Techniques for determining patient blood properties during a dialysis procedure

Abstract

Techniques and apparatuses for a de-priming process are described. For example, in one embodiment, the apparatus can include at least one processor and a memory coupled to the at least one processor, the memory can include instructions that, when executed by the processor, can cause the at least one processor to determine a priming volume of a priming fluid infused into a priming system associated with a patient during a priming phase of a dialysis treatment, cause an ultrafiltration rate of an ultrafiltration pump of a dialysis machine in fluid communication with the patient to change from a treatment ultrafiltration rate to a de-priming ultrafiltration rate to remove the priming volume over a de-priming time period, and cause the ultrafiltration rate of the ultrafiltration pump to change back to the treatment ultrafiltration rate after the de-priming time period. Other embodiments are also described.

Description

[0001] Cross Reference to Related Applications

[0002] This application claims the benefit of priority under 35 U.S.C. § 119(e) of U.S. Provisional Patent Application Serial No. 62 / 910,739, filed October 4, 2019, the entire contents of which are incorporated herein by reference in its entirety as if fully set forth herein. TECHNICAL FIELD

[0003] The present disclosure relates generally to a dialysis system, and more particularly to techniques for determining patient blood properties during a dialysis treatment. BACKGROUND

[0004] Dialysis patients can experience various complications during treatment. For example, anemia can be a major complication experienced by dialysis patients, particularly those with end-stage renal disease. Accordingly, healthcare professionals typically conduct blood tests before and during dialysis treatment to monitor such complications, such as anemia status. For example, hemoglobin (Hgb) levels can be monitored to detect anemia. Conventional testing procedures typically involve periodic blood draws, such as weekly blood draws. However, these periodic blood draws incur additional costs, are logistically difficult for healthcare providers, and require time to process before results are available. For example, blood samples are typically sent to a laboratory where pre-treatment Hgb levels are measured. While the results of these measurements are useful to guide treatment, they can take days to communicate back to the dialysis provider.

[0005] Blood monitoring devices can be used to determine patient Hgb levels during dialysis treatment. However, during certain portions of dialysis treatment, a patient’s blood can be diluted or otherwise different from normal, such that pre-dialysis Hgb measurements do not reflect the patient’s actual Hgb concentration. For example, during hemodialysis (HD), initial Hgb values obtained after the start of HD are systematically lower than the corresponding pre-HD values due to blood dilution caused by infusion of priming fluid that occurs during the start of HD.

[0006] Accordingly, conventional systems are unable to provide accurate and efficient pre-dialysis measurements of patient blood properties needed to adequately assess anemia in dialysis patients, such as to properly assess the degree of anemia reflected by pre-dialysis Hgb concentration, which is a parameter used for anemia management in clinical practice. SUMMARY

[0007] The summary is provided to introduce a selection of concepts that are further described below in the detailed description. This summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to limit the scope of the claimed subject matter.

[0008] According to various embodiments of the present disclosure, an apparatus can include at least one memory and a logic unit coupled to the at least one memory to perform a de-priming process of a patient undergoing a dialysis treatment via a dialysis machine operatively coupled to the apparatus. The logic unit can be operable to determine a priming volume of a priming fluid infused into a priming system associated with the patient during a priming phase of the dialysis treatment, cause an ultrafiltration rate of an ultrafiltration pump of the dialysis machine to change from a treatment ultrafiltration rate to a de-priming ultrafiltration rate to remove the priming volume over a de-priming time period, and cause the ultrafiltration rate of the ultrafiltration pump to change back to the treatment ultrafiltration rate after the de-priming time period.

[0009] In some embodiments of the apparatus, the logic unit can be operable to measure a blood property after the de-priming time period, the blood property including at least one of a hematocrit level or a hemoglobin (Hgb) level.

[0010] In various embodiments of the apparatus, the de-priming ultrafiltration rate can include approximately 2000 ml / hour to approximately 4000 ml / hour. In some embodiments of the apparatus, the de-priming time period can include approximately 6 minutes to approximately 10 minutes. In various embodiments of the apparatus, the de-priming ultrafiltration rate can include approximately 3000 ml / hour and the de-priming time period includes approximately 6 minutes.

[0011] In example embodiments of the apparatus, the logic unit can be operable to determine a de-priming start time for setting the ultrafiltration rate, the de-priming start time including a start time of the dialysis treatment.

[0012] In some embodiments of the apparatus, the logic unit can be operable to determine the priming volume based on a dialyzer volume and a tubing set volume. In various embodiments of the apparatus, the logic unit can be operable to determine the de-priming ultrafiltration rate based on a target blood flow rate. In some embodiments of the apparatus, the target blood flow rate can include approximately 150 ml / min to approximately 250 ml / min. In example embodiments of the apparatus, the logic unit can be operable to determine the de-priming ultrafiltration rate to remove the priming volume over the de-priming time period.

[0013] According to various embodiments of the present disclosure is a method of performing a de-priming process. The method can include, via a processor of a computing device operably coupled to a dialysis machine performing a dialysis treatment on a patient: determining a priming volume of priming fluid infused into a priming system associated with the patient during a priming phase of the dialysis treatment, causing an ultrafiltration rate of an ultrafiltration pump of the dialysis machine to change from a treatment ultrafiltration rate to a de-priming ultrafiltration rate to remove the priming volume over a de-priming time period, and causing the ultrafiltration rate of the ultrafiltration pump to change back to the treatment ultrafiltration rate after the de-priming time.

[0014] In some embodiments of the method, the method can include measuring a blood property after the de-priming time period, the blood property including at least one of a hematocrit level or a hemoglobin (Hgb) level.

[0015] In various embodiments of the method, the de-priming ultrafiltration rate can include approximately 2000 ml / hour to approximately 4000 ml / hour. In some embodiments of the method, the de-priming time period can include approximately 6 minutes to approximately 10 minutes. In various embodiments of the method, the de-priming ultrafiltration rate can include approximately 3000 ml / hour and the de-priming time period includes approximately 6 minutes.

[0016] In example embodiments of the method, the method can include determining a de-priming start time for setting the ultrafiltration rate, the de-priming start time including a start time of the dialysis treatment.

[0017] In some embodiments of the method, the method can include determining the priming volume based on a dialysis machine volume and a tubing set volume. In various embodiments of the method, the method can include determining the de-priming ultrafiltration based on a target blood flow rate. In some embodiments of the method, the target blood flow rate can include approximately 150 ml / min to approximately 250 ml / min.

[0018] In various embodiments of the method, the method can include determining the de-priming ultrafiltration rate to remove the priming volume over the de-priming time period. BRIEF DESCRIPTION OF DRAWINGS

[0019] Specific embodiments of the disclosed machine will now be described, by way of example only, with reference to the drawings in which:

[0020] Figure 1 A first example operating environment according to the present disclosure is shown;

[0021] Figure 2 A second example operating environment according to the present disclosure is shown;

[0022] Figure 3 A logical flow according to the present disclosure is shown;

[0023] Figure 4 A graph showing results of a preliminary study of the difference between laboratory measurements of hemoglobin (Hgb) values and measurements in dialysis for the de-priming process is shown;

[0024] Figure 5 A graph showing results of a preliminary study of the distribution of the difference between real-time Hgb measurements and laboratory Hgb measurements for the de-priming process is shown;

[0025] Figure 6 One exemplary embodiment of a dialysis system configured according to the present disclosure is shown; and

[0026] Figure 7 One embodiment of a computing architecture according to the present disclosure is shown. DETAILED DESCRIPTION

[0027] The present embodiments will now be described more fully with reference to the accompanying drawings, in which several exemplary embodiments are shown. The subject matter of the present disclosure, however, can be embodied in many different forms and should not be construed as limited to the embodiments set forth in this disclosure. Rather, these embodiments are provided so that this disclosure will be thorough and complete, and fully convey the scope of the subject matter to those skilled in the art. In the drawings, like numbers refer to like elements throughout.

[0028] Blood is often drawn from a dialysis patient for testing prior to dialysis to monitor patient health and detect and / or monitor complications, such as anemia. For example, a blood sample can be drawn after the patient is cannulated but before the patient is connected to a dialysis machine. These blood samples can be sent to a laboratory for processing. However, results often take several days to return to the healthcare provider. Some devices now can measure certain properties of a patient's blood during dialysis by measuring blood flowing through an extracorporeal circuit of a dialysis system. For example, the The Monitor (CLM) can measure information for a patient's hematocrit (which can be used to determine a hemoglobin (Hgb) level) and / or relative blood volume (RBV) during dialysis. In another example, the CliC device, available from Fresenius Medical Care of Waltham, MA, can measure absolute hematocrit, RBV, and continuous oxygen saturation. Thus, certain blood properties of a patient can be monitored during a dialysis treatment.

[0029] Dialysis systems typically undergo a priming process or phase prior to the start of a patient's dialysis treatment. Generally, the priming phase can operate to remove air, debris, chemicals, and / or the like from the dialysis machine and associated tubing. During hemodialysis (HD), the extracorporeal circuit and / or the patient's blood circuit can be primed with a priming fluid such as a saline solution. Thus, a volume of priming fluid (or priming volume) can be circulated through the extracorporeal circuit and the patient's blood circuit during the start of dialysis.

[0030] An effect of the priming phase (i.e., the phase during which the priming fluid is infused into the patient's bloodstream) is that patient blood flowing through the extracorporeal circuit can be diluted with the priming fluid during the initial phase of dialysis initiation. Thus, a device such as a Ciic device that measures blood properties as blood flows through the extracorporeal circuit can be measuring diluted blood, resulting in erroneous measurements (or more specifically, measurements that do not reflect actual pre-dialysis blood properties). For example, Hgb values measured via a CLM device during the initiation of dialysis (i.e., within the first 1-10 minutes) can be lower than corresponding lab results due to hemodilution of the patient's blood by the priming fluid (e.g., by approximately 0.5 g / dL). Thus, while CLM and Ciic devices are capable of determining Hgb concentrations during a dialysis treatment, pre-dialysis measurements can be systematically inaccurate due to hemodilution of the patient's blood. Accordingly, using conventional techniques, CLM and / or Ciic measurements during the first few minutes of a dialysis treatment (i.e., when the patient's blood can be diluted by the priming fluid) can not be an appropriate substitute for lab-based pre-dialysis Hgb measurements.

[0031] Accordingly, some embodiments can provide a de-priming process operable to de-prime patient blood to allow for measurement of undiluted blood properties via a blood property measurement device. In some embodiments, the de-priming process can de-prime a priming system, which can include a portion of the patient's vasculature, tubing (e.g., including the extracorporeal circuit), the dialysis machine, and / or any other component that can have been infused with priming fluid. In some embodiments, the priming system can be or can include the extracorporeal circuit used during a dialysis treatment. The de-priming process can operate to provide de-primed patient blood having the same or substantially similar properties as the patient's pre-dialysis blood. In this manner, a quasi-pre-dialysis blood sample can be taken after dialysis (or at least the priming phase of dialysis) has begun.

[0032] To access the patient's HD pre-hematocrit using the CLiC, CLM, or other device, the patient's blood must be as close as possible to its pre-treatment hematocrit state. Since the first minute or so of treatment involves pumping a known amount (e.g., 240 mL) of saline into the patient, some embodiments can include a de-priming process during the initial phase of treatment to involve a dramatic ultrafiltration, e.g., an ultrafiltration sufficient to remove a fluid volume equal to the amount of priming fluid introduced into the patient. The de-priming process can be operated quickly to minimize the likelihood of saline migrating beyond the vascular compartment. In some embodiments, the de-priming process can be performed at a relatively low blood flow rate to, e.g., minimize secondary effects of saline capture such as due to vascular access recirculation. After removing a plasma water volume equal to the priming volume or another volume sufficient to relieve the patient of priming, the patient's extracorporeal blood is, to a useful degree, close to the pre-treatment hematocrit state. After the de-priming process is complete, the CLiC, CLM, or other device can provide an Hgb measurement, e.g., a pre-dialysis Hgb concentration measurement, that would otherwise have to come from a lab.

[0033] Accordingly, some embodiments can include technical features that provide technical advantages over conventional systems, including improvements in computing technology (e.g., computing systems operable to control or otherwise manage dialysis systems). One non-limiting example of a technical advantage is allowing real-time blood property measurement devices such as the CliC and / or CLM devices to measure accurate pre-HD blood properties that, e.g., will be close enough to lab results for monitoring patient health (e.g., anemia status). Another non-limiting example of a technical advantage is operating a de-priming process using a high initial ultrafiltration rate (UFR) and a low blood flow rate that allows for rapid removal of the infused saline volume while limiting potential effects of unknown factors associated with saline extravasation and vascular refilling. Another non-limiting example of a technical advantage can include improvements in computing technology for dialysis systems and / or computing devices that operate with or otherwise interact with dialysis systems that allow such devices and systems to perform de-priming processes according to some embodiments that would not be possible with conventional computing technology and / or dialysis systems.

[0034] Furthermore, some embodiments may include technical features integrated into practical applications. For example, embodiments may include technical features (e.g., processes, algorithms, devices, equipment, and / or the like) integrated into dialysis systems and / or processes. For example, some embodiments may include a deperfusion process integrated into a dialysis system used to perform dialysis on a patient. Compared to conventional systems, dialysis systems configured according to some embodiments are better able to allow for accurate and efficient patient blood testing during dialysis, including testing of predialysis blood characteristics. In one practical application, patient blood testing may be used to determine a diagnosis, administer treatment to a patient (e.g., medical treatment, dialysis treatment, and / or similar treatment), and / or the like. In another case, the deperfusion process according to some embodiments may be integrated into practical applications that control a portion of a dialysis system, such as a filtration system including but not limited to an ultrafiltration pump, to remove perfusion fluid. In some embodiments, the deperfusion process may be integrated into practical applications that remove or substantially remove a volume of perfusion fluid from the patient and associated components (e.g., tubing, dialysis machine, extracorporeal circuit, and / or the like) during a deperfusion period. As is known to those skilled in the art, some of the technical features of the embodiments can be integrated into other practical applications.

[0035] Figure 1 An example of an operating environment 100, which may represent some embodiments, is shown. For example... Figure 1 As shown, the operating environment 100 may include a dialysis system 105 associated with a dialysis machine 170. In some embodiments, the dialysis machine 170 may include, be operatively coupled to, or otherwise associated with various components, such as an ultrafiltration (UF) pump 172, patient monitoring devices 174a-n, and / or tubing 176 (e.g., tubing for an extracorporeal circuit). In some embodiments, the dialysis machine may be or may include a dialyzer (not shown). In some embodiments, the patient monitoring devices 174a-n may include devices operable to measure or otherwise determine patient blood characteristics, including but not limited to hematocrit, Hgb, oxygen saturation, blood pressure, and / or the like. In various embodiments, the patient monitoring devices 174a-n may include a CLM device, a CLIC device, and / or the like. In some embodiments, one or more of the patient monitoring devices 174a-n may be operatively coupled to the dialysis machine 170, components of the dialysis machine 170, tubing 176, and / or the patient 178. Embodiments are not limited thereto.

[0036] In various embodiments, dialysis machine 170 can be or can include an HD dialysis system. For example, dialysis machine 170 can be or can include a Fresenius 2008T HD machine available from Fresenius Medical Care of Waltham, Massachusetts, USA. Although HD is used in the examples in this particular implementation, embodiments are not so limited as other types of dialysis systems and treatments are contemplated herein as capable of being performed in accordance with some embodiments.

[0037] In various embodiments, dialysis system 105 can include computing device 110 communicatively coupled to dialysis machine 170 and / or components associated with dialysis machine 170. Computing device 110 can be configured to be capable of, among other things, managing operational aspects of dialysis machine 170 to perform a dialysis treatment on a patient. Although only one computing device 110 and dialysis machine 170 are depicted in FIG. 1, embodiments are not so limited. In various embodiments, the functionality, operations, configurations, data storage functions, applications, logic units, and / or the like described with respect to computing device 110 can be performed by and / or stored in one or more other computing devices (not shown) coupled to computing device 110, e.g., via network 150 (i.e., network nodes 152a-n). A single computing device 110 and dialysis machine 170 are depicted for illustrative purposes only to simplify the figure. For example, computing device 110 can operate to dialysis processes for multiple dialysis machines 170 coupled to computing device 110, e.g., via network 150, in part or in whole. Embodiments are not so limited. Figure 1

[0038] ​The computing device 110 can include a transceiver 140, a display 142, an input device 144, and / or a processor circuit 120 that can be communicatively coupled to the memory unit 130. According to some embodiments, the processor circuit 120 can be, can include, and / or can have access to various logic units for performing processes. For example, the processor circuit 120 can include and / or can have access to a dialysis logic unit 122, a de-priming logic unit 124, and / or a blood property measurement logic unit 126. The processing circuit 120, the dialysis logic unit 122, the de-priming logic unit 124, the blood property measurement logic unit 126, and / or portions thereof can be implemented in hardware, software, or a combination thereof. As used in this application, the terms "logic unit," "component," "layer," "system," "circuit," "decoder," "encoder," "control loop," and / or "module" are intended to refer to computer-related entities, or groups thereof, or combinations of hardware, hardware and software, or software or software in execution, examples of which are provided by the example computing architecture 700. For example, a logic unit, circuit, or module can be and / or can include, without limitation, a process running on a processor, a processor, a hard disk drive, multiple storage drives (of optical and / or magnetic storage media), an object, an executable, a thread of execution, a program, a computer, hardware circuitry, an integrated circuit, an application-specific integrated circuit (ASIC), a programmable logic device (PLD), a digital signal processor (DSP), a field programmable gate array (FPGA), a system-on-a-chip (SoC), a memory unit, a logic gate, a register, a semiconductor device, a chip, a microchip, a chipset, a software component, a program, an application, firmware, a software module, computer code, a control loop, a proportional-integral-derivative (PID) controller, any combination of the foregoing, and / or the like.

[0039] Although the dialysis logic unit 122, the de-priming logic unit 124, and the blood property measurement logic unit 126 are depicted as being within the processor circuit 120 in Figure 1 some embodiments, embodiments are not so limited. For example, the dialysis logic unit 122, the de-priming logic unit 124, the blood property measurement logic unit 126, and / or any components thereof can be located within an accelerator, a processor core, an interface, a separate processor module, implemented entirely as a software application (e.g., the dialysis application 136), and / or the like. In some embodiments, the computing device 110 and / or components thereof can be an embedded or integrated component of a dialysis machine. For example, the processor circuit 120, the dialysis logic unit 122, the de-priming logic unit 124, the blood property measurement logic unit 126, and / or portions thereof can be disposed in or otherwise integrated into the dialysis machine 170.

[0040] The memory unit 130 can include various types of computer-readable storage media and / or systems in the form of one or more higher speed memory units, for example, read-only memory (ROM), random-access memory (RAM), dynamic RAM (DRAM), double-data rate DRAM (DDRAM), synchronous DRAM (SDRAM), static RAM (SRAM), programmable ROM (PROM), erasable programmable ROM (EPROM), electrically erasable programmable ROM (EEPROM), flash memory, polymer memory such as ferroelectric polymer memory, ovonic memory, phase change or ferroelectric memory, silicon-oxide-nitride-oxide-silicon (SONOS) memory, magnetic or optical cards, array of devices such as Redundant Array of Independent Disks (RAID) drives, solid state storage, for example, USB memory, solid state drive (SSD), and any other type of storage media suitable for storing information. In addition, the memory unit 130 can include various types of computer-readable storage media in the form of one or more lower speed memory units, including an internal (or external) hard disk drive (HDD), a magnetic floppy disk drive (FDD), and an optical disk storage drive like a CD-ROM, CDTV, DVD, digital versatile disk, and / or the like.

[0041] Memory unit 130 can store dialysis information 132 and / or blood property information 134. In some embodiments, dialysis information 132 can include generated information associated with a dialysis process, including dialysis machine 170 operational information, patient information, and / or priming information. Operational information can include UFR, UF goal (UFG), treatment time, operational parameters, and / or the like of a dialysis process. Patient information can include body temperature, heart rate, relative blood volume (RBV), oxygen saturation, blood pressure, intra-dialytic hypotension (IDH) information (e.g., predicted IDH information), and / or the like. Priming information can include information associated with a priming phase of dialysis machine 170. Non-limiting examples of priming information can include, for example, priming duration and / or volume information for determining a priming volume according to a de-priming process of various embodiments. Volume information can include dialysis machine hold volume information, dialyzer hold volume information, tubing information associated with tubing (e.g., patient line tubing, extracorporeal circuit) used to deliver fluid from dialysis machine 170 to a patient, patient extravasation rate, vascular refilling rate, and / or the like. In general, volume information can include any information that can be used to determine a volume of fluid that can be disposed within tubing 176, for example, at the time of priming (e.g., without air in the tubing). Non-limiting examples of tubing information 550 can include tubing length, tubing inner diameter, tubing outer diameter, tubing material, tubing compliance (e.g., amount of deflection under pressure), tubing volume calculation, tubing tolerances, and / or the like. In some embodiments, tubing 176 can be or can form a portion of an extracorporeal circuit. Dialysis machine hold volume information can include a volume of fluid that can be held within dialysis machine 170 and / or its constituent parts (e.g., hub, filter device, and / or the like), for example, priming fluid during a priming phase. In general, dialysis information 132 can include a measured, approximated, and / or the like, value of a priming volume, which can be indicative of a volume of priming fluid infused into a patient. Dialyzer hold volume information can include a volume of fluid that can be held within a dialyzer of dialysis machine 170 and / or its constituent parts.

[0042] In some embodiments, the de-priming logic 124 can determine at least a portion of the volume information based on operator input. For example, an operator can input certain tube characteristics, such as tube length, diameter, characteristic set information, and / or the like. In other embodiments, an operator can input a tube identifier (e.g., a manufacturer product identifier), and the de-priming logic 124 can determine at least a portion of the tube information based on available data associated with the tube identifier (e.g., via a manufacturer database, an operator database, and / or the like). In another example, an operator can create a pre-defined configuration that can be selected, the pre-defined configuration including pre-defined information defining tube information. In another example, the dialysis machine 170 can be operable to automatically determine a type of tube set, such as by reading or scanning a label or identifier on the tube or otherwise obtaining information about the tube set. Embodiments are not limited in this regard.

[0043] The blood characteristic information 134 can include values of measured blood characteristics. In general, the blood characteristics can include any characteristic of blood that can be measured and / or calculated based on a measurement. Non-limiting examples of blood characteristics can include hematocrit, Hgb, BV, RBV, ABV, oxygen saturation, blood flow rate, and / or the like.

[0044] In various embodiments, the dialysis logic 122 can be operable to perform a dialysis procedure, such as an HD treatment, on a patient via the dialysis machine 170, such as via the dialysis application 136. For example, the dialysis logic 122 can receive dialysis treatment information, such as patient characteristics, dialysis prescription information, and / or the like, to perform a dialysis procedure on a patient. In some embodiments, the dialysis logic 122, automatically or at least partially with manual intervention, can perform a priming phase of the dialysis machine 170 and / or the tubes 176. The priming phase can infuse a priming volume of priming fluid, such as via a tube, to a priming system of the dialysis machine 170. In some embodiments, the priming fluid can include saline and / or other fluids known in the art for priming a dialysis system. In some embodiments, the dialysis logic 122 can generate and / or provide a signal indicating a start and / or end of the priming procedure. In other embodiments, the dialysis logic 122 can generate and / or provide information indicative of and / or can be used to determine the priming volume.

[0045] According to some embodiments, the depriming logic 124 can operate to perform a depriming process. The depriming process according to various embodiments can operate to remove or substantially remove a volume of priming fluid from the patient and associated components (e.g., the tubing 176, the dialysis machine 170, extracorporeal circuit, and / or the like) over a depriming time period. In some embodiments, the depriming logic 124 can initiate the depriming process by setting the UFR of the infusion pump 172 to a depriming UFR over the depriming time period.

[0046] According to various embodiments, the priming volume can be determined by the depriming logic 124. An exemplary priming volume can be approximately 240 milliliters (ml). In various embodiments, the priming volume can be approximately 50 ml, approximately 100 ml, approximately 150 ml, approximately 200 ml, approximately 250 ml, approximately 300 ml, approximately 350 ml, approximately 400 ml, approximately 500 ml, and / or any value or range of values between any of these values, inclusive of the endpoints.

[0047] In some embodiments, the volume of priming fluid can be, for example, a known volume where the priming process operates to infuse a particular volume (e.g., approximately 240 ml) to the patient. In another embodiment, the volume of priming fluid can be input by a user into the dialysis machine 170, the computing device 110, the network nodes 152a-n, and / or the like. In additional embodiments, the volume of priming fluid can be determined based on characteristics of the dialysis machine 170, components of the dialysis machine 170 (e.g., filters, internal conduits, and / or the like), and / or components associated with the dialysis machine 170, such as the tubing 176. Non-limiting examples of values that can be used to determine the volume of priming fluid can include tubing volume, dialysis machine volume, tubing volume, extracorporeal circuit volume, volume of unprimed components (e.g., the dialysis machine volume can include unprimed filters), precision adjustments, error adjustments, loss or migration adjustments (e.g., a calculated or estimated value of priming fluid that migrates beyond a vascular compartment that is not affected by the UF), patient extravasation rate, vascular refilling rate, and / or the like. Generally, the precision / error adjustment information can include information indicative of the inaccuracy (e.g., tolerance, bias, error, patient extravasation rate, vascular refilling rate, and / or the like) or adjustment of the fluid volume measurements associated with the dialysis machine 170, the tubing 176, components thereof, and / or the like.

[0048] For example, the volume of priming fluid can be determined according to the following equation: volume of priming fluid = tube volume + dialysis machine volume. In some embodiments, the dialysis machine volume can be the volume of the dialyzer of the dialysis machine. In another example, the volume of priming fluid can be determined according to the following equation: volume of priming fluid = (tube volume + dialysis machine (i.e., dialyzer) volume) - volume of non-priming components. In some embodiments, the volume of priming fluid can be determined with consideration for measurement error or precision adjustments. Embodiments are not limited in this regard.

[0049] In some embodiments, the priming volume to be removed from the patient does not necessarily equal the amount of priming fluid infused into the patient. Additional considerations (e.g., patient factors and / or fluid volume factors) can be taken into account, such as a vascular refill rate (measured or estimated), a proxy for vascular refill rate (e.g., patient position and time course of patient position changes), a rate at which priming fluid is infused into the patient, a half-life of priming fluid in the patient’s vasculature, a duration of the de-priming process, a time between the start of the de-priming process and the Hgb measurement, a combination of any of the above, and / or the like. Thus, the priming volume can be determined according to the following equation: priming volume = volume of priming fluid + / - patient factors. For example, an amount of fluid lost due to a vascular refill rate can be determined and subtracted from the volume of priming fluid to determine the priming volume. Embodiments are not limited in this regard.

[0050] The de-priming logic 124 can operate to set the UFR to a de-priming UFR to initiate the de-priming process. In various embodiments, the de-priming UFR can be set to remove a priming volume from the priming system (e.g., extracorporeal circuit) over a de-priming time period. The de-priming UFR can be greater than the prescribed UFR for patient treatment. For example, the de-priming UFR can be approximately 3000 ml / hour. In various embodiments, the de-priming UFR can be approximately 100 ml / hour, approximately 200 ml / hour, approximately 300 ml / hour, approximately 400 ml / hour, 500 ml / hour, approximately 1000 ml / hour, approximately 1500 ml / hour, approximately 2000 ml / hour, approximately 2500 ml / hour, approximately 3000 ml / hour, approximately 3500 ml / hour, approximately 4000 ml / hour, approximately 5000 ml / hour, approximately 6000 ml / hour, and / or any value or range of values between any of these values, inclusive of the endpoints.

[0051] The de-priming time period can be set to a time period short enough to complete the de-priming process within a time frame that avoids or reduces priming fluid capture, priming fluid leakage beyond the vascular compartment, and / or the like, while being long enough to avoid UFRs, blood flow rates, and / or extracorporeal blood concentrations that can be harmful or otherwise undesirable to the patient. In some embodiments, the de-priming time period can be approximately 1-2 minutes (min). In other embodiments, the de-priming time period can be approximately 8 minutes. In various embodiments, the de-priming time period can be approximately 1 min, approximately 2 min, approximately 3 min, approximately 4 min, approximately 5 min, approximately 6 min, approximately 7 min, approximately 8 min, approximately 9 min, approximately 10 min, approximately 12 min, approximately 15 min, approximately 20 min, and / or any value or range of values between any of these values, inclusive of the endpoints.

[0052] In some embodiments, the de-priming logic 124 can determine the de-priming UFR and / or the de-priming time period based on various de-priming factors, such as the RBV, the priming volume, patient health characteristics, time since the end of the priming phase, rate and / or duration of priming fluid infusion, and / or the like. For example, the de-priming logic 124 can determine (e.g., from pre-determined information, experimental information, and / or the like) the time required for certain de-priming factors. For example, an RBV of B requires a first time period of A; a priming volume of D requires a second time period of C; a patient health characteristic F requires a second time period of E; and so on. The de-priming logic 124 can add the time periods determined based on the de-priming factors (i.e., A + C + E) and any other built-in time periods to determine the de-priming time period. Embodiments are not limited in this regard.

[0053] In some embodiments, the de-priming logic 124 can initiate the de-priming process based on one or more de-priming initiation factors. For example, in some embodiments, the de-priming initiation factor can be a specific start signal manually provided by a user via the dialysis machine 170, the computing device 110, and / or the network nodes 152a-n. In other embodiments, the start signal can be automatically provided, e.g., by the dialysis logic 122, in response to various stages of the priming process, including but not limited to completion of the priming process, a time period during the priming process (e.g., X min after the priming process starts), a time period after the priming process is completed, a time period after the dialysis process starts, an event (e.g., X ml of priming fluid is infused), combinations thereof, and / or the like. In other embodiments, the de-priming logic 124 can otherwise detect that the priming process has completed or any other stage of the priming process. In some embodiments, the de-priming logic 124 can initiate the de-priming process a time period after the dialysis starts, e.g., 1 min, 2 min, 3 min, 4 min, 5 min, 10 min, 15 min, 20 min, 25 min, 30 min, and / or any value or range of values between any of these values (including endpoints) after the dialysis starts. For example, the de-priming logic 124 can determine or otherwise receive information indicating how long after the dialysis process starts the patient has completed priming, and use that information to determine the start time of the de-priming process.

[0054] Generally, the de-priming process can be initiated within 1-2 minutes or otherwise as soon as possible after the priming stage is initiated, as the longer the duration since the priming stage started, the more fluid that can have migrated from the vasculature. For example, if the de-priming process starts 20 minutes after the priming stage, the actual volume of priming fluid to be removed from the patient’s vasculature is largely unknown, as the rate of priming fluid extravasation, vascular refilling, etc. is not quantified.

[0055] Accordingly, the de-priming process can be operated to begin at a start time, at a de-priming UFR, and / or for a de-priming time period. For example, the de-priming process can be operated at a rate of 3000 ml / hour for 8 minutes, and then the UFR is returned to the prescribed UFR. In various embodiments, the de-priming process can be operated to maintain the blood flow rate at a target blood flow rate, e.g., below a high threshold value and / or between a low threshold value and a high threshold value. For example, the de-priming UFR and / or the de-priming time period can be selected to maintain the target blood flow rate below about 200 ml / min. In another example, the target blood flow rate can be between about 150 ml / min and 250 ml / min. In various embodiments, the target blood flow rate can be above about 100 ml / min, about 150 ml / min, about 200 ml / min, about 250 ml / min, about 300 ml / min, about 350 ml / min, about 400 ml / min, about 450 ml / min, about 500 ml / min, and / or any value or range of values between any of these values, including the endpoints.

[0056] In various embodiments, the blood property measurement logic 126 can operate to measure, calculate, or otherwise determine at least one blood property of a patient to whom fluid is coupled to the dialysis machine 170. In some embodiments, the blood property logic 126 can determine when the end of the de-priming process has occurred, and thus, the patient blood has been de-primed. Accordingly, the blood property logic 126 can measure the patient blood property using the de-primed blood. In some embodiments, the blood property logic 126 can measure the blood property in primed, blood-diluted blood and de-primed blood, indicating the condition of the blood at the time of the measurement. For example, the blood property logic 126 can make measurements at time X (and thus using blood-diluted blood) before or during the de-priming process, and at time X+n (and thus using de-primed blood) after the de-priming process. In this way, the healthcare professional can review the difference between the values in the blood-diluted blood and the de-primed blood.

[0057] Figure 2 One example that can be representative of some embodiments is shown illustrating an operating environment 200. As shown, the operating environment 200 depicts a flowchart of a de-priming process in accordance with some embodiments. Figure 2

[0058] ​The dialysis system can be primed 205 and fluidly connected to the patient. A dialysis treatment 210 can be initiated at tl, an infusion of priming fluid to the patient during patient priming 215, thereby causing blood dilution 220 of the patient's blood. At t2, patient priming 215 has completed and a de-priming process 225 can be initiated at t3. In some embodiments, t2 and / or t3 can be a particular period of time after initiation of dialysis, such as about 1 minute to about 4 minutes after tl. At t4, the de-priming process 225 has completed and the patient has been de-primed 230 of the priming fluid. For example, the duration between t3 and t4 can be a duration determined, estimated, or otherwise established to be sufficient to remove the priming volume from the priming system. Accordingly, a blood property measurement 235 can be performed at t5, measuring a blood property of the de-primed patient's blood. In some embodiments, de-priming 230 can be or include a pre-dialysis approximation period of time (i.e., after de-priming but before the effects of the dialysis treatment) in which the de-primed patient's blood is similar or substantially similar to the patient's pre-dialysis blood. The duration of de-priming 230 (i.e., the pre-dialysis approximation period of time) can be determined based on various factors and can have a duration of, for example, about 30 seconds to about 10 minutes (including values and / or ranges between any two of these values) from the start and / or end of the de-priming process 225. In some embodiments, the de-priming logic 124 and / or the blood property measurement logic 126 can operate to determine the duration of de-priming 230 and conduct the blood property measurement 235 to determine a pre-dialysis (pre-quasi-dialysis or pre-dialysis approximation) measurement.

[0059] One or more logic flows representative of example methodologies for performing the novel aspects of the disclosed architectures are included herein. While, for purposes of simplicity of explanation, the one or more methodologies shown herein are shown and described as a series of acts, those skilled in the art will understand and appreciate that the methodologies are not limited by the order of acts. Accordingly, some acts can take place simultaneously, in other acts can take place concurrently, and / or with other acts in between. For example, those skilled in the art will understand and appreciate that a methodology could alternatively be represented as a series of interrelated states or events, such as in a state diagram. Moreover, not all acts illustrated in a methodology can be required for a novel implementation. Blocks designated with broken lines indicate optional blocks of the logic flow.

[0060] The logic flows can be implemented in software, firmware, hardware, or any combination thereof. In software and firmware embodiments, the logic flows can be implemented through computer-executable instructions stored on a non-transitory computer-readable medium or machine-readable medium. Embodiments are not limited in this regard.

[0061] Figure 3One embodiment of a logic flow 300 is shown that can represent some or all of the operations performed by one or more embodiments described herein, such as the computing device 110, the dialysis machine 170, and / or components thereof. The logic flow 300 can represent some or all of the operations performed in executing a de-priming process in accordance with some embodiments.

[0062] At block 302, the logic flow 300 can determine the start of a dialysis process. For example, the de-priming logic unit 124 can determine that a dialysis treatment for a patient has started via the dialysis machine 170. The patient can be fluidly coupled to the dialysis machine 170 via the tubing 176 (e.g., extracorporeal circuit). At block 304, the logic flow 300 can determine a priming time period 304. For example, the de-priming logic unit can determine how long priming fluid disposed within the dialysis machine 170, components thereof, and / or systems coupled thereto (e.g., patient monitoring devices 174a-n, tubing 176, and / or the like) that can hold priming fluid can take to infuse the priming fluid to the patient. At block 306, the logic flow 300 can determine a priming fluid volume. For example, the de-priming logic unit 124 can access, receive, calculate, or otherwise determine the priming volume to be removed from the patient.

[0063] At block 308, the logic flow 300 can determine de-priming parameters. Non-limiting examples of de-priming parameters can include a de-priming UFR, a de-priming UFG, a target blood flow rate (including, for example, threshold upper and lower limits), a de-priming time period, a de-priming start time, and / or the like.

[0064] At block 310, the logic flow 300 can execute a de-priming process. For example, the de-priming logic unit 124 can set the UFR of the ultrafiltration pump 172 to the de-priming UFR for the de-priming time period and then reset the UFR to the previous prescribed UFR. After completion of the de-priming process, at block 312, the logic flow 300 can measure patient blood properties. In this way, patient blood properties, such as hematocrit and / or Hgb, can be measured using de-primed, undiluted patient blood. In some embodiments, the logic flow 300 can operate to manage diagnosis and / or treatment based on patient blood properties, alone or in combination with a healthcare professional.

[0065] De-priming process pilot study: estimating pre-dialysis Hgb concentration using CLM readings in dialysis

[0066] A pilot study of a de-priming process in accordance with some embodiments was conducted in chronic HD patients. The patient population consisted of 27 patients (age 57.4 ± 15 years, 70% male, 71% African American) over 3 studies, involving (61) HD treatments in total.

[0067] Two HD pre-blood samples were drawn by Spectra East Laboratories (Rockleigh, New Jersey, United States) and measured in triplicate, and the average used for comparison to CLM determined via the de-priming process in accordance with some embodiments. The initial UFR was set to 3 L / hour for 8 minutes, then returned to the prescribed rate. Hgb was recorded continuously with the CLM. The difference between the CLM and the lab Hgb values was calculated as the CLM reading at each time point minus the average lab value.

[0068] As fluid was removed via the de-priming process by rapid ultrafiltration, the difference between the CLM and the lab values decreased and reached a minimum at approximately 6 minutes (see chart 405 of Figure 4 ), and approximately 75% of the subjects had CLM Hgb values within ±0.5 g / dL of the corresponding lab reference Hgb (see chart 505 of Figure 5 ). Generally, Figure 4 A chart 405 showing the results of the difference between laboratory measurements and real-time measurements of hemoglobin (Hgb) values for a de-priming process pilot study, Figure 5 A chart 505 showing the distribution of the results of the difference between real-time Hgb measurements and laboratory Hgb measurements at the sixth minute of a de-priming process pilot study. Using a high initial UFR of 3,000 mL / hour, 75% of the CLM Hgb values had a difference from the corresponding average laboratory measurement at the 6th minute of HD within ±0.5 g / dL.

[0069] Figure 6A schematic diagram is shown of one exemplary embodiment of a dialysis system 600 according to the present disclosure. The dialysis system 600 can be configured to provide hemodialysis (HD) treatment to a patient 601. A fluid reservoir 602 can deliver fresh dialysate to a dialyzer 604 via a tube 603, and a reservoir 606 can receive used dialysate via a tube 605 once it has passed through the dialyzer 604. A hemodialysis operation can filter particulates and / or contaminants from the patient's blood through a patient-external filtration device, such as the dialyzer 604. As the dialysate passes through the dialyzer 604, unfiltered patient blood also enters the dialyzer 604 via a tube 607, and filtered blood is returned to the patient 601 via a tube 609. Arterial pressure can be monitored via a pressure sensor 610, inflow pressure via a sensor 618, and venous pressure via a pressure sensor 614. An air trap and detector 616 can ensure that air is not introduced into the patient's blood as it is filtered and returned to the patient 601. The flow of blood and the flow of dialysate can be controlled via respective pumps, including a blood pump 612 and a fluid pump 620. Blood thinner heparin 622 can be used in conjunction with saline 624 to ensure that blood clots do not form or obstruct blood flow through the system.

[0070] In some embodiments, the dialysis system 600 can include a controller 650, which can be similar to the computing device 110 and / or its constituent parts (e.g., the processor circuit 420). The controller 650 can be configured to monitor fluid pressure readings to identify fluctuations indicative of patient parameters such as heart rate and / or respiratory rate. In some embodiments, the patient heart rate and / or respiratory rate can be determined from fluid pressure in fluid flow lines and fluid bags. The controller 650 can also be operatively connected to and / or in communication with additional sensors or sensor systems, devices, and / or the like, although the controller 650 can use any available data regarding a patient's biological function or other patient parameters. For example, the controller 650 can send patient data to the computing device 110 to perform processing according to some embodiments.

[0071] Figure 7 One embodiment of an exemplary computing architecture 700 suitable for implementing various embodiments as previously described is shown. In various embodiments, the computing architecture 700 can comprise or be implemented as part of an electronic device. In some embodiments, the computing architecture 700 can be representative of, for example, the computing device 702 and / or its constituent parts. Embodiments are not limited in this context.

[0072] As used in this application, the terms "system" and "component" and "module" are intended to refer to a computer-related entity, either hardware, a combination of hardware and software, software, or software in execution, examples of which are provided by the exemplary computing architecture 700. For example, a component can be, but is not limited to being, a process running on a processor, a processor, a hard disk drive, multiple storage drives (of optical and / or magnetic storage medium), an object, an executable, a thread of execution, a program, and / or a computer. By way of illustration, both an application running on a server and the server can be a component. One or more components can reside within a process and / or thread of execution, and a component can be localized, co-resident, and / or distributed among one or more computers. Also, a component can be a software

[0073] Computing architecture 700 includes various common computing elements, such as one or more processors, multi-core processors, co-processors, memory units, chipsets, controllers, peripherals, interfaces, oscillators, timing devices, video cards, audio cards, multimedia input / output (I / O) components, power supplies, and so forth. As such, embodiments are not limited by the materials used in the construction of the computing architecture 700.

[0074] As shown in Figure 7 FIG. 11, the computing architecture 700 includes a processing unit 704, a system memory 706, and a system bus 708. The processing unit 704 can be any of various commercially available processors, including without limitation and processors; application, embedded, and secure processors; and and processors; IBM and Cell processors; and processors; and similar processors. Dual microprocessors, multi-core processors, and other multi-processor architectures can also be employed as the processing unit 704.

[0075] The system bus 708 provides an interface for system constituents including, but not limited to, the system memory 706 to the processing unit 704. The system bus 708 can be any of several types of bus structures including, but not limited to, a memory bus, a peripheral bus, and a local bus using any of a variety of commercially available bus architectures. Interface adapters can connect to the system bus 708 via an appropriate socket architecture. Example socket architectures can include, but are not limited to, an Accelerated Graphics Port (AGP), Card Bus, (Extended) Industry Standard Architecture ((E)ISA), Micro Channel Architecture (MCA), NuBus, Peripheral Component Interconnect (Extended) (PCI(X)), PCI Express, Personal Computer Memory Card International Association (PCMCIA), and the like.

[0076] The system memory 706 can include various types of computer-readable storage media in the form of one or more higher speed memory units, such as read-only memory (ROM), random-access memory (RAM), dynamic RAM (DRAM), Double-Data Rate DRAM (DDRAM), synchronous DRAM (SDRAM), static RAM (SRAM), programmable ROM (PROM), erasable programmable ROM (EPROM), electrically erasable programmable ROM (EEPROM), flash memory, polymer memory such as ferroelectric polymer memory, ovonic memory, phase change or ferroelectric memory, silicon-oxide-nitride-oxide-silicon (SONOS) memory, magnetic or optical cards, an array of devices and other array of storage devices, solid state memory devices (e.g., USB memory, solid state drives (SSDs), and any other type of storage media suitable for storing information. In Figure 7 In the illustrated embodiment, the system memory 706 can include non-volatile memory 710 and / or volatile memory 712. A basic input / output system (BIOS) can be stored in the non-volatile memory 710.

[0077] The computer 702 can include various types of computer-readable storage media in the form of one or more lower storage units, including an internal (or external) hard disk drive (HDD) 714, a magnetic floppy disk drive (FDD) 716 to read from or write to a removable magnetic disk 718, and an optical disk drive 720 to read from or write to a removable optical disk 722 (e.g., a CD-ROM or DVD). The HDD 714, FDD 716 and optical disk drive 720 can be connected to the system bus 708 by a HDD interface 724, an FDD interface 726 and an optical drive interface 729, respectively. The HDD interface 724 for an external drive implementation can include at least one or both of Universal Serial Bus (USB) and IEEE 1384 interface technologies.

[0078] The drives and associated computer-readable media provide volatile and / or nonvolatile storage of data, data structures, computer-executable instructions, and so forth. For example, a number of program modules can be stored in the drives and memory units 710, 712, including an operating system 730, one or more application programs 732, other program modules 734, and program data 736. In one embodiment, the one or more application programs 732, other program modules 734, and program data 736 can include, for example, the various application programs and / or components of the computing device 110.

[0079] A user can enter commands and information into the computer 702 through one or more wired / wireless input devices, e.g., a keyboard 738 and a pointing device, such as a mouse 740. Other input devices can include a microphone, an infrared (IR) remote control, a radio-frequency (RF) remote control, a game pad, a stylus pen, a card reader, a dongle, a fingerprint reader, a glove, a graphic input pen, a joystick, a keyboard, a retina reader, a touch screen (e.g., capacitive, resistive, etc.), a trackball, a trackpad, a sensor, a stylus, and the like. These and other input devices are often connected to the processing unit 704 through an input device interface 742 that is coupled to the system bus 708, but can be connected by other interfaces such as a parallel port, an IEEE 994 serial port, a game port, a USB port, an IR interface, and so on.

[0080] A monitor 744 or other type of display device is also connected to the system bus 708 via an interface, such as a video adapter 746. The monitor 744 can be internal or external to the computer 702. In addition to the monitor 744, a computer typically includes other peripheral output devices, such as speakers, printers, and so forth.

[0081] The computer 702 can operate in a networked environment using logical connections to one or more remote computers, such as a remote computer 749. The remote computer 749 can be a workstation, a server computer, a router, a personal computer, portable computer, microprocessor-based entertainment appliance, a peer device or other common network node, and typically includes many or all of the elements described relative to the computer 702, although, for purposes of brevity, only a memory / storage device 750 is illustrated. The logical connections depicted include wire / wireless connectivity to a local area network (LAN) 752 and / or larger networks, e.g., wide area network (WAN) 754. Such LAN and WAN networking environments are commonplace in offices and companies and facilitate enterprise-wide computer networks, such as intranets, all of which can connect to a global communications network, such as the Internet.

[0082] When used in a LAN networking environment, the computer 702 is connected to the LAN 752 through a wire and / or wireless communication network interface or adaptor 756. The adaptor 756 can facilitate wire and / or wireless communications to the LAN 752, which can also include a wireless access point disposed thereon for communicating with the wireless functionality of the adaptor 756.

[0083] When used in a WAN networking environment, the computer 702 can include a modem 758, or be connected to a communications server on the WAN 754, or have other means for establishing communications over the WAN 754, such as by way of the Internet. The modem 759, which can be internal or external and a wire and / or wireless device, is connected to the system bus 708 via the input device interface 742. In a networked environment, program modules depicted relative to the computer 702, or portions thereof, can be stored in the remote memory / storage device 750. It will be appreciated that the network connections shown are exemplary and other means of establishing a communications link between the computers can be used.

[0084] The computer 702 is operable with a wired and / or wireless communication device or entity employing the IEEE 802 series standards, or the like, for example, to communicate with the wireless device (e.g., IEEE 802.16 air modulation techniques) operatively disposed in a wireless communication. This includes at least Wi-Fi (or Wireless Fidelity), WiMax, and Bluetooth™ wireless technologies, among others. TMWireless technology, etc. Thus, the communication can be of a pre-defined structure as with regular networks, or just an ad-hoc communication between at least two devices. Wi-Fi networks use radio technologies such as IEEE 802.11x (a, b, g, n, etc.) to provide secure, reliable, fast wireless connections, a similar to wired networks. Wi-Fi networks can be used to connect computers to the Internet, to other devices on a home network, and to the phones on a home network, which provide a secure and easy-to-use connection that a user needs.

[0085] Many specific details have been set forth herein to provide a thorough understanding of embodiments. It will be appreciated, however, that embodiments can be practiced without these specific details. In other instances, well-known operations, components and circuits have not been described in detail in order to avoid obscuring embodiments. It will be appreciated that the specific structural and functional details set forth herein are representative and do not necessarily limit the scope of embodiments.

[0086] Coupled and connected, as well as their derivatives, can be used to describe some embodiments. These terms are not intended as synonyms for each other. For example, some embodiments can be described using the terms "connected" and / or "coupled" to indicate that two or more elements are in direct physical or electrical contact with each other. "Coupled" can also mean that two or more elements are not in direct contact with each other, but yet still co-operate or interact with each other.

[0087] Unless specifically stated otherwise, it can be appreciated that terms such as "processing," "computing," "calculating," "determining," or the like, refer to the action and / or processes of a computer or computing system or similar electronic computing device, manipulating and / or transforming data represented as physical quantities (e.g., electronic) within the computing system's registers and / or memories into other data similarly represented as physical quantities within the computing system's memories, registers or other such information storage, transmission or display devices. Embodiments are not limited in this regard.

[0088] It should be noted that the methods described herein do not have to be performed in the order described or in any particular order. Furthermore, the various activities described with respect to the methods identified herein can be performed in serial or parallel.

[0089] Although specific embodiments have been illustrated and described herein, it should be appreciated that any arrangement calculated to achieve the same purpose can be substituted for the specific embodiments shown. This disclosure is intended to cover any and all adaptations or variations of various embodiments. It is to be understood that the above description is intended to be illustrative, and not restrictive, of the scope of the various embodiments. Combinations of the above embodiments, and other embodiments not specifically described herein, will be apparent to those of skill in the art upon reviewing the above description. The scope of various embodiments includes any other applications in which the above compositions, structures, and methods are used.

[0090] Although the subject matter has been described in language specific to structural features and / or methodological acts, it is to be understood that the subject matter defined in the appended claims is not necessarily limited to the specific features or acts described above. Rather, the specific features and acts described above are disclosed as example forms of implementing the claims.

[0091] As used herein, an element or operation recited in the singular and preceded with the word "a" or "an" should be understood as not excluding plural elements or operations, unless explicitly stated otherwise. Furthermore, references to "one embodiment" of the present disclosure are not intended to be interpreted as excluding the existence of additional embodiments that also incorporate those features.

[0092] The present disclosure is not limited to the specific embodiments described herein. Indeed, in addition to the embodiments described herein, other various embodiments and modifications thereof will be apparent to those skilled in the art from the foregoing description and drawings. Thus, such other embodiments and modifications are intended to fall within the scope of the present disclosure. Furthermore, although the present disclosure has been described herein in the context of particular implementations in a particular environment for a particular purpose, those of ordinary skill in the art will recognize that its usefulness is not limited thereto and that the present disclosure can be beneficially implemented in any number of environments for any number of purposes. Thus, claims stemming from this description are to be interpreted within, and to be accorded the broadest interpretation consistent with, the full scope of the claims.

Claims

1. An apparatus comprising: at least one memory; and a logic unit coupled to the at least one memory to perform a de-priming process of a patient undergoing a dialysis treatment via a dialysis machine operably coupled to the apparatus, the logic unit to: determine a priming volume of a priming fluid infused into a priming system associated with the patient during a priming phase of the dialysis treatment, cause an ultrafiltration rate of an ultrafiltration pump of the dialysis machine to change from a treatment ultrafiltration rate to a de-priming ultrafiltration rate to remove the priming volume over a predefined de-priming time period, the de-priming ultrafiltration rate determined to be capable of removing the priming volume over the de-priming time period, and cause the ultrafiltration rate of the ultrafiltration pump to change back to the treatment ultrafiltration rate after the predefined de-priming time period.

2. The apparatus of claim 1, wherein, the logic unit to measure a blood property after the de-priming time period, the blood property comprising at least one of a hematocrit level or a hemoglobin (Hgb) level.

3. The apparatus of claim 1 or 2, wherein, the de-priming ultrafiltration rate comprises 2000 ml / hour to 4000 ml / hour.

4. The apparatus of claim 1 or 2, wherein, the predefined de-priming time period comprises 6 minutes to 10 minutes.

5. The apparatus of claim 1, wherein, the de-priming ultrafiltration rate comprises 3000 ml / hour and the predefined de-priming time period comprises 6 minutes.

6. The apparatus of any one of claims 1-2, 5, wherein, the logic unit to determine a de-priming start time for setting the ultrafiltration rate, the de-priming start time comprising a start time of the dialysis treatment.

7. The apparatus of any one of claims 1-2, 5, wherein, the logic unit to determine the priming volume based on a dialyzer volume and a tubing set volume.

8. The apparatus of any one of claims 1-2, 5, wherein, the logic unit to determine the de-priming ultrafiltration rate based on a target blood flow rate.

9. The apparatus of claim 8, wherein, the target blood flow rate comprises 150 ml / min to 250 ml / min.

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