Systems and methods for monitoring fluid volume during peritoneal dialysis

Abstract

Techniques for monitoring fluid volume during peritoneal analysis include: continuously calculating lower abdominal fluid volume during a dwell time of a peritoneal dialysis treatment based at least on bioimpedance data from electrodes located on the patient's upper thigh; and continuously calculating intraperitoneal volume during a dwell time of a peritoneal dialysis treatment based at least on bioimpedance data from electrodes located on the patient's upper thigh and electrodes located on the patient's torso.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims the benefit of U.S. Provisional Patent Application Serial No. 62 / 913,217, filed October 10, 2019, entitled “Systems and Methods for Monitoring Fluid Volumes During Peritoneal Dialysis,” which is incorporated herein by reference in its entirety. Background Art

[0003] Peritoneal dialysis is a renal replacement therapy for patients with kidney disease. In clinical practice, it is difficult to obtain information about the change in fluid volume in the peritoneal cavity during the dwell time. In order to understand the characteristics of the peritoneum, the knowledge of ultrafiltration volume (UFV) is important in clinical routine. For single peritoneal dialysis treatment, the final ultrafiltration volume can be calculated based on the weight difference between the dialysate discharged and the dialysate injected. However, the weight difference between the dialysate discharged and the dialysate injected can not provide any knowledge about the dynamic changes of peritoneal volume (intraperitoneal volume, IPV) during the dwell time (dwell time), including the timing of the peak value of peritoneal volume.

[0004] The approaches described in this section were not necessarily conceived and / or carried out prior to the filing of this application. Therefore, unless otherwise indicated, the approaches described in this section should not be construed as prior art. Summary of the Invention

[0005] One or more embodiments include an apparatus and method for continuously monitoring fluid changes in a patient's lower abdomen and / or peritoneal cavity. The apparatus can be secured with a belt or other wearable item, such as around the patient's waist.

[0006] One or more embodiments include a pressure sensor for monitoring dialysate pressure in the peritoneal cavity during the dwell time. The device can calculate one or more metrics based on the pressure data. For example, the device can calculate tissue compliance as a function of pressure changes and fluid volume changes.

[0007] One or more embodiments include a temperature sensor for monitoring the temperature of the dialysate in the peritoneal cavity during the dwell time.The device can calculate one or more metrics based on the temperature data.

[0008] One or more embodiments use multi-frequency bioimpedance, where 4 to 8 electrodes are used to inject current and measure fluid changes. The electrodes can be made of any conductive material. Some of all the electrodes can be integrated into clothing worn by the patient (e.g., underwear, a belt, and / or another type of clothing).

[0009] One or more embodiments use wireless networking technology to transmit some or all signals to and / or from the device.

[0010] One or more embodiments include one or more switches (e.g., a three-way switch) to control dialysate infusion, residence time, and drain. The device can transmit instructions to the peritoneal dialysis device to control the switch(es) and / or control one or more other components of the peritoneal dialysis device.

[0011] One or more embodiments use bioimpedance data to detect the maximum fluid volume in the peritoneal cavity.

[0012] One or more embodiments include one or more body composition models that allow for measurement of intraperitoneal fluid volume and / or lower abdominal fluid volume (e.g., interstitial fluid volume and / or bladder capacity). The body composition model can be an equivalent circuit model that describes lower abdominal body composition and / or peritoneal cavity composition in terms of resistance. The equivalent circuit model can also include one or more capacitors.

[0013] One or more embodiments allow for measurement of fluid in both the peritoneal cavity and the lower abdomen (eg, interstitial tissue and / or bladder), either separately or simultaneously.The device may be configured to switch between calculation modes, for example, under the control of a digital switch.

[0014] One or more embodiments may be applied to monitor fluid changes at other locations in the body. For example, the devices and / or methods described herein may be used to continuously monitor abdominal effusion due to liver disease, pleural effusion due to heart disease, and / or internal bleeding due to various causes.

[0015] In general, in one aspect, an apparatus includes one or more processors and one or more non-transitory computer-readable media storing instructions that, when executed by the one or more processors, cause the apparatus to perform operations comprising: continuously calculating lower abdominal fluid volume during a dwell time of a peritoneal dialysis treatment based at least on bioimpedance data from electrodes located on an upper thigh of a patient; and continuously calculating intraperitoneal volume during a dwell time of a peritoneal dialysis treatment based at least on bioimpedance data from electrodes located on an upper thigh of the patient and electrodes located on the torso of the patient.

[0016] The operation may further include: detecting a first switching condition for switching from a first calculation mode for calculating a plurality of lower abdominal fluid volumes to a second calculation mode for calculating intraperitoneal volume; and, in response to detecting the first switching condition, switching from the first calculation mode to the second calculation mode. The operation may further include: detecting a second switching condition for switching from the second calculation mode to the first calculation mode; and, in response to detecting the second switching condition, switching from the second calculation mode to the first calculation mode. The first switching condition and the second switching condition may be states of a digital switch.

[0017] The operation may further include: detecting a first switching condition for switching from a first calculation mode for calculating intraperitoneal volume to a second calculation mode for calculating lower abdominal fluid volume; and, in response to detecting the first switching condition, switching from the first calculation mode to the second calculation mode. The operation may further include detecting a second switching condition for switching from the second calculation mode to the first calculation mode; and, in response to detecting the second switching condition, switching from the second calculation mode to the first calculation mode. The first switching condition and the second switching condition may be states of a digital switch.

[0018] The operations may also include obtaining bioimpedance data from the first plurality of electrodes and the second plurality of electrodes via wireless transmission.

[0019] Calculating the lower abdominal fluid volume may include applying bioimpedance data from electrodes located on the patient's upper thigh to a circuit model based at least in part on interstitial tissue resistance and peritoneal cavity resistance. The circuit model may include at least interstitial tissue resistance, peritoneal cavity resistance, local muscle resistance, and bladder resistance in parallel, wherein the circuit model can be simplified to the interstitial tissue resistance and peritoneal cavity resistance in parallel, and wherein the interstitial tissue resistance is greater than the peritoneal cavity resistance, such that the circuit model can be used to calculate changes in the lower abdominal fluid volume.

[0020] Calculating peritoneal volume may include applying bioimpedance data from electrodes located on an upper thigh of the patient to a circuit model based at least in part on a first resistance in parallel between (a) a first electrode in a first plurality of electrodes and a second electrode in a second plurality of electrodes and (b) a second resistance in parallel between a third electrode in the first plurality of electrodes and a fourth electrode in the second plurality of electrodes. The first resistance may correspond to a peritoneal cavity resistance on a right side of the patient's body, and the second resistance may correspond to a peritoneal cavity resistance on a left side of the patient's body.

[0021] The electrodes located on the patient's upper thigh may include a first electrode pair adjacent to the patient's right upper thigh and a second electrode pair adjacent to the patient's left upper thigh, and the electrodes located on the patient's torso may include a third electrode pair adjacent to the patient's right torso and a fourth electrode pair adjacent to the patient's left torso.

[0022] The operations may further include transmitting instructions to control operation of the peritoneal dialysis machine based at least on one or more of the lower abdominal fluid volume and / or the intraperitoneal volume.

[0023] Electrodes located on the patient's upper thigh can be integrated into clothing worn by the patient. The lower abdominal fluid volume can correspond to the bladder volume. The lower abdominal fluid volume can correspond to the interstitial volume.

[0024] In general, in one aspect, a device includes one or more processors and one or more non-transitory computer-readable media storing instructions that, when executed by the one or more processors, cause the device to perform operations comprising: continuously calculating an intraperitoneal volume during a dwell time of a peritoneal dialysis treatment based on at least bioimpedance data from (a) an electrode located on an upper thigh of a patient and (b) an electrode located on the torso of the patient; continuously obtaining a dialysate pressure in the patient's peritoneal cavity during the dwell time; and continuously calculating a tissue compliance value during the dwell time based on at least the intraperitoneal volume and the dialysate pressure in the patient's peritoneal cavity.

[0025] The operations may also include determining that at least one of the tissue compliance values ​​corresponds to a pathological condition; and generating an alert indicating that the pathological condition is detected.

[0026] The operations may also include transmitting instructions to control operation of the peritoneal dialysis machine based at least on at least one of the tissue compliance values.

[0027] The procedure may also include continuously obtaining the dialysate temperature in the patient's peritoneal cavity during the dwell time.

[0028] The electrodes located on the patient's upper thigh may include a first electrode pair adjacent to the patient's right upper thigh and a second electrode pair adjacent to the patient's left upper thigh, and the electrodes located on the patient's torso may include a third electrode pair adjacent to the patient's right torso and a fourth electrode pair adjacent to the patient's left torso.

[0029] In general, in one aspect, a system includes an electrode configured for placement on a patient's upper thigh, an electrode configured for placement on a patient's torso, a device including one or more processors, and one or more non-transitory computer-readable media storing instructions that, when executed by the one or more processors, cause the device to perform operations comprising: continuously calculating lower abdominal fluid volume during a dwell time of a peritoneal dialysis treatment based at least on bioimpedance data from the electrode located on the patient's upper thigh; and continuously calculating intraperitoneal volume during a dwell time of a peritoneal dialysis treatment based at least on bioimpedance data from the electrode located on the patient's upper thigh and the electrode located on the patient's torso.

[0030] The operation may further include: detecting a first switching condition for switching from a first calculation mode for calculating a plurality of lower abdominal fluid volumes to a second calculation mode for calculating intraperitoneal volume; and, in response to detecting the first switching condition, switching from the first calculation mode to the second calculation mode. The operation may further include: detecting a second switching condition for switching from the second calculation mode to the first calculation mode; and, in response to detecting the second switching condition, switching from the second calculation mode to the first calculation mode. The first switching condition and the second switching condition may be states of a digital switch.

[0031] The operation may further include: detecting a first switching condition for switching from a first calculation mode for calculating intraperitoneal volume to a second calculation mode for calculating lower abdominal fluid volume; and, in response to detecting the first switching condition, switching from the first calculation mode to the second calculation mode. The operation may further include detecting a second switching condition for switching from the second calculation mode to the first calculation mode; and, in response to detecting the second switching condition, switching from the second calculation mode to the first calculation mode. The first switching condition and the second switching condition may be states of a digital switch.

[0032] The operations may also include obtaining bioimpedance data from the first plurality of electrodes and the second plurality of electrodes via wireless transmission.

[0033] Calculating the lower abdominal fluid volume may include applying bioimpedance data from electrodes located on the patient's upper thigh to a circuit model based at least in part on interstitial tissue resistance and peritoneal cavity resistance. The circuit model may include at least interstitial tissue resistance, peritoneal cavity resistance, local muscle resistance, and bladder resistance in parallel, wherein the circuit model can be simplified to the interstitial tissue resistance and peritoneal cavity resistance in parallel, and wherein the interstitial tissue resistance is greater than the peritoneal cavity resistance, such that the circuit model can be used to calculate changes in the lower abdominal fluid volume.

[0034] Calculating peritoneal volume may include applying bioimpedance data from electrodes located on an upper thigh of the patient to a circuit model based at least in part on a first resistance in parallel between (a) a first electrode in a first plurality of electrodes and a second electrode in a second plurality of electrodes and (b) a second resistance in parallel between a third electrode in the first plurality of electrodes and a fourth electrode in the second plurality of electrodes. The first resistance may correspond to a peritoneal cavity resistance on a right side of the patient's body, and the second resistance may correspond to a peritoneal cavity resistance on a left side of the patient's body.

[0035] The electrodes located on the patient's upper thigh may include a first electrode pair adjacent to the patient's right upper thigh and a second electrode pair adjacent to the patient's left upper thigh, and the electrodes located on the patient's torso may include a third electrode pair adjacent to the patient's right torso and a fourth electrode pair adjacent to the patient's left torso.

[0036] The operations may further include transmitting instructions to control operation of the peritoneal dialysis machine based at least on one or more of the lower abdominal fluid volume and / or the intraperitoneal volume.

[0037] Electrodes located on the patient's upper thigh can be integrated into clothing worn by the patient. The lower abdominal fluid volume can correspond to the bladder volume. The lower abdominal fluid volume can correspond to the interstitial volume.

[0038] In general, in one aspect, a system includes an electrode configured for placement on an upper thigh of a patient, an electrode configured for placement on a torso of a patient, a device including one or more processors, and one or more non-transitory computer-readable media storing instructions that, when executed by the one or more processors, cause the device to perform operations comprising: continuously calculating an intraperitoneal volume during a dwell time of a peritoneal dialysis treatment based at least on bioimpedance data from (a) the electrode located on the upper thigh of the patient and (b) the electrode located on the torso of the patient; continuously obtaining a dialysate pressure in the patient's peritoneal cavity during the dwell time; and continuously calculating a tissue compliance value during the dwell time based at least on the intraperitoneal volume and the dialysate pressure in the patient's peritoneal cavity.

[0039] The operations may also include determining that at least one of the tissue compliance values ​​corresponds to a pathological condition; and generating an alert indicating that the pathological condition is detected.

[0040] The operations may also include transmitting instructions to control operation of the peritoneal dialysis machine based at least on at least one of the tissue compliance values.

[0041] The procedure may also include continuously obtaining the dialysate temperature in the patient's peritoneal cavity during the dwell time.

[0042] The electrodes located on the patient's upper thigh may include a first electrode pair adjacent to the patient's right upper thigh and a second electrode pair adjacent to the patient's left upper thigh, and the electrodes located on the patient's torso may include a third electrode pair adjacent to the patient's right torso and a fourth electrode pair adjacent to the patient's left torso.

[0043] In general, in one aspect, one or more non-transitory computer-readable media store instructions that, when executed by one or more processors, cause the one or more processors to perform operations comprising: continuously calculating lower abdominal fluid volume during a dwell time of a peritoneal dialysis treatment based at least on bioimpedance data from electrodes located on an upper thigh of a patient; and continuously calculating intraperitoneal volume during a dwell time of a peritoneal dialysis treatment based at least on bioimpedance data from electrodes located on an upper thigh of the patient and electrodes located on the torso of the patient.

[0044] The operation may further include: detecting a first switching condition for switching from a first calculation mode for calculating a plurality of lower abdominal fluid volumes to a second calculation mode for calculating intraperitoneal volume; and, in response to detecting the first switching condition, switching from the first calculation mode to the second calculation mode. The operation may further include: detecting a second switching condition for switching from the second calculation mode to the first calculation mode; and, in response to detecting the second switching condition, switching from the second calculation mode to the first calculation mode. The first switching condition and the second switching condition may be states of a digital switch.

[0045] The operation may further include: detecting a first switching condition for switching from a first calculation mode for calculating intraperitoneal volume to a second calculation mode for calculating lower abdominal fluid volume; and, in response to detecting the first switching condition, switching from the first calculation mode to the second calculation mode. The operation may further include detecting a second switching condition for switching from the second calculation mode to the first calculation mode; and, in response to detecting the second switching condition, switching from the second calculation mode to the first calculation mode. The first switching condition and the second switching condition may be states of a digital switch.

[0046] The operations may also include obtaining bioimpedance data from the first plurality of electrodes and the second plurality of electrodes via wireless transmission.

[0047] Calculating the lower abdominal fluid volume may include applying bioimpedance data from electrodes located on the patient's upper thigh to a circuit model based at least in part on interstitial tissue resistance and peritoneal cavity resistance. The circuit model may include at least interstitial tissue resistance, peritoneal cavity resistance, local muscle resistance, and bladder resistance in parallel, wherein the circuit model can be simplified to the interstitial tissue resistance and peritoneal cavity resistance in parallel, and wherein the interstitial tissue resistance is greater than the peritoneal cavity resistance, such that the circuit model can be used to calculate changes in the lower abdominal fluid volume.

[0048] Calculating peritoneal volume may include applying bioimpedance data from an electrode located on an upper thigh of the patient to a circuit model based at least in part on (a) a first resistance between a first electrode in a first plurality of electrodes and a second electrode in a second plurality of electrodes in parallel with (b) a second resistance between a third electrode in the first plurality of electrodes and a fourth electrode in the second plurality of electrodes. The first resistance may correspond to a peritoneal cavity resistance on a right side of the patient's body, and the second resistance may correspond to a peritoneal cavity resistance on a left side of the patient's body.

[0049] The electrodes located on the patient's upper thigh may include a first electrode pair adjacent to the patient's right upper thigh and a second electrode pair adjacent to the patient's left upper thigh, and the electrodes located on the patient's torso may include a third electrode pair adjacent to the patient's right torso and a fourth electrode pair adjacent to the patient's left torso.

[0050] The operations may further include transmitting instructions to control operation of the peritoneal dialysis machine based at least on one or more of the lower abdominal fluid volume and / or the intraperitoneal volume.

[0051] Electrodes located on the patient's upper thigh can be integrated into clothing worn by the patient. The lower abdominal fluid volume can correspond to the bladder volume. The lower abdominal fluid volume can correspond to the interstitial volume.

[0052] In general, in one aspect, one or more non-transitory computer-readable media store instructions that, when executed by one or more processors, cause the one or more processors to perform operations comprising: continuously calculating an intraperitoneal volume during a dwell time of a peritoneal dialysis treatment based at least on bioimpedance data from (a) electrodes located on an upper thigh of the patient and (b) electrodes located on the torso of the patient; continuously obtaining a dialysate pressure in the patient's peritoneal cavity during the dwell time; and continuously calculating a tissue compliance value during the dwell time based at least on the intraperitoneal volume and the dialysate pressure in the patient's peritoneal cavity.

[0053] The operations may also include determining that at least one of the tissue compliance values ​​corresponds to a pathological condition; and generating an alert indicating that the pathological condition is detected.

[0054] The operations may also include transmitting instructions to control operation of the peritoneal dialysis machine based at least on at least one of the tissue compliance values.

[0055] The procedure may also include continuously obtaining the temperature of the dialysate in the patient's peritoneal cavity during the dwell time.

[0056] The electrodes located on the patient's upper thigh may include a first electrode pair adjacent to the patient's right upper thigh and a second electrode pair adjacent to the patient's left upper thigh, and the electrodes located on the patient's torso may include a third electrode pair adjacent to the patient's right torso and a fourth electrode pair adjacent to the patient's left torso.

[0057] In general, in one aspect, one or more non-transitory computer-readable media store instructions that, when executed by one or more processors, cause the one or more processors to perform operations comprising: controlling one or more switches to enable communication with a first subset of electrodes located on a peritoneal dialysis patient; calculating intraperitoneal volume based on at least first bioimpedance data from the first subset of electrodes; controlling the one or more switches to enable communication with a second subset of electrodes located on the peritoneal dialysis patient, at least one electrode in the first subset being different from any electrode in the second subset; and calculating extraperitoneal volume based on at least second bioimpedance data from the second subset of electrodes. The one or more switches may control relay boxes, each relay box being associated with one or more corresponding electrodes.

[0058] The operation may also include adjusting one or more of a sampling rate or a measurement interval between the intraperitoneal volume and the extraperitoneal volume.

[0059] One or more of the embodiments described in this specification and / or recited in the claims may not be included in this summary. BRIEF DESCRIPTION OF THE DRAWINGS

[0060] Various aspects of at least one embodiment are discussed below with reference to the accompanying drawings, which are not intended to be drawn to scale. The accompanying drawings are included to provide illustration and a further understanding of the various aspects and embodiments and are incorporated into and constitute a part of the specification but are not intended to define the limits of the present disclosure. In the drawings, each identical or nearly identical component illustrated in various figures is represented by a like numeral. For clarity, some components may not be labeled in every figure. In the drawings:

[0061] Figure 1 is a block diagram of an example of a system according to an embodiment;

[0062] Figure 2 is a block diagram of an example of a monitoring device according to an embodiment;

[0063] Figure 3 An example of monitoring lower abdominal fluid volume according to an embodiment is shown;

[0064] Figure 4 An example of a circuit model according to an embodiment is shown;

[0065] Figure 5 An example of monitoring intraperitoneal volume according to an embodiment is shown;

[0066] Figure 6 An example of a circuit model according to an embodiment is shown;

[0067] Figure 7 An example of a graph showing lower abdominal fluid volume over time according to an embodiment is shown;

[0068] Figure 8 An example of a graph showing lower abdominal fluid volume over time according to an embodiment is shown;

[0069] Figure 9 shows an example of a graph of peritoneal volume over time according to an embodiment;

[0070] Figure 10 is a flow chart of an example of operations for monitoring volume during peritoneal dialysis, according to an embodiment;

[0071] Figure 11 is a block diagram of an example of a computer system according to an embodiment; and

[0072] Figures 12A-12B An example of monitoring intraperitoneal volume and extraperitoneal volume according to an embodiment is shown. DETAILED DESCRIPTION

[0073] The following table of contents is provided for the convenience of the reader and is not intended to limit the scope of the present disclosure.

[0074] 1. System Architecture

[0075] 2. Illustrative Examples

[0076] 3. Flowchart

[0077] 4. Miscellaneous; Extensions

[0078] 5. Computing devices

[0079] 1. System Architecture

[0080] Figure 1 is a block diagram of an example of a system 100 according to an embodiment. In one embodiment, the system 100 may include Figure 1 More or fewer components than shown. Figure 1 The components shown in can be local or remote from each other. Figure 1 The components shown can be implemented in software and / or hardware. Each component can be distributed across multiple applications and / or machines. Multiple components can be combined into a single application and / or machine. Operations described with respect to one component can be performed by another component.

[0081] In one embodiment, the monitoring device 102 is secured to the patient, such as a belt 122, a strap, a clip, or other securing device secured to the patient's waist. The monitoring device 102 refers to hardware and / or software configured to perform the operations described herein for monitoring fluid volume during peritoneal dialysis. Examples of operations for monitoring fluid volume during peritoneal dialysis are described below. The monitoring device 102 may include the following references: Figure 2 Describes the component.

[0082] In one embodiment, the monitoring device 102 includes a wireless networking device (not shown), such as Wi-Fi, and / or other types of wireless networking devices configured to receive data from and / or transmit data to one or more other components of system 100 (e.g., electrodes 124, pressure sensor 108, and / or temperature sensor 110). One or more switches and / or switches described herein (including those that may not be described herein) may be used to receive data from and / or transmit data to one or more other components of system 100 (e.g., switch 106, fill / drain switch 116, and / or dialysate switch 114). Figure 1The switches and / or switch conditions shown in FIG can be digital switches, i.e., switches that operate entirely or at least partially based on electrical signals and / or software instructions. One or more other components of system 100 can also include a wireless networking device (not shown) configured to communicate with monitoring device 102.

[0083] In one embodiment, to monitor fluid volume, the monitoring device 102 receives data from electrodes 124 placed on the patient's body. The electrodes 124 can be placed in positions that improve the signal-to-noise ratio relative to other possible electrode placements (e.g., compared to placement on the patient's arms, feet, and / or torso that produces a lower signal-to-noise ratio). For example, one set of electrodes can be placed on the patient's thighs, while another set of electrodes can be placed on the patient's torso. Specifically, an electrode pair S1, I1 can be placed close to each other on the patient's right thigh, an electrode pair S2, I2 can be placed close to each other on the patient's left thigh, an electrode pair I3, S3 can be placed close to each other on the patient's right torso, and an electrode pair I4, S4 can be placed close to each other on the patient's left torso. In one embodiment, this configuration allows for monitoring fluid volume while improving the signal-to-noise ratio relative to other possible electrode placements.

[0084] In one embodiment, electrodes I1, I2, I3, and I4 are current injection electrodes. Electrodes I1, I2, I3, and I4 can be configured to inject multi-frequency current (e.g., from 1 kHz to 1000 kHz) at their respective locations. Electrodes S1, S2, S3, and S4 are sensors for capturing bioimpedance data, such as measuring voltage. In one embodiment, the monitoring device 102 uses data from electrodes 124 to continuously (i.e., on an ongoing basis and / or at specific intervals) calculate fluid volume during peritoneal dialysis treatment. The monitoring device 102 can use bioimpedance spectroscopy to calculate peritoneal fluid volume. Techniques for calculating peritoneal fluid volume based on bioimpedance spectroscopy data are described in commonly owned Patent Cooperation Treaty (PCT) patent application serial number WO2013185080A1, entitled “System and Method for Monitoring and Controlling Ultrafiltration Volume Using Segmented Bioimpedance During Peritoneal Dialysis,” filed on June 7, 2013, the entire contents of which are incorporated herein by reference.

[0085] In one embodiment, the monitoring device 102 is configured to communicate with a peritoneal dialysis device 104. The peritoneal dialysis device 104 refers to the hardware and / or software configured to supply and drain dialysate 112 during peritoneal dialysis treatment, for example, using a pump 118. For example, the peritoneal dialysis device 104 may be one of a range of peritoneal dialysis devices offered by Fresenius Healthcare or other manufacturers.

[0086] In one embodiment, the peritoneal dialysis device 104 is configured to supply a single dialysate 112. Alternatively, the peritoneal dialysis device 104 can be configured to supply multiple dialysates 112, depending on the state of the dialysate switch 114. For example, the dialysate 112 can include 1.5% dextrose, 2.5% dextrose, and 4.25% dextrose. The dialysate switch 114 can be an n-way (e.g., three-way) switch for selecting between the available dialysates 112. In one embodiment, the monitoring device 102 is configured to transmit instructions (e.g., via wires and / or using a wireless protocol) to change the state of the dialysate switch 114, thereby switching the specific dialysate 112 supplied by the peritoneal dialysis device 104.

[0087] In one embodiment, the peritoneal dialysis device 104 includes a fill / drain switch 116 that switches between fill and drain. When the fill / drain switch 116 is in the fill state, the peritoneal dialysis device 104 infuses dialysate 112 into the patient. When the fill / drain switch 116 is in the drain state, the peritoneal dialysis device 104 removes fluid from the patient to a drain 120. The monitoring device 102 can be configured to transmit instructions (e.g., via wires and / or using a wireless protocol) to change the state of the fill / drain switch 116, thereby switching the peritoneal dialysis device 104 from fill to drain and / or vice versa.

[0088] In one embodiment, the switch 106 determines whether fluid is allowed to flow between the peritoneal dialysis device 104 and the patient. If the switch 106 is in the closed state, fluid will not flow between the peritoneal dialysis device 104 and the patient, regardless of the state of the fill / drain switch 116. If the switch 106 is in the open state, fluid can flow into or out of the patient, depending on the state of the fill / drain switch 116. The monitoring device 102 can be configured to transmit instructions (e.g., via wires and / or using a wireless protocol) to change the state of the switch 106, thereby controlling whether fluid is allowed to flow between the peritoneal dialysis device 104 and the patient. In one embodiment, the switch 106 is a three-way switch configured to switch between fill, drain, and dwell time. The switch 106 can also be configured to control the pump 118, for example, via wireless communication. The switch 106 can be a component of the peritoneal dialysis device 104 or separate from the peritoneal dialysis device 104.

[0089] In one embodiment, the pressure sensor 108 is configured to measure fluid pressure. Specifically, the pressure sensor 108 can be configured to measure fluid pressure in the peritoneal cavity. The pressure sensor 108 can be a component of the switch 106.

[0090] In one embodiment, the temperature sensor 110 is configured to measure the dialysate temperature. For example, the temperature sensor 110 can be fixed to the catheter. The intraperitoneal temperature can represent the body's core temperature, which is important for certain diagnoses (e.g., inflammation and / or infection).

[0091] In one embodiment, the combination of measurements of intraperitoneal volume, intraperitoneal pressure, and / or intraperitoneal temperature can provide comprehensive biological information relevant to the care of peritoneal dialysis patients.

[0092] In one embodiment, one or more components of system 100 are implemented on one or more digital devices. The term "digital device" generally refers to any hardware device that includes a processor. A digital device can refer to a physical device that executes an application or a virtual machine. Examples of digital devices include computers, tablet computers, laptop computers, desktop computers, netbooks, servers, network servers, network policy servers, proxy servers, general-purpose machines, special-purpose hardware devices, hardware routers, hardware switches, hardware firewalls, hardware network address translators (NATs), hardware load balancers, mainframes, televisions, content receivers, set-top boxes, printers, mobile phones, smartphones, personal digital assistants ("PDAs"), wireless receivers and / or transmitters, base stations, communication management equipment, routers, switches, controllers, access points, and / or client devices.

[0093] Figure 2 is a block diagram of an example of a monitoring device 102 according to an embodiment. In one embodiment, the monitoring device 102 may include Figure 2 More or fewer components than shown. Figure 2 The components shown in can be local or remote from each other. Figure 2 The components shown can be implemented in software and / or hardware. Each component can be distributed across multiple applications and / or machines. Multiple components can be combined into a single application and / or machine. Operations described with respect to one component can be performed by another component.

[0094] In one embodiment, the monitoring device 102 includes a biometric data processor 128. The biometric data processor 128 refers to hardware and / or software configured to receive signals from the bioimpedance spectrum 126, the pressure sensor 108, and / or the temperature sensor 110 and generate outputs based on the signals. For example, the biometric data processor 128 may include a signal processing component and a hardware processor configured to execute instructions. As described above, the monitoring device 102 may be configured to wirelessly receive one or more signals corresponding to biometric data from the corresponding sensor(s). Specifically, the bioimpedance spectrum 126 includes resistance data from the electrodes 124, which reflects changes in fluid volume. The biometric data processor 128 is configured to filter and analyze the input signals to calculate fluid volume. To calculate fluid volume, the biometric data processor 128 may apply the inputs (or transformations thereof) to one or more body composition models 132. The body composition model(s) 132 may correspond to one or more equivalent circuits. Examples of body composition model(s) 132 corresponding to equivalent circuits are described below.

[0095] In one embodiment, the biometric data processor 128 is configured to calculate one or more other metrics in addition to fluid volume. For example, as described in further detail below, the biometric data processor 128 can be configured to calculate tissue compliance and / or other metrics in conjunction with fluid temperature and / or fluid pressure.

[0096] In one embodiment, the biometric data processor 128 is configured to generate an output based on its calculations. For example, the biometric data processor 128 can be configured to transmit the output to the user interface 130, transmit instructions to one or more switches (e.g., switch 106, dialysate switch 114, and / or fill / drain switch 116), and / or transmit instructions to control a pump (e.g., pump 118). In one embodiment, the biometric data processor 128 is configured to instruct the peritoneal dialysis device 104 to switch between fill, dwell time, and / or drain according to an algorithm designed to maximize ultrafiltration volume, for example, according to a physician's prescription.

[0097] In one embodiment, user interface 130 refers to the hardware and / or software configured to facilitate communication between a user (e.g., a patient or clinician) and monitoring device 102. User interface 130 presents user interface elements and receives input via the user interface elements. User interface 130 can be a graphical user interface (GUI), a command line interface (CLI), a tactile interface, a voice command interface, and / or any other type of interface or a combination thereof. Examples of user interface elements include check boxes, radio buttons, drop-down lists, list boxes, buttons, switches, text fields, date and time selectors, command lines, sliders, pages, and forms.

[0098] 2. Illustrative Examples

[0099] For the sake of clarity, detailed examples are described below. The components and / or operations described below should be understood as examples that may not be applicable to one or more embodiments. Therefore, the components and / or operations described below should not be interpreted as limiting the scope of one or more embodiments.

[0100] Figure 3 An example of monitoring the fluid volume in the lower abdomen according to one embodiment is shown. As described above, electrodes I1 and I2 are current injection electrodes, and electrodes S1 and S2 are sensors. P and R IT Represent the electrical resistance in the peritoneal cavity and interstitial tissue, respectively. Figure 3 The electrode placement shown can be used to measure changes in bioimpedance in the interstitial space and bladder.

[0101] also, Figure 3 An example of electrodes I1, I2, S1, and S2 being integrated into a garment 204 worn by a patient, such as underwear or another type of clothing, is shown. Other electrodes (e.g., electrodes I3, I4, S3, and S4) may also be integrated into the same garment 204 (with appropriate modifications, e.g., by designing the garment 204 to also cover the patient's torso) and / or into a separate garment. Integrating electrodes into the garment 204 can help ensure proper placement of the electrodes, thereby improving the signal-to-noise ratio and obtaining a more accurate bioimpedance spectrum.

[0102] Figure 4 An example of a circuit model according to an embodiment is shown. Specifically, Figure 4 Shown is the corresponding Figure 3 Example of an equivalent circuit model for electrode placement. This model describes the lower abdominal body composition, where R 1-2 Represents the total resistance from electrodes S1 and S2. These two resistors R INRepresents the resistance between the electrode and the skin, that is, the resistance from the electrode to the abdominal compartment, which is less than the resistance in any compartment (including the peritoneal cavity, muscle mass, bladder, and interstitial tissue). M and C M Represents local muscle resistance and capacitance respectively. R p Represents the resistance of the peritoneal cavity. R IT and C IT Represents interstitial tissue resistance and capacitance respectively. b and C b Represents the resistance and capacitance of the bladder respectively. IT Less than R P , R P Less than R M . Figure 4 The model can be simplified to two resistors in parallel (R IT and R P ). R b In peritoneal dialysis patients, the resistance R in the peritoneal cavity is constant and negligible. p Greater than the resistance R in the interstitial tissue IT or the resistance R in the muscle M , so the equivalent resistance from the model represents the resistance in the interstitial tissue and / or bladder. Therefore, Figure 4 The model can be used to calculate changes in interstitial tissue and / or bladder volume.

[0103] Figure 5 An example of monitoring intraperitoneal volume according to one embodiment is shown. Specifically, Figure 5 The arrangement of eight electrodes I1, S1, I2, S2, I3, S3, I4, S4 for measuring the intraperitoneal volume is shown. Two electrodes I1, I3 on ​​the right side of the patient and two electrodes I2, I4 on the left side of the patient are used to inject current. Two electrodes S1, S3 on the right side of the patient and two electrodes S2, S4 on the left side of the patient are used to measure the resistance R generated on the right and left sides of the patient respectively. PR and R PL voltage.

[0104] Figure 6 An example of a circuit model according to an embodiment is shown. Specifically, Figure 6 Shown is the corresponding Figure 5 Example of an equivalent circuit model for an electrode placement. The model includes a parallel resistor R PR and R PL The two resistors R IN Less than R PL and R PRBecause the current can pass through the peritoneal cavity, changes in peritoneal volume can be accurately measured. Before measuring changes in peritoneal volume, a calibration can be performed using an initial volume of fresh dialysate.

[0105] Figure 7 An example of a graph showing lower abdominal fluid volume versus time according to one embodiment is shown. Specifically, Figure 7 Shows the use of Figure 4 A diagram of a model measuring fluid in the lower abdomen of a normal subject. Figure 3 In the configuration shown, four electrodes were placed on a subject in a seated position. The measurement consisted of three phases: (1) a five-minute baseline; (2) drinking 0.6 liters of water during the second five-minute period; and (3) the change in bladder water over the following 30 minutes. In this example, no fluid was introduced into the peritoneum and other compartments, such as muscle mass and interstitial fluid. Therefore, changes in lower abdominal fluid can be interpreted as increases in bladder fluid.

[0106] Figure 8 An example of a graph showing lower abdominal fluid volume versus time according to one embodiment is shown. Specifically, Figure 8 Shows the use of Figure 4 Graph of measurements of lower abdominal fluid (i.e., resistance change at 5 kHz) during residence time in peritoneal dialysis treatment using a model of Figure 3 The configuration shown is where four electrodes are placed on the subject. A peritoneal dialysis treatment consists of three phases: (a) infusion of 2 liters of dialysate; (b) a dwell time of 4 hours; and (c) a drainage phase. Figure 8 In the present study, no fluid changes corresponding to the infusion or drainage phases were observed because measurements were performed only in the interstitial compartment and not in the peritoneal cavity. Figure 8 The resistance measurement may indicate changes in the fluid in the interstitial compartment.

[0107] Figure 9 An example of a graph of peritoneal volume over time according to one embodiment is shown. Specifically, Figure 9 Shows the use of Figure 6 The model monitors the fluid changes in the peritoneal cavity of peritoneal dialysis patients. Figure 5 The configuration shown shows eight electrodes placed on the subject. In this example, the three phases (i.e., infusion, residence time, and drainage) can be clearly observed, as the model allows for the assessment of the total change in fluid volume.

[0108] Figures 12A-12BAn example of monitoring both intraperitoneal volume (EPV) and extraperitoneal volume (IPV) according to one embodiment is shown. Measuring IPV using segmented bioimpedance is a powerful method for assessing the ability of the peritoneum to clear excess fluid during peritoneal dialysis. In addition, monitoring IPV during peritoneal dialysis treatment can identify the maximum ultrafiltration volume, thereby optimizing the residence time for individual patients. However, if monitoring EPV assumes that the EPV of the area surrounding the peritoneal cavity is constant, then changes in EPV may interfere with the IPV measurement.

[0109] The following is an example of a method for assessing EPV during peritoneal therapy, allowing the relationship between EPV and IPV to be assessed during therapy. As described above, EPV can be assessed using four electrodes and IPV can be measured using eight electrodes. Figures 12A-12B The example shown allows for continuous measurement of EPV and IPV, using switches to selectively transmit signals from eight electrodes to two inputs of a bioimpedance device.

[0110] Specifically, Figure 12A The placement of eight electrodes I1, S1, I2, S2, I3, S3, I4, S4 is shown. The two electrodes I1, I3 on ​​the right side of the patient and the two electrodes I2, I4 on the left side of the patient are used to inject current. The two electrodes S1, S3 on the right side of the patient and the two electrodes S2, S4 on the left side of the patient are used to measure the resistance R generated on the right and left sides of the patient respectively. PR and R PL Voltage. R IT Represents the electrical resistance in the interstitial tissue.

[0111] like Figure 12B As shown, one or more switches communicatively coupled to the electrodes can be used to measure EPV and IPV. In this example, the switches are used to Figure 12A The eight relay boxes (r1 to r8) for the eight electrodes shown in FIG. The connection between the electrodes and the relay boxes can be wired, wireless, or a combination thereof. The relay boxes are configured to pass signals from the respective electrodes to the input points of the bioimpedance device 1206. The controller 1204 may include one or more processors and may be configured to use the relay boxes to automatically and alternately switch between the electrodes to measure IPV (via R PR and R PL ) and EPV (via R IT In one embodiment, the controller 1204 includes one or more settings that determine the sampling rate(s) and / or measurement interval(s) between the IPV and EPV. For example, the controller 1204 may be configured via an application programming interface (API) and / or a user interface ( Figure 12B (not shown) to adjust the settings.

[0112] 3. Flowchart

[0113] Figure 10 is a flow chart illustrating an example of operations for monitoring fluid volume during a peritoneal dialysis session, according to one embodiment. Figure 10 One or more of the operations shown in may be modified, rearranged, or omitted altogether. Figure 10 The particular order of operations shown should not be construed as limiting the scope of one or more embodiments.

[0114] In one embodiment, electrodes are placed on the patient to monitor the lower abdominal fluid volume (1002). As described above, the electrodes may be placed on the patient to monitor the lower abdominal fluid volume (1002). Figure 3 Place as shown.

[0115] In one embodiment, electrodes are placed on the patient to monitor peritoneal fluid volume (1004). The electrodes may include Figure 5 The electrodes shown, as described above, include Figure 3 The electrodes shown can also be used to calculate fluid volume in the lower abdomen.

[0116] In one embodiment, the monitoring device obtains biometric data during peritoneal dialysis (1006). The biometric data may include bioimpedance data from the electrodes and may also include data corresponding to fluid pressure and / or fluid temperature. During peritoneal dialysis, the monitoring device obtains biometric data continuously (i.e., on an ongoing basis and / or at regular intervals). As described above, the monitoring device may obtain some or all of the biometric data wirelessly.

[0117] In one embodiment, the monitoring device calculates fluid volume (1008). Specifically, the monitoring device calculates lower abdominal fluid volume (e.g., interstitial fluid volume and / or bladder volume) and / or peritoneal fluid volume. The monitoring device may include two or more calculation modes for calculating different types of fluid volumes, and may be configured to switch between calculation modes based on user input and / or automatic switching conditions. Alternatively, the monitoring device may be configured to calculate two or more fluid volumes in parallel, i.e., without switching between calculation modes.

[0118] In one embodiment, the monitoring device calculates one or more metrics based on fluid pressure and / or fluid temperature (1010). The metrics can be based on a combination of fluid pressure, fluid temperature, and / or one or more fluid volumes. For example, the monitoring device can calculate tissue compliance as a function of changes in fluid pressure and changes in fluid volume (e.g., dP / dV).

[0119] In one embodiment, the monitoring device determines whether an alarm condition is detected (1012). An alarm condition is a condition that requires human attention. For example, an alarm condition may indicate a rapid change in fluid volume, fluid volume above or below a threshold, a rapid change in tissue compliance, or tissue compliance above or below a threshold. Because the monitoring device continuously calculates fluid volume and / or other metrics, one or more embodiments are able to quickly detect an alarm condition without undue delay that could jeopardize the patient's health or their care. If the monitoring device detects an alarm condition, the monitoring device generates an alarm indicating the alarm condition (1014). The monitoring device may, for example, send the alarm to a user interface of the monitoring device.

[0120] In one embodiment, the monitoring device determines whether to change the operation of the peritoneal dialysis machine (1016). For example, the monitoring device may detect a peak in the amount of ultrafiltration. In general, the monitoring device may detect a condition that warrants a change in the state of a switch, pump, and / or another component of the peritoneal dialysis machine. If the corresponding condition(s) are met, the monitoring device transmits one or more instructions (1018) to the peritoneal dialysis machine, instructing the peritoneal dialysis machine (or its components) to change its operation accordingly. Alternatively, the monitoring device may generate an alarm instructing a person to manually adjust the operation of the peritoneal dialysis machine.

[0121] In one embodiment, the monitoring device determines whether to switch the fluid volume calculation mode (1020). Specifically, the monitoring device may determine whether to switch from one calculation mode to another based on user input and / or automatic switching conditions. If the corresponding condition(s) are met, the monitoring device switches the fluid volume calculation mode (1022). For example, the monitoring device may switch from calculating the lower abdominal fluid volume to calculating the peritoneal fluid volume, or vice versa.

[0122] As described above, the monitoring device is configured to continuously monitor fluid volume. Thus, the monitoring device continues to obtain biometric data and perform calculations based on the biometric data until a termination condition (not shown) is satisfied. For example, continuous monitoring may terminate when peritoneal dialysis treatment is complete, when the monitoring device is powered off, in response to user input, and / or in response to an automatic termination condition. If the monitoring device switches between calculation modes, the term "continuously," as used herein, applies to the period of time that the monitoring device is in the corresponding calculation mode.

[0123] 4. Miscellaneous

[0124] In one embodiment, a system includes one or more devices, including one or more hardware processors, configured to perform any of the operations described herein and / or recited in any claims.

[0125] In one embodiment, one or more non-transitory computer-readable storage media store(s) instructions that, when executed by one or more hardware processors, result in performance of any of the operations described herein and / or recited in any claims.

[0126] According to one embodiment, any combination of the features and functions described herein may be used. In the foregoing description, embodiments have been described with reference to numerous specific details that may vary from implementation to implementation. Accordingly, the description and drawings are to be regarded as illustrative rather than restrictive. The sole and exclusive indicator of the scope of the invention, and the scope intended by the applicants to be the scope of the invention, is the literal and equivalent range of the set of claims issuing from this application, in the specific form in which such claims issue, including any subsequent amendments.

[0127] 5. Computing devices

[0128] In one embodiment, the techniques described herein are implemented by one or more special-purpose computing devices (i.e., computing devices specifically configured to perform a specific function). The special-purpose computing device(s) may be hardwired to perform these techniques, and / or may include digital electronic devices, such as one or more application-specific integrated circuits (ASICs), field programmable gate arrays (FPGAs), and / or network processing units (NPUs) that are permanently programmed to perform these techniques. Alternatively or additionally, the computing device may include one or more general-purpose hardware processors that are programmed to perform these techniques in accordance with program instructions in firmware, memory, and / or other storage. Alternatively or additionally, the special-purpose computing device may combine customized hard-wired logic, ASICs, FPGAs, or NPUs with customized programming to implement these techniques. The special-purpose computing device may include a desktop computer system, a portable computer system, a handheld device, a networked device, and / or any other device that combines hardwiring and / or program logic to implement the technology.

[0129] For example, Figure 11 1 is a block diagram of an example of a computer system 1100 according to an embodiment. Computer system 1100 includes a bus 1102 or other communication mechanism for communicating information, and a hardware processor 1104 coupled with bus 1102 for processing information. Hardware processor 1104 may be a general-purpose microprocessor.

[0130] The computer system 1100 also includes a main memory 1106, such as a random access memory (RAM) or other dynamic storage device, coupled to the bus 1102 for storing information and instructions to be executed by the processor 1104. The main memory 1106 may also be used for storing temporary variables or other intermediate information during execution of instructions by the processor 1104. When stored in one or more non-transitory storage media accessible to the processor 1104, these instructions cause the computer system 1100 to function as a special-purpose machine customized to perform the operations specified in the instructions.

[0131] Computer system 1100 also includes a read only memory (ROM) 1108 or other static storage device coupled to bus 1102 for storing static information and instructions for processor 1104. A storage device 1110, such as a magnetic or optical disk, is provided and coupled to bus 1102 for storing information and instructions.

[0132] Computer system 1100 can be coupled via bus 1102 to a display 1112, such as a liquid crystal display (LCD), a plasma display, an electronic ink display, a cathode ray tube (CRT) monitor, or any other type of device for displaying information to a computer user. An input device 1114, including alphanumeric and other keys, can be coupled to bus 1102 for communicating information and command selections to processor 1104. Alternatively or additionally, computer system 1100 can receive user input via cursor control 1116, such as a mouse, trackball, trackpad, or cursor direction keys, for communicating direction information and command selections to processor 1104 and for controlling cursor movement on display 1112. This input device typically has two degrees of freedom in two axes, a first axis (e.g., x) and a second axis (e.g., y), which allows the device to specify a position in a plane. Alternatively or additionally, computer system 1100 can include a touch screen. Display 1112 can be configured to receive user input via one or more pressure-sensitive sensors, multi-touch sensors, and / or gesture sensors. Alternatively or additionally, computer system 1100 may receive user input via a microphone, a camera, and / or some other type of user input device (not shown).

[0133] Computer system 1100 can implement the techniques described herein using custom hardwired logic, one or more ASICs or FPGAs, firmware, and / or program logic, which, in combination with other components of computer system 1100, render or program computer system 1100 into a special-purpose machine. According to one embodiment, computer system 1100 performs the techniques described herein in response to processor 1104 executing one or more sequences of one or more instructions contained in main memory 1106. These instructions can be read into main memory 1106 from another storage medium, such as storage device 1110. Execution of the sequences of instructions contained in main memory 1106 causes processor 1104 to perform the process steps described herein. Alternatively or in addition, hardwired circuitry can be used in place of or in combination with software instructions.

[0134] As used herein, the term "storage media" refers to one or more non-transitory media that store data and / or instructions that cause a machine to operate in a particular manner. Such storage media may include non-volatile media and / or volatile media. Non-volatile media include, for example, optical or magnetic disks, such as storage device 1110. Volatile media include dynamic memory, such as main memory 1106. Common forms of storage media include, for example, floppy disks, flexible disks, hard disks, solid-state drives, magnetic tape or other magnetic data storage media, CD-ROMs or any other optical data storage media, any physical medium with a pattern of holes, RAM, programmable read-only memory (PROM), erasable PROM (EPROM), flash-EPROM, non-volatile random access memory (NVRAM), any other memory chip or cartridge, content addressable memory (CAM), and ternary content addressable memory (TCAM).

[0135] Storage media are distinct from transmission media, but can be used in conjunction with them. Transmission media participate in the transfer of information between storage media. Examples of transmission media include coaxial cables, copper wire, and optical fiber, including the wires that comprise bus 1102. Transmission media can also take the form of acoustic or light waves, such as those generated during radio wave and infrared data communications.

[0136] Various forms of media may be involved in delivering one or more sequences of one or more instructions to the processor 1104 for execution. For example, the instructions may initially be carried by a disk or solid-state drive of a remote computer. The remote computer may load the instructions into its dynamic memory and send the instructions over the network via a network interface controller (NIC), such as an Ethernet controller or a Wi-Fi controller. The NIC local to the computer system 1100 may receive the data from the network and place the data on the bus 1102. The bus 1102 transfers the data to the main memory 1106, from which the processor 1104 retrieves and executes the instructions. The instructions received by the main memory 1106 may optionally be stored on the storage device 1110 before or after execution by the processor 1104.

[0137] Computer system 1100 also includes a communication interface 1118 coupled to bus 1102. Communication interface 1118 provides two-way data communication coupled to network link 1120, which is connected to local network 1122. For example, communication interface 1118 can be an integrated services digital network (ISDN) card, a cable modem, a satellite modem, or a modem that provides a data communication connection to a corresponding type of telephone line. As another example, communication interface 1118 can be a local area network (LAN) card to provide a data communication connection to a compatible LAN. A wireless link can also be implemented. In any such implementation, communication interface 1118 sends and receives electrical, electromagnetic, or optical signals that carry digital data streams representing various types of information.

[0138] The network link 1120 typically provides data communication to other data devices through one or more networks. For example, the network link 1120 may provide a connection to a host computer 1124 through a local network 1122 or to data equipment operated by an Internet Service Provider (ISP) 1126. The ISP 1126, in turn, provides data communication services through the global packet data communication network now commonly referred to as the "Internet" 1128. Both the local network 1122 and the Internet 1128 use electrical, electromagnetic, or optical signals that carry digital data streams. The signals through the various networks, as well as the signals on the network link 1120 and through the communication interface 1118, are example forms of transmission media that carry the digital data to and from the computer system 1100.

[0139] Computer system 1100 can send messages and receive data, including program code, through the network(s), network link 1120, and communication interface 1118. In the Internet example, server 1130 can transmit the requested code for an application program through Internet 1128, ISP 1126, local network 1122, and communication interface 1118.

[0140] The received code may be executed by processor 1104 as it is received, and / or stored in storage device 1110 or other non-volatile storage for later execution.

Claims

1. One or more non-transitory computer-readable media storing instructions that, when executed by one or more processors, cause the one or more processors to perform operations comprising: continuously calculating a plurality of lower abdominal fluid volumes during a dwell time of a peritoneal dialysis treatment based on at least bioimpedance data from a first plurality of electrodes located on an upper thigh of the patient; continuously calculating a plurality of intraperitoneal volumes during a dwell time of a peritoneal dialysis treatment based at least on the bioimpedance data from the first plurality of electrodes and the bioimpedance data from a second plurality of electrodes located on the patient's torso; as well as controlling operation of a pump of the peritoneal dialysis machine to maximize ultrafiltration volume based at least on one or more of the plurality of lower abdominal fluid volumes and one or more of the plurality of intraperitoneal volumes; Wherein, calculating the intraperitoneal volume includes applying bioimpedance data from the first plurality of electrodes to a circuit model, the circuit model being based at least in part on a first resistance in parallel between (a) a first electrode in the first plurality of electrodes and a second electrode in the second plurality of electrodes, and (b) a second resistance between a third electrode in the first plurality of electrodes and a fourth electrode in the second plurality of electrodes.

2. The one or more non-transitory computer-readable media of claim 1 , the operations further comprising: detecting a first switching condition for switching from a first calculation mode for calculating the plurality of lower abdominal fluid volumes to a second calculation mode for calculating the plurality of intraperitoneal volumes; as well as In response to detecting the first switching condition, switching from the first computing mode to the second computing mode.

3. The one or more non-transitory computer-readable media of claim 2, the operations further comprising: detecting a second switching condition for switching from the second computing mode to the first computing mode; as well as In response to detecting the second switching condition, switching from the second computing mode to the first computing mode.

4. The one or more non-transitory computer-readable media of claim 1 , the operations further comprising: detecting a first switching condition for switching from a first calculation mode for calculating the plurality of intraperitoneal volumes to a second calculation mode for calculating the plurality of lower abdominal fluid volumes; as well as In response to detecting the first switching condition, switching from the first computing mode to the second computing mode.

5. The one or more non-transitory computer-readable media of claim 4, the operations further comprising: detecting a second switching condition for switching from the second computing mode to the first computing mode; as well as In response to detecting the second switching condition, switching from the second computing mode to the first computing mode.

6. The one or more non-transitory computer-readable media of claim 1 , wherein calculating the plurality of lower abdominal fluid volumes comprises applying bioimpedance data from the first plurality of electrodes to a circuit model based at least in part on interstitial tissue resistance and peritoneal cavity resistance.

7. One or more non-transitory computer-readable media according to claim 6, wherein the circuit model based at least in part on interstitial tissue resistance and peritoneal cavity resistance comprises at least interstitial tissue resistance, peritoneal cavity resistance, local muscle resistance and bladder resistance in parallel, The circuit model can be simplified to the interstitial tissue resistance and the peritoneal cavity resistance in parallel, and The interstitial tissue resistance is greater than the peritoneal cavity resistance, so that the circuit model can be used to calculate the change of the lower abdominal fluid volume.

8. One or more non-transitory computer-readable media according to claim 1, wherein the first plurality of electrodes includes a first electrode pair proximate to the upper right thigh of the patient and a second electrode pair proximate to the upper left thigh of the patient, and The second plurality of electrodes includes a third electrode pair proximate to the right torso of the patient and a fourth electrode pair proximate to the left torso of the patient.

9. The one or more non-transitory computer-readable media of claim 1 , the operations further comprising: Instructions are transmitted to control operation of the peritoneal dialysis machine based at least on one or more of the plurality of lower abdominal fluid volumes and / or the plurality of intraperitoneal volumes.

10. The one or more non-transitory computer-readable media of claim 1, wherein at least the first plurality of electrodes are integrated into a garment worn by the patient.

11. The one or more non-transitory computer-readable media of claim 1, wherein the plurality of lower abdominal fluid volumes correspond to one or more of bladder volumes or interstitial volumes.

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