffusion that subsequently occurs has the effect that at time point x, concentration equilibrium of the two solutions 10 and 20 has already occurred. After a relatively short duration, a homogeneous mixed solution 30 may be present in the peritoneum 2, as in Figure 4 As shown in .

[0047] Absorption curve, as exemplified in Figure 5 As shown in , it provides conclusions about the detoxification effect during the dwell phase (Dwell). The time course of the absorption curve depends on whether the patient is a high or low transporter. A high transport capacity means that a concentration equilibrium of dissolved particles is achieved quickly between blood and dialysate, corresponding to a steep curve course at the beginning and a rapid attainment of a steady state. In addition, the steepness of the absorption curve depends on the glucose concentration or the type of solution used. This can be seen from Figure 6 As is known in the literature, different substances have different absorption curves. For large molecules such as proteins and insulin, the absorption curves are usually smooth and approximately linear.

[0048] Common to all absorption curves for smaller molecules is that the concentration gradient is relatively high and runs linearly at the beginning of the dwell phase. This means that the effective substance transport remains constant during the initial period. The dependence of the substance transport on the applied inflow volume is Figure 6 Rather, in the illustration, it is assumed that the patient is ideally filled with fresh solution. In practice, however, the properties and amount of the residual solution 20 must also be taken into account. In any case, it is assumed that the substance transport properties are affected by the residual solution relative to the Figure 6 The variation of the idealized observation.

[0049] Now, according to the invention, it is proposed to use the unnecessary inflow volume in order to replace a small part of the used solution of the peritoneum during the dwell phase (Dwell) in order to achieve additional substance transport. Figure 7As can be seen in the diagram of , wherein the y-axis shows the filling volume in the peritoneum of the patient. In the scope of the example shown, the allowed residual volume is determined to be 1000ml (lower horizontal line) and the allowed patient volume is determined to be 3400ml (upper horizontal line). The prescription is shown by a theoretical (lower) treatment curve and does not take into account the residual volume. In the process of actual treatment according to a higher treatment curve, if the inflow volume as a prescription and the residual volume still present in the peritoneum before the corresponding inflow phase begin cause a total volume exceeding the allowed patient volume, then the dialysis liquid planned according to the prescription always remains remaining. In the example shown, additional partial replacement is performed during the stay phase in cycles 4, 6 and 8, respectively, wherein, in this case, unused and thus remaining inflow solution is consumed. This is symbolized by a sawtooth line. Partial replacement is not performed in odd-numbered cycles, because the stay time is relatively small, so that the use of available excess volume is not so effective in the described cycle. In cycle 2, there is no residual volume available yet.

[0050] Within the scope of the invention, partial replacement should always be carried out during the dwell phase (Dwell). The preferred time for starting the partial replacement is after approximately half of the dwell time has elapsed and after approximately 80% of the dwell time has elapsed, because at this time the dialysate is normally no longer as effective as at the beginning of the treatment, while on the other hand the renewed solution can still fully exert its effect.

[0051] In one example, the prescribed inflow volume can be 3000 ml and the residual volume can be determined as 50%, i.e. 1500 ml. The maximum volume is determined as 110%, i.e. 3300 ml. That is, if a new inflow phase is started directly when the residual volume is reached, then only a maximum of 1800 ml is allowed to flow into the patient. The percentage share of the residual solution is therefore (1500 / 3300)*100%=45%. Since the effect of the dialysis solution decreases with the residence time in the peritoneum, as in Figure 8 This can have a significant impact on treatment efficiency, as can be seen in the relationship shown in .

[0052] Assuming that the remaining liquid consists only of dialysate that has been in the peritoneal cavity for an average of about 2 hours (without a UF component), for the situation mentioned in the example, an effect of the mixed solution is obtained that is between the effect of a generally fresh dialysate and the effect of a 45 / 55 mix. This is shown graphically in Fig. 9, where the effect of the extracted UF volume (=UF effect) is shown for the fresh solution. The UF effect of the remaining solution is derived from the UF effect curve of the fresh solution, which is shifted to the left at 2 hours. The effect of the mixed solution is derived by the added overlap under the assumption that the mixing ratio is approximately 50%, as in the above calculation example. In practice, the remaining solution also includes the ultrafiltration volume with zero effect. That is, by the partial replacement of the solution according to the invention, the blood-dialysate-concentration gradient is increased and thus the effect of the treatment is improved.

[0053] exist Fig.10 In the Figure 7 The outflow shown in FIG. is also an alternative according to the invention. There, the partial replacement cycle begins with an inflow, so as to generally avoid outflow pressure problems. In this variant, the volume of the preceding inflow phase can be reduced by the volume of the inflow for the partial replacement cycle, as can be seen in the figure.

[0054] Partial replacement is not only Figure 7 The implementation method and Fig.10 In the embodiment of the invention, the dialysis solution is distributed over several cycles. On the one hand, this has efficiency reasons; on the other hand, the situation of the conventionally existing residual volume may also change during the treatment. Therefore, if a disturbance occurs or the pump is repositioned, the dialysis solution must be discarded, for example.

[0055] In the context of the present invention, it may be sensible to design the partial replacement volume effective during the partial replacement process to be as large as possible. Fig.11 In FIG. 1 , the proportion of fresh solution in the peritoneum is shown as a function of the number and volume of partial exchange cycles using the above calculation example. After a normal inflow, 550 ml of fresh solution and 450 ml of residual solution are in the patient's peritoneal cavity. The higher the exchange volume, the higher the proportion of fresh solution at the end, as can also be seen from the following Fig.11 The values ​​of the graph are as shown in Table 1.

[0056] Table 1

[0057]

[0058] Another embodiment of the present invention is Fig.12 In the embodiment described, the partial replacement process is performed only during two cycles. For cycles with short residence time, it may not make sense to generate a partial replacement cycle due to the short residence time.

[0059] In a variant of the concept according to the invention, it is proposed that unused inflow solution be used alternatively or additionally in order to slightly increase the inflow, such as in Fig.13. Of course, the maximum permissible patient volume must not be exceeded. This variant of the method control can be advantageous for adapted prescriptions, since in this treatment mode, cycles with small and large inflow volumes alternate. The cycles with small inflow volumes can be increased within predefined limits of, for example, 10%.

[0060] The advantages of the concept according to the invention include that almost no or at least little liquid is introduced into the drainage device. The total volume of solution connected can be applied meaningfully for the treatment. Time-consuming and knowledge-intensive adaptation measures such as the creation of a tidal prescription or subsequent editing are no longer necessary. The disadvantages of the adaptation measures are compensated. The adjustment is carried out very dynamically and in accordance with the situation. The efficiency of the treatment is increased. The patient is not overfilled. No time delay of the treatment is required. No additional disturbances need to be expected, so that the patient does not need to be woken up for the method control. The concept is suitable for specific treatments.

Claims

1. A device for performing a peritoneal dialysis treatment, the device comprising a reservoir for fresh dialysis fluid, an interface for connecting to a patient's peritoneal catheter, an outlet for used dialysis fluid and a control unit connected to an actuator, wherein: The device is designed to carry out a plurality of successive inflow-dwelling-outflow cycles for a treatment based on a prescription stored in the control unit, in which a dialysis fluid is conveyed from the reservoir to the patient and, after a specific dwell time in the peritoneum of the patient, is discharged again via the outlet. It is characterized in that The device is also designed to replace a portion of the dialysis fluid in the peritoneum of the patient with fresh dialysis fluid prescribed for the preceding cycle from the reservoir which was not sufficiently consumed in at least one preceding cycle before the end of the dwell time, if the volume of fresh dialysis fluid prescribed for the preceding cycle was not sufficiently consumed in at least one preceding cycle.

2. The device according to claim 1, characterized in that During the partial replacement carried out in advance, a maximum of 50% of the total volume of the dialysis fluid present in the peritoneum is replaced.

3. The device according to claim 2, characterized in that During the partial replacement carried out in advance, a maximum of 30% of the total volume of the dialysis fluid in the peritoneum is replaced.

4. The device according to claim 2, characterized in that During the partial replacement carried out in advance, a maximum of 20% of the total volume of the dialysis fluid in the peritoneum is replaced.

5. The device according to claim 2, characterized in that The residence time is not prolonged or shortened by the partial replacement carried out in advance and / or the total volume of dialysis fluid present in the peritoneum of the patient is not changed by the partial replacement carried out in advance.

6. The device according to any one of claims 2 to 5, characterized in that The partial replacement in advance is performed in multiple entry and exit steps.

7. The device according to claim 6, characterized in that The entry and exit steps follow directly upon each other.

8. The device according to claim 6, characterized in that At least five entry steps are provided and / or a maximum of 200 ml is delivered by means of each entry step.

9. The device according to any one of claims 1 to 5, characterized in that The early replacement is not carried out until at least 50% of the prescribed stay time has elapsed and / or the early replacement is terminated before a maximum of 80% of the prescribed stay time has elapsed.

10. The device according to any one of claims 1 to 5, characterized in that The device is designed to replace a portion of the dialysis fluid located in the peritoneum of the patient with fresh dialysis fluid from the reservoir in a plurality of cycles even before the end of the dwell time during the treatment.

11. The device according to any one of claims 1 to 5, characterized in that The device is designed to start a partial replacement cycle only when a dwell time prescribed for the respective cycle exceeds a minimum time.

12. The device according to any one of claims 2 to 5, characterized in that A maximum volume of dialysis fluid which is permitted to be present in the peritoneum of the patient is determined in the control unit and, due to sufficient consumption, is exceeded, resulting in insufficient consumption of the volume of fresh dialysis fluid prescribed for the preceding cycle.

13. The device according to claim 12, characterized in that The device is designed to deliver a prescribed total amount of dialysis fluid to the patient during the treatment.

14. The device according to claim 13, characterized in that Based on the consideration of the maximum volume, a possible differential quantity which is not delivered during the conventional inflow phase is completely delivered during at least one or more cycles during the preceding replacement.

15. A device for performing a peritoneal dialysis treatment, the device comprising a reservoir for fresh dialysis fluid, an interface for connecting to a patient's peritoneal catheter, an outlet for used dialysis fluid and a control unit connected to an actuator, wherein: The device is designed to carry out a plurality of successive inflow-dwelling-outflow cycles for a treatment based on a prescription stored in the control unit, in which a dialysis fluid is conveyed from the reservoir to the patient and, after a specific dwell time in the peritoneum of the patient, is discharged again via an outlet. It is characterized in that The device is also designed to increase the total inflow volume in at least one subsequent cycle using the fresh dialysis fluid prescribed for the previous cycle that was not sufficiently consumed in at least one previous cycle, if the volume of fresh dialysis fluid prescribed for the previous cycle was not sufficiently consumed in the previous cycle.

16. The device according to claim 15, wherein the device is a device according to any one of claims 2 to 5.

17. The device according to claim 16, characterized in that A maximum volume of dialysis fluid which is permitted to be present in the peritoneum of the patient is determined in the control unit and, due to sufficient consumption, is exceeded, resulting in insufficient consumption of the volume of fresh dialysis fluid prescribed for the preceding cycle.

18. The device according to claim 17, characterized in that The device is designed to deliver a prescribed total amount of dialysis fluid to the patient during the treatment.

19. The device according to claim 18, characterized in that Based on the consideration of the maximum volume, possible differential quantities which are not delivered during a conventional inflow phase are completely delivered during at least one or more cycles, in which part of the dialysis fluid in the patient's peritoneum is replaced by fresh dialysis fluid from the reservoir before the end of the dwell time.

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