Fluid treatment system for a patient

Abstract

The present disclosure relates to a fluid treatment patient system for a patient, comprising at least one protein dialysis circuit to remove water soluble and protein bound toxins, especially wherein the protein is preferably albumin, wherein the dialysis circuit comprises at least one or two dialyzers, wherein the circuit is configured to perform the dialysis at least such that a continuous recirculation and purification of the protein containing dialysate, preferably albumin containing dialysate, is performed, especially wherein these treatments are preferably performed with two dialyzers or one single dialyzer, and wherein the membrane areas is sufficient for toxin elimination.

Description

[0001] DTS Ref: 40247.ADT.P110PC 02.12.2025

[0002] - 1 -

[0003] Fluid treatment system for a patient

[0004] The present disclosure relates to a fluid treatment system and its components, especially for providing dialysis or a dialysis like treatment to a patient.

[0005] Known systems are inter alia described in W02009071103A1 , which discloses dialysate regeneration unit adapted for regenerating a dialysate containing carrier substances comprises a first flow path and a second flow path. The first flow path comprises a first supply unit adapted for adding an acidic fluid to the dialysate flowing in the first flow path, and a detoxification unit located downstream of the first supply unit. The detoxification unit is adapted for removing toxins from the acidified dialysate flowing in the first flow path. The second flow path extends in parallel to the first flow path. The second flow path comprises a second supply unit adapted for adding an alkaline fluid to the dialysate flowing in the second flow path, and a further detoxification unit located downstream of the second supply unit. The further detoxification unit is adapted for removing toxins from the alkalized dialysate flowing in the second flow path.

[0006] Disclosed are especially the following aspects:

[0007] A fluid treatment patient system for a patient, comprising at least one protein dialysis circuit to remove water soluble and protein bound toxins, especially wherein the protein is preferably albumin, wherein the dialysis circuit comprises at least one or two dialyzers, wherein the circuit is configured to perform the dialysis at least such that a continuous recirculation and purification of the protein containing dialysate, preferably albumin containing dialysate, is performed, especially wherein these treatments are preferably performed with two dialyzers 10 or one single dialyzer 10A, and wherein the membrane areas is sufficient for toxin elimination.

[0008] A fluid treatment patient system for a patient, preferably according to aspect 1 , comprising an independent pH control module, wherein the pH control module is DTS Ref: 40247.ADT.P110PC 02.12.2025

[0009] - 2 - configured to regulate the pH of a patient by carbon dioxide level of the patient in the blood.

[0010] A fluid treatment patient system for a patient, preferably according to aspect 1 or aspect 2, comprising an independent adjustment module, the adjustment module being configured and arranged for the adjustment of the Bicarbonate HCO3- / Bic concentration within the dialysate passing through the dialyzers 10 an getting in contact with the patients 1 blood through the extracorporeal blood circuit - remove carbon dioxide CO2 from the patients’ blood and adjust the acid-base balance of the patient.

[0011] By being able to adjust the bicarbonate, the water consumption be better controlled and handled.

[0012] In particular, if the salts and other solutes needed for the treatment is provided in a dry concentrated from, then water can be used from a standing supply line, which is commonly available in hospitals. Alternatively, water can be provided in fluid bags to the amount needed, and depending on the condition of the patient, the solute concentrates can be provided as needed from the dry powders.

[0013] A fluid treatment patient system for a patient, preferably according to one of the preceding aspects, comprising an independent adjustment module of the buffering capacity of the dialysate by modifying the buffering agents and their concentrations therefore within the dialysate that passes through the dialyzers 10 and getting in contact with the patient 1 blood through the extracorporeal blood circuit - wherein the system is preferably used to adapt the toxin extraction rates from the patient’s blood to the dialysate.

[0014] A fluid treatment patient system for a patient, preferably according to one of the preceding aspects, where the system is capable to perform a dialysis RRT including iHD, SLED, CVVHD where no extra protein is added to the dialysate and preferably mainly water-soluble toxins are removed. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0015] - 3 -

[0016] A fluid treatment patient system for a patient, preferably according to one of the preceding aspects, wherein the dialysis is performed with single pass dialysate flow, partly single pass dialysate flow and / or recirculating dialysate flow where the recirculated dialysate could be diluted and partially removed.

[0017] A fluid treatment patient system for a patient, preferably according to one of the preceding aspects, wherein the treatment is performed with one dialyzer 10A whereas the membrane area chosen for the treatment is preferably small but still sufficient for toxin elimination.

[0018] A fluid treatment patient system for a patient, preferably according to one of the preceding aspects, wherein the purifying the dialysate is performed optionally additional filters 33 ,34 but preferably the treatment is performed without additional filters.

[0019] A fluid treatment patient system for a patient, preferably according to one of the preceding aspects, wherein the treatment is performed with variation of the proportion of recycled dialysate from complete recirculation to single pass preferred for IHD.

[0020] A fluid treatment patient system for a patient, preferably according to one of the preceding aspects, wherein the treatment is performed with One or two dialyzers and one or two filters can be used to purify the dialysate.

[0021] A fluid treatment patient system for a patient, preferably according to one of the preceding aspects, wherein the system comprises at least one switch system, especially a cross switch for regeneration of at least a part of the fluids, especially of the dialysate, preferably the albumin in the dialysate and / or to clean at least partially filter membranes.

[0022] A fluid treatment patient system for a patient, preferably according to one of the preceding aspects, wherein the system comprises at least one control mechanism preferably proportional valves adjust the amount of fluid pumped on the one hand from the bicarbonate path and on the other hand from the permeate path, especially whereby the ratio of bicarbonate solution and bicarbonate solution is adjusted according to a sensor preferably a conductivity sensor measuring the conductivity of the fluid. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0023] - 4 -

[0024] A fluid treatment patient system for a patient, preferably according to one of the preceding aspects, wherein the system comprises at least one sensor preferably a conductivity sensor measuring the conductivity of the fluid.

[0025] Further details and advantages of the present disclosure shall be described in connection with the drawings.

[0026] It is shown in

[0027] Fig. 1 a schematical overview of the hydraulics of the system according to the present disclosure;

[0028] Fig. 2 a further schematical overview of the hydraulics of the system according to the present disclosure;

[0029] Fig. 3 a further schematical overview of the hydraulics of the system according to the present disclosure;

[0030] Fig. 4 a further schematical overview of the hydraulics of the system according to the present disclosure;

[0031] Fig. 5 a further schematical overview of the hydraulics of the system according to the present disclosure;

[0032] Fig. 6 a further schematical overview of the hydraulics of the system according to the present disclosure;

[0033] Fig. 7 a further schematical overview of the hydraulics of the system according to the present disclosure; and

[0034] Fig. 8 a diagram showing treatment parameters iHD SLEDD, CVVHD.

[0035] Figure 1 shows one embodiment of the claimed invention:

[0036] The embodiment comprises a patient 1 that is connected to a dialysis device 100, and in particular to a dialyzer 10. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0037] - 5 -

[0038] The embodiment of the invention comprises multiple circuits and fluid paths, in particular a first blood line 2, a second blood line 16, a first fluid connection 30, a second fluid connection 76, a first regeneration circuit 43, a second regeneration circuit 44, a circuit 63, a fluid connection block 75, a dialysate inlet 19 and a dialysate outlet 20.

[0039] The first blood line 2 is intended for leading the blood coming from the patient 1 to the extracorporeal circuit and as shown leads the blood this way.

[0040] The second blood line 16 is for returning the blood to the patient 1 .

[0041] Moreover, the system comprises a plurality of reservoirs and chambers, including a first reservoir 4, a second reservoir 13, a third reservoir 25, a fourth reservoir 26, a fifth reservoir 65, a sixth reservoir 66, a seventh reservoir 67, an eighth reservoir 68, a ninth reservoir 69 and a tenth reservoir 70, a first fluid compartment 71 , a fluid compartment 72 and a fluid bag 73A.

[0042] Additionally, the device comprises multiple pumps, as a first metering pump 27, a second metering pump 47, a third metering pump 48, a fourth metering pump 49, a fifth metering pump 50, a seventh pump 60, a first regeneration pump 39, a second regeneration pump 40, a first infusion pump 6, a second infusion pump 15, a first dialysate pump 18, a second dialysate pump 21 , a first waste pump 35 and a second waste pump 36.

[0043] Furthermore, the system comprises multiple sensors, in particular a first sensor 5, a second sensor 7, a third sensor 9, a fourth sensor 11 , a fifth sensor 14, a sixth sensor 17, an eighth sensor 41 , a ninth sensor 42, a tenth sensor 58, and an eleventh sensor 61.

[0044] The device comprises a valve circuit 37 and additionally multiple valves, as a first bypass valve 22, a fourth valve 31 , a fifth valve 32, a first switching valve 45, a second switching valve 46, and a single pass outlet valve 29.

[0045] Additionally, the system comprises several gas separators, a first gas separator 51 , a second gas separator 52, a third gas separator 53, a fourth gas separator 54, a fifth gas separator 55, a sixth gas separator 56 and a seventh gas separator 57.

[0046] Furthermore, the system comprises heating elements as a first heater 23, a second heater 38, a third heater 62 and a heat exchanger 64. DTS Ref: 40247.ADT.P110PC

[0047] 02.12.2025

[0048] - 6 -

[0049] The system further comprises a first filter 33, a second filter 34.

[0050] Moreover, the system comprises a container 73, a scale 74 and a control mechanism 59.

[0051] The device comprises multiple circuits and fluid paths.

[0052] The device comprises two dialyzers 10 that are set in parallel and further named as dialyzer 10.

[0053] A first circuit comprises extracorporeal blood lines 2,16 connecting a patient 1 to a dialyzer 10.

[0054] A second circuit connects the dialyzer 10 to a reservoir 25.

[0055] A third circuit connects the reservoir 25 with a detoxification unit 33, 34 over recirculation paths 43, 44.

[0056] Further fluid paths, in particular acidic, alkaline, waste, permeate and bicarbonate paths are connected to the circuits.

[0057] A patient 1 is connected via an extracorporeal first blood line 2 to a dialyzer 10 and further from the dialyzer 10 via an extracorporeal second blood line 16 back to the patient 1 building a first circuit.

[0058] The first circuit comprises a feeding first blood line 2 that starts at the patient 1 and ends at the dialyzer 10.

[0059] The first blood line 2 comprises a first blood line infusion connection 3 between the patient 1 and the dialyzer 10. This connection point 3 connects the first blood line 2 to a first infusion solution fluid bag 4.

[0060] Between the first blood line infusion connection 3 and the first infusion solution fluid bag 4 is a first infusion pump 6. Between the first infusion pump 6 and the first infusion solution fluid bag 4 is a first sensor 5. The infusion solution of the first infusion solution fluid bag 4 is supplied into the extracorporeal first blood line 2 via first blood line infusion connection 3 via the first infusion pump 6.

[0061] Between the first blood line infusion connection 3 and the dialyzer 10 along the extracorporeal first blood line 2 is a second sensor 7, further upstream a blood pump 8 and a further upstream a third sensor 9. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0062] - 7 -

[0063] The first blood line 2 splits into two directions between the third sensor 9 and the dialyzer 10.

[0064] In one direction the blood flows through one dialyzer 10 and in one direction the blood flows through another dialyzer 10, as the dialyzers 10 are set in parallel.

[0065] The fluid enters, passes through and leaves the dialyzer 10.

[0066] The fluid line leaving dialyzer 10 and dialyzer 10 merge at a connection point to the second blood line 16.

[0067] The first circuit comprises a second blood line 16 leading back to the patient 1. This second blood line 16 starts at the dialyzer 10 and ends at the patient 1.

[0068] Between the dialyzer 10 and the patient 1 along the second blood line 16 there is a second blood line infusion connection 12.

[0069] Between the second blood line infusion connection 12 and the dialyzer 10 there is a fourth sensor 11 .

[0070] The second blood line infusion connection 12 connects the second blood line 16 to a second infusion solution fluid bag 13.

[0071] Between the second blood line infusion connection 12 and the second infusion solution fluid bag 13 is a second infusion pump 15. Between the second infusion pump 15 and the second infusion solution bag 13 there is a fifth sensor 14. The infusion solution of the second infusion solution fluid bag 13 is supplied into the extracorporeal second blood line 16 via second blood line infusion connection 12 via the second infusion pump

[0072] 15.

[0073] The dialyzer 10 is on one side directly connected to the extracorporeal blood lines 2,

[0074] 16. In particular one end of this one side of the dialyzer 10 is directly connected to the first blood line 2 coming from the patient 1 and the other end of this one side is connected with the second blood line 16 leading back to the patient 1.

[0075] Therefore, the dialyzer 10 is on one side connected to the first circuit. On the other side the dialyzer 10 is connected to the second circuit. DTS Ref: 40247.ADT.P110PC

[0076] 02.12.2025

[0077] - 8 -

[0078] The second circuit starts at the dialyzer 10 and continues to the third reservoir 25 and ends at the dialyzer 10. Further fluid paths split off from the second circuit.

[0079] Between the dialyzer 10 and the third reservoir 25 the dialysate flows through a dialysate outlet 20 from the dialyzer 10 through a second dialysate pump 21 , through a seventh sensor 24 and further through a first heater 23 towards the third reservoir 25.

[0080] Between the first heater 23 and the third reservoir 25 is a first fluid connection 30 leading towards the fluid waste bag 72.

[0081] In particular the first fluid connection 30 is a waste path.

[0082] Between the first heater 23 and the third reservoir 25 - in particular between the first fluid connection 30 of the waste path and the third reservoir 25 - is a fluid connection leading to a third circuit.

[0083] The dialysate flow is partially or completely flowing into the third dialysate reservoir 25 or is partially or completely flowing into the third circuit or into the waste path.

[0084] The fluid flows from the reservoir to the dialyzer 10 through a sixth sensor 17, through a first dialysate pump 18 towards a dialysate inlet 19 at the dialyzer 10.

[0085] Between the first dialysate pump 18 and the dialysate inlet 19 there is a second fluid connection 76.

[0086] In particular the second fluid connection 76 is a waste path.

[0087] The dialysate inlet 19 and the dialysate outlet 20 can be connected in a way, that the blood flow 2, 10, 16 and the dialysate flow entering, passing through and leaving the dialyzer lead in the same direction or in the opposite direction.

[0088] In parallel to the dialyzer 10 there is a first bypass valve 22 and fluid path.

[0089] The fluid path is connecting to the second fluid circuit on one end between the dialyzer 10 and the second dialysate pump 21 and on the other end between the dialyzer 10 and the first dialysate pump 18.

[0090] Along this fluid path there is the first bypass valve 22.

[0091] The third circuit, starts from the fluid flow of the second circuit and flows over pumps 39, 40 and ends at the third reservoir 25. DTS Ref: 40247.ADT.P110PC

[0092] 02.12.2025

[0093] - 9 -

[0094] Between the one end of the third circuit - between the third reservoir 25 and the first heater 23 - and the regeneration pumps 39, 40 is a connection point 79.

[0095] This connection point 79 is connecting the dialysate flow with a fourth reservoir 26. The infusion solution 26 from the fourth reservoir 26 flows through a sensor system 26 through a first metering pump 27 to the fluid connecting point 79.

[0096] Further upstream the connecting point 79 towards the pumps 39, 40 the flow is split into two directions. In one direction the fluid flows towards the first regeneration pump 39, building a fluid path 43 and a first recirculation circuit 43.

[0097] In the other direction the flow is directed towards the second regeneration pump 40, building a fluid path 44 and a second recirculation circuit 44.

[0098] The first recirculation path 43 continues further from the first regeneration pump 39 towards the eighth sensor 41 to a first filter 33.

[0099] This first filter 33 is a first detoxification unit 33.

[0100] The fluid is then directed into the first detoxification unit 33, through the first detoxification unit 33 and out of the first detoxification unit 33.

[0101] The fluid flows out of the first detoxification unit 33 in two directions.

[0102] In one direction the fluid flows from the first detoxification unit 33 through a first waste pump 35 into the fluid connection between the second detoxification unit 34 and the fluid waste bag 72.

[0103] In particular the fluid connects between a second waste pump 36 and the fluid connection block 75.

[0104] The fluid further flows through the fluid connection block 75 into the fluid waste bag 72.

[0105] In a second direction, the fluid flows from the first detoxification unit 33 through a fourth valve 31 towards a valve circuit 37.

[0106] The valve circuit 37 is a mixing point 37.

[0107] The second recirculation path 44 leads further from the second regeneration pump 40 towards the ninth sensor 42 to a second filter 34. This second filter 34 is a second detoxification unit 34. DTS Ref: 40247.ADT.P110PC

[0108] 02.12.2025

[0109] - 10 -

[0110] The fluid flows into the second detoxification unit 34, through the second detoxification unit 34 and out of the second detoxification unit 34.

[0111] The fluid flows out of the second detoxification unit 34 in two directions.

[0112] In one direction the fluid flows from the second detoxification unit 34 through the second waste pump 36 and further flows through the fluid connection block 75 into the fluid waste bag 72.

[0113] In a second direction, the fluid flows from the second detoxification unit 34 through a fifth valve 32 towards the valve circuit 37. The valve circuit 37 is the mixing point 37.

[0114] At the mixing point 37 the first recirculation circuit 43 and the second recirculation circuit 44 meet. In particular at the mixing point 37 the fluid flowing out of the first detoxification unit 33 and out of the second detoxification unit 34 meet and the two fluid connections get merged to one fluid connection.

[0115] From the mixing point 37 the one fluid connection leads over a second heater 38 towards the third reservoir 25 and into the third reservoir 25. At this point the third circuit and the second circuit meet.

[0116] In particular the third circuit ends at that point.

[0117] The device comprises two concentrate containers 65, 67 which are connected to the recirculation paths 44, 43.

[0118] The fifth reservoir 65 comprises an acid solution 65.

[0119] The acid solution 65 flows from the fifth reservoir 65 through a first gas separator 51 through a third metering group 48 into the first recirculation path 43.

[0120] This fluid path is the acidic path.

[0121] The acidic path starts at the fifth reservoir 65 and ends at the first recirculation circuit 43 between the first regeneration pump 39 and the eighth sensor 41 .

[0122] The seventh reservoir 67 comprises a base solution 67.

[0123] The base solution 67 flows from the seventh reservoir 67 through a second gas separator 52 through a second metering group 47 into the second recirculation path 44. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0124] - 11 -

[0125] This fluid path is the alkaline path.

[0126] The alkaline path starts at the seventh reservoir 67 and ends at the second recirculation path 44 between the second regeneration pump 40 and the ninth sensor 42.

[0127] Between the acidic path and the alkaline path there is a switching mechanism 45, 46. The switching mechanism 45, 46 comprises two switching valves 45, 46.

[0128] The first switching valve 45 is set between the second metering group 47 along the alkaline path and the second recirculation path 44, in particular between the ninth sensor 42 and the second regeneration pump 40.

[0129] The second switching valve 46 is set between the third metering group 48 along the acidic path and the first recirculation path 43, in particular between the eighth sensor 41 and the first regeneration pump 39.

[0130] A container 73 comprises a chamber for waste fluid 72, a chamber for permeate 70, a chamber for bicarbonate 69, a first powder bag 66 and a second powder bag 68.

[0131] The container 73 is connected to a scale 74 on the side where no connections are leading out of the container 73.

[0132] The connections leading from the comprised chambers and bags of the container 73 towards other circuits are connected to a fluid connection block 75. The fluid connection block 75 is outside the container 73 and on the side where the connections are leading out of the container 73.

[0133] The chamber for permeate 70 and the chamber for bicarbonate 69 are connected via a fluid connection 71. The fluid connection 71 is inside the container 73.

[0134] The chamber for permeate 70 is connected to the powder bags 66, 68. The connection is inside the container 73.

[0135] The first powder bag 66 comprises acidic powder 66.

[0136] The electrolyte solution 66 of the first powder bag 66 flows over a seventh gas separator 57 into the acid path. DTS Ref: 40247.ADT.P110PC

[0137] 02.12.2025

[0138] - 12 -

[0139] In particular the fluid connects between the acidic solution 65 and the first recirculation circuit 43. In particular it connects between the first gas separator 51 and the third metering group 48.

[0140] The second powder bag 68 comprises alkaline powder 68. The electrolyte solution 68 of the second powder bag 68 flows over a sixth gas separator 56 into the alkaline path.

[0141] In particular the fluid connects between the base solution 67 and the second recirculation circuit 44, in particular it connects between the second gas separator 52 and the second metering group 47.

[0142] The bicarbonate path leads from the chamber of bicarbonate 69 towards the alkaline path.

[0143] The fluid connection from the chamber for bicarbonate 69 leads out of the container 73 through the fluid connection block 75 along a bicarbonate path 53 through a third gas separator 53 towards control mechanism 59.

[0144] The bicarbonate path leads over a fifth metering pump 50 and a tenth sensor 58 into the alkaline path.

[0145] In particular, the bicarbonate path 53 connects with the alkaline path between the second metering pump 47 and the switching mechanism 45, 46.

[0146] At control mechanism 59, saturated bicarbonate solution is diluted with water.

[0147] Based on control mechanism 59, the ration between permeate and bicarbonate is regulated.

[0148] The fluid connection from the chamber of permeate 70 leads out of the container 73 through the fluid connection block 75 along the permeate path 54 through a fifth gas separator 55, and at least partially further through a fourth metering pump 49 towards the acidic path.

[0149] Along the permeate path 54 between the fifth gas separator 55 and the fourth metering pump 49 the fluid flows through a third heater 62, through a seventh pump 60 and through a fourth gas separator 54. DTS Ref: 40247.ADT.P110PC

[0150] 02.12.2025

[0151] - 13 -

[0152] The permeate path 54 comprises an eleventh sensor 61 that measures in a circuit 63 which connects on one end between the third heater 62 and the fifth gas separator 55 and on the other end at the fourth gas separator 54.

[0153] The permeate path 54 is connected with the waste path through a heat exchanger 64.

[0154] The connection is on one end along the waste path between the fluid connection block 75 and the second waste pump 36 and on the other end along the permeate path between the fifth gas separator 55 and the third heater 62.

[0155] The chamber for waste fluid 72 is within a fluid container 73.

[0156] The chamber for waste fluid 72 can be accessed by a fluid connection.

[0157] This fluid connection is the waste path.

[0158] In particular the waste path is split up and has further connections.

[0159] One connection is a first waste path via the second fluid connection 76 and another connection is a second waste path via the first fluid connection 30.

[0160] The first waste path leads along the second fluid connection 76 starting from the second circuit - in particular between the dialysate inlet 19 of the dialyzer 10 and the first dialysate pump 18.

[0161] The first waste path - in particular the second fluid connection 76 - connects to the second waste path between the second detoxification unit 34 and the fluid waste bag 72 - in particular between the fluid connection block 75 and the heat exchanger 64 along the second waste path.

[0162] Finally, at the connection point the first and second waste path flow together and flow through the fluid connection block 75 into the chamber for waste fluid 72.

[0163] The second waste path starts between the first heater 23 of the second circuit and the third reservoir 25 and is leading towards a fluid waste bag 72.

[0164] The second waste path leads through a single pass outlet valve 29 along a first fluid connection 30.

[0165] The first fluid connection 30 splits up at a connection point from the main fluid connection 30. DTS Ref: 40247.ADT.P110PC

[0166] 02.12.2025

[0167] - 14 -

[0168] The main fluid connection 30 flows directly into the fluid connection - along the waste path - between the second detoxification unit 34 and the second waste pump 36, and further flows through the fluid connection block 75 into the fluid waste bag 72.

[0169] The split fluid connection 30 is split at the connection point and flows into a point between the first filter 33 and the first waste pump 35.

[0170] The fluid flows further from the fluid connection point between the first detoxification unit 33 and the first waste pump 35, through a first waste pump 35 and then further into the fluid connection between the second waste pump 36 and the fluid connection block 75.

[0171] There, the split-up fluid connection 30 meets the main fluid connection 30. Then the fluid further flows through the fluid connection block 75 into the fluid waste bag 72.

[0172] Features and / or elements and / or paths and / or connection points and / or connection lines of Fig. 1 indicated by dashed or dotted lines or light grey can be considered optional, including fourth valve 31 , fifth valve 32, fifth gas separator 55, sixth gas separator 56, seventh gas separator 57, acid powder 66 or first powder bag 66 or electrolyte solution 66), alkaline powder 68 (or second powder bag 68 or eight reservoir 68 or electrolyte solution 68), heat exchanger 64 and / or second fluid connection 76.

[0173] Figure 2 shows one embodiment of the claimed invention:

[0174] The embodiment comprises a patient 1 that is connected to a dialysis device 100, and in particular to a dialyzer 10.

[0175] The embodiment of the invention comprises multiple circuits and fluid paths, in particular a first blood line 2, a second blood line 16, a first fluid connection 30, a second fluid connection 76, a first regeneration circuit 43, a second regeneration circuit 44, a circuit 63, a fluid connection block 75, a dialysate inlet 19 and a dialysate outlet 20.

[0176] Moreover, the system comprises a plurality of reservoirs and chambers, including a first reservoir 4, a second reservoir 13, a third reservoir 25, a fourth reservoir 26, a fifth reservoir 65, a sixth reservoir 66, a seventh reservoir 67, an eighth reservoir 68, a ninth reservoir 69 and a tenth reservoir 70, a first fluid compartment 71 , a fluid compartment 72 and a fluid bag 73A.

[0177] Additionally, the device comprises multiple pumps, as a first metering pump 27, a second metering pump 47, a third metering pump 48, a fourth metering pump 49, a fifth DTS Ref: 40247.ADT.P110PC 02.12.2025

[0178] - 15 - metering pump 50, a sixth pump 77, a seventh pump 60, a first regeneration pump 39, a second regeneration pump 40, a first infusion pump 6, a second infusion pump 15, a first dialysate pump 18, a second dialysate pump 21 , a first waste pump 35 and a second waste pump 36.

[0179] Furthermore, the system comprises multiple sensors, in particular a first sensor 5, a second sensor 7, a third sensor 9, a fourth sensor 11 , a fifth sensor 14, a sixth sensor 17, an eighth sensor 41 , a ninth sensor 42, a tenth sensor 58, an eleventh sensor 61 , and a twelfth sensor 78.

[0180] The device comprises a valve circuit 37 and additionally multiple valves, as a first bypass valve 22, a fourth valve 31 , a fifth valve 32, a first switching valve 45, a second switching valve 46, and a single pass outlet valve 29.

[0181] Additionally, the system comprises several gas separators, a first gas separator 51 , a second gas separator 52, a third gas separator 53, a fourth gas separator 54, a fifth gas separator 55, a sixth gas separator 56 and a seventh gas separator 57.

[0182] Furthermore, the system comprises heating elements as a first heater 23, a second heater 38, a third heater 62 and a heat exchanger 64.

[0183] The system further comprises a first filter 33, a second filter 34.

[0184] Moreover, the system comprises a container 73, a scale 74 and a control mechanism 59.

[0185] The device comprises multiple circuits and fluid paths.

[0186] A first circuit comprises extracorporeal blood lines 2,16 connecting a patient 1 to a dialyzer 10.

[0187] A second circuit connects the dialyzer 10 to a third reservoir 25.

[0188] A third circuit connects the third reservoir 25 with a detoxification unit 33, 34 over recirculation paths 43, 44.

[0189] Further fluid paths, in particular acidic, alkaline, waste, permeate and bicarbonate paths are connected to the circuits. DTS Ref: 40247.ADT.P110PC

[0190] 02.12.2025

[0191] - 16 -

[0192] A Patient 1 is connected via an extracorporeal first blood line 2 to a dialyzer 10 and further from the dialyzer 10 via an extracorporeal second blood line 16 back to the patient 1 building a first circuit.

[0193] The first circuit comprises a feeding first blood line 2 that starts at the patient 1 and ends at the dialyzer 10.

[0194] The first blood line 2 comprises a first blood line infusion connection 3 between the patient 1 and the dialyzer 10.

[0195] This connection point 3 connects the first blood line 2 to a first infusion solution fluid bag 4.

[0196] Between the first blood line infusion connection 3 and the first infusion solution fluid bag 4 is a first infusion pump 6. Between the first infusion pump 6 and the first infusion solution fluid bag 4 is a first sensor 5. The infusion solution of the first infusion solution fluid bag 4 is supplied into the extracorporeal first blood line 2 via first blood line infusion connection 3 via the first infusion pump 6.

[0197] Between the first blood line infusion connection 3 and the dialyzer 10 along the extracorporeal first blood line 2 is a second sensor 7, further upstream a blood pump 8 and a further upstream a third sensor 9.

[0198] The first blood line 2 splits into two directions between the third sensor 9 and the dialyzer 10.

[0199] In one direction the blood flows through one dialyzer 10 and in one direction the blood flows through another dialyzer 10, as the dialyzers 10 are set in parallel.

[0200] The fluid enters, passes through and leaves the dialyzer 10.

[0201] The fluid line leaving dialyzer 10 and dialyzer 10 merge at a connection point to the second blood line 16.

[0202] The first circuit comprises a second blood line 16 leading back to the patient 1. This second blood line 16 starts at the dialyzer 10 and ends at the patient 1.

[0203] Between the dialyzer 10 and the patient 1 along the second blood line 16 there is a second blood line infusion connection 12. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0204] - 17 -

[0205] Between the second blood line infusion connection 12 and the dialyzer 10 there is a fourth sensor 11 .

[0206] The second blood line infusion connection 12 connects the second blood line 16 to an second infusion solution fluid bag 13.

[0207] Between the second blood line infusion connection 12 and the second infusion solution fluid bag 13 is a second infusion pump 15.

[0208] Between the second infusion pump 15 and the second infusion solution bag 13 there is a fifth sensor 14.

[0209] The infusion solution of the second infusion solution fluid bag 13 is supplied into the extracorporeal second blood line 16 via second blood line infusion connection 12 via the second infusion pump 15.

[0210] The dialyzer 10 is on one side directly connected to the extracorporeal blood lines 2, 16.

[0211] In particular one end of this one side of the dialyzer 10 is directly connected to the first blood line 2 coming from the patient 1 and the other end of this one side is connected with the second blood line 16 leading back to the patient 1.

[0212] Therefore, the dialyzer 10 is on one side connected to the first circuit.

[0213] On the other side the dialyzer 10 is connected to the second circuit.

[0214] The second circuit starts at the dialyzer 10 and leads over the third reservoir 25 and ends at the dialyzer 10.

[0215] Further fluid paths split off from the second circuit.

[0216] Between the dialyzer 10 and the third reservoir 25 the dialysate flows through a dialysate outlet 20 from the dialyzer 10 through a dialysate pump 21 , through a seventh sensor 24 and further through a first heater 23 towards the third reservoir 25.

[0217] Between the first heater 23 and the third reservoir 25 is a first fluid connection 30 leading towards the fluid waste bag 72.

[0218] In particular the fluid connection is a waste path. DTS Ref: 40247.ADT.P110PC

[0219] 02.12.2025

[0220] - 18 -

[0221] Between the first heater 23 and the third reservoir 25 - in particular between the first fluid connection 30 of the waste path and the third reservoir 25 - is a fluid connection leading to a third circuit.

[0222] The dialysate flow is partially or completely flowing into the dialysate third reservoir 25 or is partially or completely flowing into the third circuit or into the waste path.

[0223] The fluid flows from the reservoir to the dialyzer 10 through a sixth sensor 17, through a first dialysate pump 18 towards a dialysate inlet 19 at the dialyzer 10.

[0224] Between the first dialysate pump 18 and the dialysate inlet 19 there is a second fluid connection 76.

[0225] In particular the second fluid connection 76 is a waste path.

[0226] The dialysate inlet 19 and the dialysate outlet 20 can be connected in a way, that the blood flow 2,10,16 and the dialysate flow entering, passing through and leaving the dialyzer lead in the same direction or in the opposite direction.

[0227] In parallel to the dialyzer 10 there is a first bypass valve 22 and fluid path. The fluid path is connecting to the second fluid circuit on one end between the dialyzer 10 and the second dialysate pump 21 and on the other end between the dialyzer 10 and the first dialysate pump 18.

[0228] Along this fluid path there is the first bypass valve 22.

[0229] The third circuit, starts from the fluid flow of the second circuit and flows over pumps 39, 40 and ends at the third reservoir 25.

[0230] Between the one end of the third circuit - between the third reservoir 25 and the first heater 23 - and the first and second regeneration pumps 39, 40 is a connection point 79.

[0231] This connection point 79 is connecting the dialysate flow with a fourth reservoir 26.

[0232] The infusion solution 26 of the fourth reservoir 26 flows through a sensor system 26 through a first metering pump 27 to the fluid connecting point 79.

[0233] Further upstream the connecting point 79 towards the pumps 39, 40 the flow is split into two directions. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0234] - 19 -

[0235] In one direction the flow leads towards the first regeneration pump 39, building a fluid path 43 and a first recirculation circuit 43.

[0236] In the other direction the flow flows towards the second regeneration pump 40, building a fluid path 44 and a second recirculation circuit 44.

[0237] The first recirculation path 43 flows further from the first regeneration pump 39 towards the eighth sensor 41 to a first filter 33.

[0238] This first filter 33 is a first detoxification unit 33.

[0239] The fluid flows into the first detoxification unit 33, through the first detoxification unit 33 and out of the first detoxification unit 33.

[0240] The fluid flows out of the first detoxification unit 33 in two directions.

[0241] In one direction the fluid flows from the first detoxification unit 33 through a first waste pump 35 into the fluid connection between the second detoxification unit 34 and the fluid waste bag 72.

[0242] In particular the fluid connects between a second waste pump 36 and the fluid connection block 75.

[0243] The fluid further flows through the fluid connection block 75 into the fluid waste bag 72.

[0244] In a second direction, the fluid flows from the first detoxification unit 33 through a fourth valve 31 towards a valve circuit 37.

[0245] The valve circuit 37 is a mixing point 37.

[0246] The second recirculation path 44 leads further from the second regeneration pump 40 towards the ninth sensor 42 to a second filter 34.

[0247] This second filter 34 is a second detoxification unit 34.

[0248] The fluid flows into the second detoxification unit 34, through the second detoxification unit 34 and out of the second detoxification unit 34.

[0249] The fluid flows out of the second detoxification unit 34 in two directions.

[0250] In one direction the fluid flows from the second detoxification unit 34 through the second waste pump 36 and further flows through the fluid connection block 75 into the fluid waste bag 72. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0251] - 20 -

[0252] In a second direction, the fluid flows from the second detoxification unit 34 through a fifth valve 32 towards the valve circuit 37.

[0253] The valve circuit 37 is the mixing point 37.

[0254] At the mixing point 37 the first recirculation circuit 43 and the second recirculation circuit 44 meet. In particular at the mixing point 37 the fluid flowing out of the first detoxification unit 33 and out of the second detoxification unit 34 meet and the two fluid connections get merged to one fluid connection.

[0255] From the mixing point 37 the one fluid connection leads over a second heater 38 towards the third reservoir 25 and into the third reservoir 25.

[0256] At this point the third circuit and the second circuit meet.

[0257] In particular the third circuit end at that point.

[0258] The device comprises two concentrate containers 65, 67 which are connected to the recirculation paths 44, 43.

[0259] The fifth reservoir 65 comprises an acid solution 65.

[0260] The acid solution 65 flows from the concentrate container 65 through a first gas separator 51 through a third metering group 48 into the first recirculation path 43.

[0261] This fluid path is the acidic path.

[0262] The acidic path starts at the fifth reservoir 65 and ends at the first recirculation circuit 43 between the first regeneration pump 39 and the eighth sensor 41 .

[0263] The seventh reservoir 67 comprises a base solution 67.

[0264] The base solution 67 flows from the seventh reservoir 67 through a second gas separator 52 through a second metering group 47 into the second recirculation path 44.

[0265] This fluid path is the alkaline path. The alkaline path starts at the seventh reservoir 67 and ends at the second recirculation path 44 between the second regeneration pump 40 and the ninth sensor 42.

[0266] Between the acidic path and the alkaline path there is a switching mechanism 45, 46. The switching mechanism 45, 46 comprises two switching valves 45, 46. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0267] - 21 -

[0268] The switching valve 45 is set between the second metering group 47 along the alkaline path and the second recirculation path 44, in particular between the sensor 42 and the second regeneration pump 40.

[0269] The second switching valve 46 is set between the third metering group 48 along the acidic path and the first recirculation path 43, in particular between the eighth sensor 41 and the first regeneration pump 39.

[0270] A container 73 comprises a chamber for waste fluid 72, a chamber for permeate 70, a chamber for bicarbonate 69, a first powder bag 66 and a second powder bag 68.

[0271] The container 73 is connected to a scale 74 on the side where no connections are leading out of the container 73.

[0272] The connections leading from the comprised chambers and bags of the container 73 towards other circuits are connected to a fluid connection block 75.

[0273] The fluid connection block 75 is outside the container 73 and on the side where the connections are leading out of the container 73.

[0274] The chamber for permeate 70 and the chamber for bicarbonate 69 are connected via a fluid connection 71. The fluid connection 71 is inside the container 73.

[0275] The chamber for permeate 70 is connected to the powder bags 66, 68. The connection is inside the container 73.

[0276] The first powder bag 66 comprises acidic powder 66.

[0277] The electrolyte solution 66 of the powder bag 66 flows over a seventh gas separator 57 into the acid path.

[0278] In particular the fluid connects between the acidic solution 65 and the first recirculation circuit 43.

[0279] In particular it connects between the first gas separator 51 and the third metering group 48.

[0280] The second powder bag 68 comprises alkaline powder 68.

[0281] The electrolyte solution 68 of the second powder bag 68 flows over a sixth gas separator 56 into the alkaline path. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0282] - 22 -

[0283] In particular the fluid connects between the base solution 67 and the second recirculation circuit 44, in particular it connects between the second gas separator 52 and the second metering group 47.

[0284] The fluid connection from the chamber for bicarbonate 69 leads out of the container 73 through the fluid connection block 75 along a bicarbonate path 53 through a third gas separator 53.

[0285] The bicarbonate path leads from the chamber for bicarbonate 69 over the connection point towards the alkaline paths.

[0286] At control mechanism 59, saturated bicarbonate solution is diluted with water.

[0287] Based on control mechanism 59, the ration between permeate and bicarbonate is regulated.

[0288] From the control mechanism 59 the bicarbonate path leads over a fifth metering pump 50 and a tenth sensor 58 into the alkaline path.

[0289] In particular the bicarbonate path connects with the alkaline path between the second metering pump 47 and the switching mechanism 45, 46.

[0290] Optionally, the bicarbonate path can at least partly flow through a sixth pump 77, through a twelfth sensor 78 towards a connection point.

[0291] This connection point is between the third reservoir 25 and the sixth sensor 17.

[0292] The fluid connection from the chamber of permeate 70 leads out of the container 73 through the fluid connection block 75 along the permeate path 54 through a fifth gas separator 55, at least partially further through a fourth metering pump 49 towards the acidic path.

[0293] Along the permeate path 54 between the fifth gas separator 55 and the fourth metering pump 49 the fluid flows through a third heater 62, through a seventh pump 60 and through a fourth gas separator 54.

[0294] The permeate path 54 comprises an eleventh sensor 61 that measures in a circuit 63 which connects on one end between the third heater 62 and the fifth gas separator 55 and on the other end at the fourth gas separator 54.

[0295] The permeate path 54 is connected with the waste path through a heat exchanger 64. DTS Ref: 40247.ADT.P110PC

[0296] 02.12.2025

[0297] - 23 -

[0298] The connection is on one end along the waste path between the fluid connection block

[0299] 75 and the second waste pump 36 and on the other end along the permeate path between the fifth gas separator 55 and the third heater 62.

[0300] The chamber for waste fluid 72 is within a fluid container 73.

[0301] The chamber for waste fluid 72 can be accessed by a fluid connection.

[0302] This fluid connection is the waste path. In particular the waste path is split up and has further connections. One connection is a first waste path via the second fluid connection

[0303] 76 and another connection is a second waste path via the first fluid connection 30.

[0304] The first waste path leads along the second fluid connection 76 starting from the second circuit - in particular between the dialysate inlet 19 of the dialyzer 10 and the first dialysate pump 18.

[0305] The first waste path - in particular the second fluid connection 76 - connects to the second waste path between the second detoxification unit 34 and the fluid waste bag 72 - in particular between the fluid connection block 75 and the heat exchanger 64 along the second waste path.

[0306] Finally at the connection point the first and second waste path flow together and flow through the fluid connection block 75 into the chamber for waste fluid 72.

[0307] The second waste path starts between the first heater 23 of the second circuit and the third reservoir 25 and is leading towards a fluid waste bag 72.

[0308] The second waste path leads through a single pass outlet valve 29 along a first fluid connection 30.

[0309] The first fluid connection 30 splits up at a connection point from the main fluid connection 30.

[0310] The main fluid connection 30 flows directly into the fluid connection - along the waste path - between the second detoxification unit 34 and the second waste pump 36, and further flows through the fluid connection block 75 into the fluid waste bag 72.

[0311] The split fluid connection 30 is split at the connection point and flows into a point between the first filter 33 and the first waste pump 35. DTS Ref: 40247.ADT.P110PC

[0312] 02.12.2025

[0313] - 24 -

[0314] The fluid flows further from the fluid connection point between the first detoxification unit 33 and the first waste pump 35, through a first waste pump 35 and then further into the fluid connection between the second waste pump 36 and the fluid connection block 75.

[0315] There, the split-up fluid connection 30 meets the main fluid connection 30.

[0316] Then the fluid further flows through the fluid connection block 75 into the fluid waste bag 72.

[0317] Features and / or elements and / or paths and / or connection points and / or connection lines of Fig. 2 indicated by dashed or dotted lines or light grey can be considered optional, including fourth valve 31 , fifth valve 32, fifth gas separator 55, sixth gas separator 56, seventh gas separator 57, acid powder 66 (or first powder bag 66 or electrolyte solution 66), alkaline powder 68 (or second powder bag 68 or eight reservoir 68 or electrolyte solution 68), heat exchanger 64, second fluid connection 76 and / or sixth pump 77 and / or twelfth sensor 78.

[0318] Figure 3 shows one embodiment of the claimed invention:

[0319] The embodiment comprises a patient 1 that is connected to a dialysis device 100, and in particular to dialyzers 10A and 10B.

[0320] The embodiment of the invention comprises multiple circuits and fluid paths, in particular a first blood line 2, a second blood line 16, a first fluid connection 30, a second fluid connection 76, a first regeneration circuit 43, a second regeneration circuit 44, a circuit 63, a fluid connection block 75, a dialysate inlet 19 and a dialysate outlet 20.

[0321] Moreover, the system comprises a plurality of reservoirs and chambers, including a first reservoir 4, a second reservoir 13, a third reservoir 25, a fourth reservoir 26, a fifth reservoir 65, a sixth reservoir 66, a seventh reservoir 67, an eighth reservoir 68, a ninth reservoir 69 and a tenth reservoir 70, a first fluid compartment 71 , a fluid compartment 72 and a fluid bag 73A.

[0322] Additionally, the device comprises multiple pumps, as a first metering pump 27, a second metering pump 47, a third metering pump 48, a fourth metering pump 49, a fifth metering pump 50, a seventh pump 60, a first regeneration pump 39, a second DTS Ref: 40247.ADT.P110PC

[0323] 02.12.2025

[0324] - 25 - regeneration pump 40, a first infusion pump 6, a second infusion pump 15, a first dialysate pump 18, a second dialysate pump 21 , a first waste pump 35 and a second waste pump 36.

[0325] Furthermore, the system comprises multiple sensors, in particular a first sensor 5, a second sensor 7, a third sensor 9, a fourth sensor 11 , a fifth sensor 14, a sixth sensor 17, an eighth sensor 41 , a ninth sensor 42, a tenth sensor 58, and an eleventh sensor 61.

[0326] The device comprises a valve circuit 37 and additionally multiple valves, as a first bypass valve 22, a fourth valve 31 , a fifth valve 32, a first switching valve 45, a second switching valve 46, and a single pass outlet valve 29.

[0327] Additionally, the system comprises several gas separators, a first gas separator 51 , a second gas separator 52, a third gas separator 53, a fourth gas separator 54, a fifth gas separator 55, a sixth gas separator 56 and a seventh gas separator 57.

[0328] Furthermore, the system comprises heating elements as a first heater 23, a second heater 38, a third heater 62 and a heat exchanger 64.

[0329] The system further comprises a first filter 33, a second filter 34.

[0330] Moreover, the system comprises a container 73, a scale 74 and a control mechanism 59.

[0331] The device comprises multiple circuits and fluid paths.

[0332] A first circuit comprises extracorporeal blood lines 2,16 connecting a patient 1 to two dialyzers 10A, 10B.

[0333] A second circuit connects the two dialyzers 10A, 10B to a third reservoir 25.

[0334] A third circuit connects the third reservoir 25 with a detoxification unit 33, 34 over recirculation paths 43, 44.

[0335] Further fluid paths, in particular acidic, alkaline, waste, permeate and bicarbonate paths are connected to the circuits. DTS Ref: 40247.ADT.P110PC

[0336] 02.12.2025

[0337] - 26 -

[0338] A Patient 1 is connected via an extracorporeal first blood line 2 to two dialyzers 10A, 10B and further from the two dialyzers 10A, 10B via an extracorporeal second blood line 16 back to the patient 1 building a first circuit.

[0339] The first circuit comprises a feeding first blood line 2 that starts at the patient 1 and ends at the two dialyzers 10A, 10B.

[0340] The first blood line 2 comprises a first blood line infusion connection 3 between the patient 1 and the two dialyzers 10A, 10B.

[0341] This connection point 3 connects the blood line 2 to a first infusion solution fluid bag 4.

[0342] Between the first blood line infusion connection 3 and the first infusion solution fluid bag 4 is a first infusion pump 6.

[0343] Between the first infusion pump 6 and the first infusion solution fluid bag 4 is a first sensor 5.

[0344] The infusion solution of the first infusion solution fluid bag 4 is supplied into the extracorporeal first blood line 2 via first blood line infusion connection 3 via the first infusion pump 6.

[0345] Between the first blood line infusion connection 3 and the two dialyzers 10A, 10B along the extracorporeal first blood line 2 is a second sensor 7, further upstream a blood pump 8 and a further upstream a third sensor 9.

[0346] The first blood line 2 splits into two directions between the third sensor 9 and the two dialyzers 10A, 10B.

[0347] In one direction the blood flows through one dialyzer 10A and in one direction the blood flows through another dialyzer 10B, as the dialyzers 10A, 10B are set in parallel.

[0348] The fluid enters, passes through and leaves the dialyzer 10A on one side and enters, passes through and leaves the dialyzer 10B on the other side.

[0349] The fluid lines leaving dialyzer 10A and dialyzer 10B merge at a connection point to the second blood line 16.

[0350] The first circuit comprises a second blood line 16 leading back to the patient 1 .

[0351] This second blood line 16 starts at the two dialyzers 10A, 10B and ends at the patient 1. DTS Ref: 40247.ADT.P110PC

[0352] 02.12.2025

[0353] - 27 -

[0354] Between the two dialyzers 10A, 10B and the patient 1 along the second blood line 16 there is a second blood line infusion connection 12.

[0355] Between the second blood line infusion connection 12 and the two dialyzers 10A, 10B there is a sensor 11 .

[0356] The second blood line infusion connection 12 connects the second blood line 16 to a second infusion solution fluid bag 13.

[0357] Between the second blood line infusion connection 12 and the second infusion solution fluid bag 13 is a second infusion pump 15.

[0358] Between the second infusion pump 15 and the second infusion solution bag 13 there is a fifth sensor 14.

[0359] The infusion solution of the second infusion solution fluid bag 13 is supplied into the extracorporeal second blood line 16 via second blood line infusion connection 12 via the second infusion pump 15.

[0360] The two dialyzers 10A, 10B are on one side directly connected to the extracorporeal blood lines 2, 16.

[0361] In particular one end of this one side of the two dialyzers 10A, 10B is directly connected to the first blood line 2 coming from the patient 1 and the other end of this one side is connected with the second blood line 16 leading back to the patient 1.

[0362] Therefore, the two dialyzers 10A, 10B are on one side connected to the first circuit.

[0363] On the other side the two dialyzers 10A, 10B are connected to the second circuit.

[0364] The second circuit starts at the two dialyzers 10A, 10B and leads over the third reservoir 25 and ends at the two dialyzers 10A, 10B.

[0365] Further fluid paths split off from the second circuit.

[0366] Between the two dialyzers 10A, 10B and the third reservoir 25 the dialysate flows through a dialysate outlet 20 from the two dialyzers 10A, 10B through a second dialysate pump 21 , through a seventh sensor 24 and further through a first heater 23 towards the third reservoir 25. DTS Ref: 40247.ADT.P110PC

[0367] 02.12.2025

[0368] - 28 -

[0369] Between the first heater 23 and the third reservoir 25 is a first fluid connection 30 leading towards the fluid waste bag 72.

[0370] In particular the fluid connection is a waste path.

[0371] Between the first heater 23 and the third reservoir 25 - in particular between the first fluid connection 30 of the waste path and the third reservoir 25 - is a fluid connection leading to a third circuit.

[0372] The dialysate flow is partially or completely flowing into the dialysate third reservoir 25 or is partially or completely flowing into the third circuit or into the waste path.

[0373] The fluid flow 19 from the reservoir to the two dialyzers 10A, 10B leads through a sixth sensor 17, through a first dialysate pump 18 towards a dialysate inlet 19 at the two dialyzers 10A, 10B

[0374] Between the first dialysate pump 18 and the dialysate inlet 19 there is a second fluid connection 76.

[0375] In particular the second fluid connection 76 is a waste path.

[0376] The dialysate inlet 19 and the dialysate outlet 20 can be connected in a way, that the blood flow 2,10,16 and the dialysate flow entering, passing through and leaving the two dialyzers 10A, 10B lead in the same direction or in the opposite direction.

[0377] In parallel to the two dialyzers 10A, 10B there is a first bypass valve 22 and fluid path.

[0378] The fluid path is connecting to the second fluid circuit on one end between the two dialyzers 10A, 10B and the second dialysate pump 21 and on the other end between the two dialyzers 10A, 10B and the first dialysate pump 18.

[0379] Along this fluid path there is the first bypass valve 22.

[0380] The third circuit, starts from the fluid flow of the second circuit and flows over pumps 39, 40 and ends at the third reservoir 25.

[0381] Between the one end of the third circuit - between the third reservoir 25 and the first heater 23 - and the regeneration pumps 39, 40 is a connection point 79. DTS Ref: 40247.ADT.P110PC

[0382] 02.12.2025

[0383] - 29 -

[0384] This connection point 79 is connecting the dialysate flow with a fourth reservoir 26. The infusion solution 26 of the fourth reservoir 26 flows through a sensor system 26 through a first metering pump 27 to the fluid connecting point 79.

[0385] Further upstream the connecting point 79 towards the pumps 39, 40 the flow is split into two directions.

[0386] In one direction the flow leads towards the first regeneration pump 39, building a fluid path 43 and a first recirculation circuit 43.

[0387] In the other direction the flow leads towards the second regeneration pump 40, building a fluid path 44 and a second recirculation circuit 44.

[0388] The first recirculation path 43 leads further from the first regeneration pump 39 towards the eighth sensor 41 to a first filter 33.

[0389] This first filter 33 is a first detoxification unit 33.

[0390] The fluid flows into the first detoxification unit 33, through the first detoxification unit 33 and out of the first detoxification unit 33.

[0391] The fluid flows out of the first detoxification unit 33 in two directions.

[0392] In one direction the fluid flows from the first detoxification unit 33 through a first waste pump 35 into the fluid connection between the second detoxification unit 34 and the fluid waste bag 72.

[0393] In particular the fluid connects between a second waste pump 36 and the fluid connection block 75.

[0394] The fluid further flows through the fluid connection block 75 into the fluid waste bag 72.

[0395] In a second direction, the fluid flows from the first detoxification unit 33 through a fourth valve 31 towards a valve circuit 37.

[0396] The valve circuit 37 is a mixing point 37.

[0397] The second recirculation path 44 leads further from the second pump 40 towards the ninth sensor 42 to a second filter 34.

[0398] This second filter 34 is a second detoxification unit 34. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0399] - 30 -

[0400] The fluid flows into the second detoxification unit 34, through the second detoxification unit 34 and out of the second detoxification unit 34.

[0401] The fluid flows out of the second detoxification unit 34 in two directions.

[0402] In one direction the fluid flows from the second detoxification unit 34 through the second waste pump 36 and further flows through the fluid connection block 75 into the fluid waste bag 72.

[0403] In a second direction, the fluid flows from the second detoxification unit 34 through a fifth valve 32 towards the valve circuit 37.

[0404] The valve circuit 37 is the mixing point 37.

[0405] At the mixing point 37 the first recirculation circuit 43 and the second recirculation circuit 44 meet.

[0406] In particular at the mixing point 37 the fluid flowing out of the first detoxification unit 33 and out of the second detoxification unit 34 meet and the two fluid connections get merged to one fluid connection.

[0407] From the mixing point 37 the one fluid connection leads over a second heater 38 towards the third reservoir 25 and into the third reservoir 25.

[0408] At this point the third circuit and the second circuit meet.

[0409] In particular the third circuit ends at that point.

[0410] The device comprises two concentrate containers 65, 67 which are connected to the recirculation paths 44, 43.

[0411] The fifth reservoir 65 comprises an acid solution 65.

[0412] The acid solution 65 flows from the fifth reservoir 65 through a first gas separator 51 through a third metering group 48 into the first recirculation path 43.

[0413] This fluid path is the acidic path.

[0414] The acidic path starts at the fifth reservoir 65 and ends at the first recirculation circuit 43 between the first regeneration pump 39 and the eighth sensor 41 .

[0415] The seventh reservoir 67 comprises a base solution 67. DTS Ref: 40247.ADT.P110PC

[0416] 02.12.2025

[0417] - 31 -

[0418] The base solution 67 flows from the seventh reservoir 67 through a second gas separator 52 through a second metering group 47 into the second recirculation path 44.

[0419] This fluid path is the alkaline path.

[0420] The alkaline path starts at the seventh reservoir 67 and ends at the second recirculation path 44 between the second regeneration pump 40 and the ninth sensor 42.

[0421] Between the acidic path and the alkaline path there is a switching mechanism 45, 46. The switching mechanism 45, 46 comprises two switching valves 45, 46.

[0422] The switching valve 45 is set between the second metering group 47 along the alkaline path and the second recirculation path 44, in particular between the ninth sensor 42 and the second regeneration pump 40.

[0423] The switching valve 46 is set between the metering group 48 along the acidic path and the first recirculation path 43, in particular between the eighth sensor 41 and the first regeneration pump 39.

[0424] A container 73 comprises a chamber for waste fluid 72, a chamber for permeate 70, a chamber for bicarbonate 69, a first powder bag 66 and a second powder bag 68.

[0425] The container 73 is on a scale 74.

[0426] The connections leading from the comprised chambers and bags of the container 73 towards other circuits are connected to a fluid connection block 75.

[0427] The fluid connection block 75 is outside the container 73 and on the side where the connections are leading out of the container 73.

[0428] The chamber for permeate 70 and the chamber for bicarbonate 69 are connected via a fluid connection 71.

[0429] The fluid connection 71 is inside the container 73.

[0430] The chamber for permeate 70 is connected to the powder bags 66, 68. The connection is inside the container 73.

[0431] The powder bag 66 comprises acidic powder 66. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0432] - 32 -

[0433] The electrolyte solution 66 of the first powder bag 66 flows over a seventh gas separator 57 into the acid path.

[0434] In particular the fluid connects between the acidic solution 65 and the first recirculation circuit 43.

[0435] In particular it connects between the first gas separator 51 and the third metering group 48.

[0436] The second powder bag 68 comprises alkaline powder 68.

[0437] The electrolyte solution 68 of the second powder bag 68 flows over a sixth gas separator 56 into the alkaline path.

[0438] In particular the fluid connects between the base solution 67 and the second recirculation circuit 44, in particular it connects between the second gas separator 52 and the second metering group 47.

[0439] The bicarbonate path leads from the chamber of bicarbonate 69 towards the alkaline and acidic path.

[0440] The fluid connection from the chamber for bicarbonate 69 leads out of the container 73 through the fluid connection block 75 along a bicarbonate path 53 through a third gas separator 53 towards a control mechanism 59.

[0441] The bicarbonate path leads towards the alkaline path.

[0442] The bicarbonate path leads over a fifth metering pump 50 and a tenth sensor 58 into the alkaline path.

[0443] In particular the bicarbonate path 53 connects with the alkaline path between the seventh metering pump 47 and the switching mechanism 45, 46.

[0444] At control mechanism 59, saturated bicarbonate solution is diluted with water.

[0445] Based on control mechanism 59, the ration between permeate and bicarbonate is regulated.

[0446] The fluid connection from the chamber of permeate 70 leads out of the container 73 through the fluid connection block 75 along the permeate path 54 through a fifth gas DTS Ref: 40247.ADT.P110PC

[0447] 02.12.2025

[0448] - 33 - separator 55 and at least partially further through a fourth metering pump 49 towards the acidic path.

[0449] Along the permeate path 54 between the gas fifth separator 55 and the fourth metering pump 49 the fluid flows through a third heater 62, through a seventh pump 60 and through a fourth gas separator 54.

[0450] The permeate path 54 comprises an eleventh sensor 61 that measures in a circuit 63 which connects on one end between the third heater 62 and the fifth gas separator 55 and on the other end at the fourth gas separator 54.

[0451] The permeate path 54 is connected with the waste path through a heat exchanger 64.

[0452] The connection is on one end along the waste path between the fluid connection block 75 and the second waste pump 36 and on the other end along the permeate path between the fifth gas separator 55 and the third heater 62.

[0453] The chamber for waste fluid 72 is within a fluid container 73.

[0454] The chamber for waste fluid 72 can be accessed by a fluid connection.

[0455] This fluid connection is the waste path.

[0456] In particular the waste path is split up and has further connections.

[0457] One connection is a first waste path via second the fluid connection 76 and another connection is a second waste path via the first fluid connection 30.

[0458] The first waste path leads along the second fluid connection 76 starting from the second circuit - in particular between the dialysate inlet 19 of the two dialyzers 10A, 10B and the first dialysate pump 18.

[0459] The first waste path - in particular the second fluid connection 76 - connects to the second waste path between the second detoxification unit 34 and the fluid waste bag 72 - in particular between the fluid connection block 75 and the heat exchanger 64 along the second waste path.

[0460] Finally, at the connection point the first and second waste path flow together and flow through the fluid connection block 75 into the chamber for waste fluid 72.

[0461] The second waste path starts between the first heater 23 of the second circuit and the third reservoir 25 and is leading towards a fluid waste bag 72. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0462] - 34 -

[0463] The second waste path leads through a single pass outlet valve 29 along a first fluid connection 30.

[0464] The first fluid connection 30 splits up at a connection point from the main fluid connection 30.

[0465] The main fluid connection 30 flows directly into the fluid connection - along the waste path - between the second detoxification unit 34 and the second waste pump 36, and further flows through the fluid connection block 75 into the fluid waste bag 72.

[0466] The split fluid connection 30 is split at the connection point and flows into a point between the first filter 33 and the first filter pump 35.

[0467] The fluid flows further from the fluid connection point between the first detoxification unit 33 and the first waste pump 35, through a first waste pump 35 and then further into the fluid connection between the second waste pump 36 and the fluid connection block 75.

[0468] There, the split-up fluid connection 30 meets the main fluid connection 30.

[0469] Then the fluid further flows through the fluid connection block 75 into the fluid waste bag 72.

[0470] Features and / or elements and / or paths and / or connection points and / or connection lines of Fig. 3 indicated by dashed or dotted lines or light grey can be considered optional, including dialyzer 10B, fourth valve 31 , fifth valve 32, fifth gas separator 55, sixth gas separator 56, seventh gas separator 57, acid powder 66 (or first powder bag 66 or electrolyte solution 66), alkaline powder 68 (or second powder bag 68 or eight reservoir 68 or electrolyte solution 68), heat exchanger 64, second fluid connection 76 and / or single pass outlet valve 29 and / or first fluid connection 30. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0471] - 35 -

[0472] Figure 4 shows one embodiment of the claimed invention:

[0473] The embodiment comprises a patient 1 that is connected to a dialysis device 100, and in particular to dialyzers 10A and 10B.

[0474] The embodiment of the invention comprises multiple circuits and fluid paths, in particular a first blood line 2, a second blood line 16, a first fluid connection 30, a second fluid connection 76, a first regeneration circuit 43, a second regeneration circuit 44, a circuit 63, a fluid connection block 75, a dialysate inlet 19 and a dialysate outlet 20.

[0475] Moreover, the system comprises a plurality of reservoirs and chambers, including a first reservoir 4, a second reservoir 13, a third reservoir 25, a fourth reservoir 26, a fifth reservoir 65, a sixth reservoir 66, a seventh reservoir 67, an eighth reservoir 68, a ninth reservoir 69 and a tenth reservoir 70, a first fluid compartment 71 , a fluid compartment 72 and a fluid bag 73A.

[0476] Additionally, the device comprises multiple pumps, as a first metering pump 27, a second metering pump 47, a third metering pump 48, a fourth metering pump 49, a fifth metering pump 50, a seventh pump 60, a first regeneration pump 39, a second regeneration pump 40, a first infusion pump 6, a second infusion pump 15, a first dialysate pump 18, a second dialysate pump 21 , a first waste pump 35 and a second waste pump 36.

[0477] Furthermore, the system comprises multiple sensors, in particular a first sensor 5, a second sensor 7, a third sensor 9, a fourth sensor 11 , a fifth sensor 14, a sixth sensor 17, an eighth sensor 41 , a ninth sensor 42, a tenth sensor 58, and an eleventh sensor 61.

[0478] The device comprises a valve circuit 37 and additionally multiple valves, as a first bypass valve 22, a fourth valve 31 , a fifth valve 32, a first switching valve 45, a second switching valve 46, and a single pass outlet valve 29.

[0479] Additionally, the system comprises several gas separators, a first gas separator 51 , a second gas separator 52, a third gas separator 53, a fourth gas separator 54, a fifth gas separator 55, a sixth gas separator 56 and a seventh gas separator 57.

[0480] Furthermore, the system comprises heating elements as a first heater 23, a second heater 38, a third heater 62 and a heat exchanger 64. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0481] - 36 -

[0482] Moreover, the system comprises a container 73, a scale 74 and a control mechanism 59.

[0483] The device comprises multiple circuits and fluid paths.

[0484] A first circuit comprises extracorporeal blood lines 2,16 connecting a patient 1 to two dialyzers 10A, 10B.

[0485] A second circuit connects the two dialyzers 10A, 10B to a third reservoir 25.

[0486] A third circuit connects the third reservoir 25 to recirculation paths 43, 44.

[0487] Further fluid paths, in particular acidic, alkaline, waste, permeate and bicarbonate paths are connected to the circuits.

[0488] A Patient 1 is connected via an extracorporeal first blood line 2 to two dialyzers 10A, 10B and further from the two dialyzers 10A, 10B via an extracorporeal second blood line 16 back to the patient 1 building a first circuit.

[0489] The first circuit comprises a feeding first blood line 2 that starts at the patient 1 and ends at the two dialyzers 10A, 10B.

[0490] The first blood line 2 comprises a first blood line infusion connection 3 between the patient 1 and the two dialyzers 10A, 10B.

[0491] This connection point 3 connects the first blood line 2 to a first infusion solution fluid bag

[0492] 4.

[0493] Between the first blood line infusion connection 3 and the first infusion solution fluid bag 4 is a first infusion pump 6.

[0494] Between the infusion pump 6 and the first infusion solution fluid bag 4 is a first sensor

[0495] 5.

[0496] The infusion solution of the first infusion solution fluid bag 4 is supplied into the extracorporeal first blood line 2 via first blood line infusion connection 3 via the first infusion pump 6.

[0497] Between the first blood line infusion connection 3 and the two dialyzers 10A, 10B along the extracorporeal first blood line 2 is a second sensor 7, further upstream a blood pump 8 and a further upstream a third sensor 9. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0498] - 37 -

[0499] The first blood line 2 splits into two directions between the third sensor 9 and the two dialyzers 10A, 10B.

[0500] In one direction the blood flows through one dialyzer 10A and in one direction the blood flows through another dialyzer 10B, as the dialyzers 10A, 10B are set in parallel.

[0501] The fluid enters, passes through and leaves the dialyzer 10A on one side and enters, passes through and leaves the dialyzer 10B on the other side.

[0502] The fluid lines leaving dialyzer 10A and dialyzer 10B merge at a connection point to the second blood line 16.

[0503] The first circuit comprises a blood line 16 leading back to the patient 1 .

[0504] This second blood line 16 starts at the two dialyzers 10A, 10B and ends at the patient 1.

[0505] Between the two dialyzers 10A, 10B and the patient 1 along the second blood line 16 there is a second blood line infusion connection 12.

[0506] Between the second blood line infusion connection 12 and the two dialyzers 10A, 10B there is a fourth sensor 11 .

[0507] The second blood line infusion connection 12 connects the second blood line 16 to a second infusion solution fluid bag 13.

[0508] Between the second blood line infusion connection 12 and the second infusion solution fluid bag 13 is a second infusion pump 15.

[0509] Between the second infusion pump 15 and the second infusion solution bag 13 there is a fifth sensor 14.

[0510] The infusion solution of the second infusion solution fluid bag 13 is supplied into the extracorporeal second blood line 16 via second blood line infusion connection 12 via the second infusion pump 15.

[0511] The two dialyzers 10A, 10B are on one side directly connected to the extracorporeal blood lines 2, 16.

[0512] In particular one end of this one side of the two dialyzers 10A, 10B is directly connected to the first blood line 2 coming from the patient and the other end of this one side is connected with the second blood line 16 leading back to the patient. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0513] - 38 -

[0514] Therefore, the two dialyzers 10A, 10B are on one side connected to the first circuit.

[0515] On the other side the two dialyzers 10A, 10B are connected to the second circuit.

[0516] The second circuit starts at the two dialyzers 10A, 10B and the fluid flows over the third reservoir 25 and ends at the two dialyzers 10A, 10B.

[0517] Further fluid paths split off from the second circuit.

[0518] Between the two dialyzers 10A, 10B and the third reservoir 25 the dialysate flows through a dialysate outlet 20 from the two dialyzers 10A, 10B through a second dialysate pump 21 , through a seventh sensor 24 and further through a first heater 23 towards the third reservoir 25.

[0519] Between the first heater 23 and the third reservoir 25 is a first fluid connection 30 leading towards the fluid waste bag 72.

[0520] In particular the fluid connection is a waste path.

[0521] Between the first heater 23 and the third reservoir 25 - in particular between the first fluid connection 30 of the waste path and the third reservoir 25 - is a fluid connection leading to a third circuit.

[0522] The dialysate flow is partially or completely flowing into the dialysate third reservoir 25 or is partially or completely flowing into the third circuit or into the waste path.

[0523] The fluid flow 19 from the third reservoir 25 to the two dialyzers 10A, 10B leads through a sixth sensor 17, through a first dialysate pump 18 towards a dialysate inlet 19 at the two dialyzers 10A, 10B

[0524] Between the first dialysate pump 18 and the dialysate inlet 19 there is a second fluid connection 76.

[0525] In particular the second fluid connection 76 is a waste path.

[0526] The dialysate inlet 19 and the dialysate outlet 20 can be connected in a way, that the blood flow 2,10,16 and the dialysate flow entering, passing through and leaving the two dialyzers 10A, 10B lead in the same direction or in the opposite direction.

[0527] In parallel to the two dialyzers 10A, 10B there is a first bypass valve 22 and fluid path. DTS Ref: 40247.ADT.P110PC

[0528] 02.12.2025

[0529] - 39 -

[0530] The fluid path is connecting to the second fluid circuit on one end between the two dialyzers 10A, 10B and the second dialysate pump 21 and on the other end between the two dialyzers 10A, 10B and the first dialysate pump 18.

[0531] Along this fluid path there is the first bypass valve 22.

[0532] The third circuit, starts from the fluid flow of the second circuit and flows over pumps 39, 40 and ends at the third reservoir 25.

[0533] Between the one end of the third circuit - between the third reservoir 25 and the first heater 23 - and the regeneration pumps 39, 40 is a connection point 79.

[0534] This connection point 79 is connecting the dialysate flow with a fourth reservoir 26.

[0535] The infusion solution 26 of the fourth reservoir 26 flows through a sensor system 26 through a first metering pump 27 to the fluid connecting point 79.

[0536] Further upstream the connecting point 79 towards the pumps 39, 40 the flow is split into two directions.

[0537] In one direction the flow leads towards the first regeneration pump 39, building a fluid path 43 and a first recirculation circuit 43.

[0538] In the other direction the flow leads towards the second regeneration pump 40, building a fluid path 44 and a second recirculation circuit 44.

[0539] The first recirculation path 43 leads further from the first regeneration pump 39 through the eighth sensor 41 towards a mixing point 37.

[0540] The fluid splits at a connection point along the first recirculation path 43 between the eighth sensor 41 and the mixing point 37 in two directions.

[0541] In one direction the fluid flows through a first waste pump 35 into the fluid connection between the second recirculation path 44 and the fluid waste bag 72.

[0542] In particular the fluid connects between a second waste pump 36 and the fluid connection block 75.

[0543] The fluid further flows through the fluid connection block 75 into the fluid waste bag 72. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0544] - 40 -

[0545] In a second direction, the fluid flows through a fourth valve 31 towards a valve circuit 37.

[0546] The valve circuit 37 is a mixing point 37.

[0547] The second recirculation path 44 leads further from the second regeneration pump 40 through the ninth sensor 42 towards a mixing point 37.

[0548] The fluid splits at a connection point along the second recirculation path 44 between the ninth sensor 42 and the mixing point 37 in two directions.

[0549] In one direction the fluid flows through the second waste pump 36 and further flows through the fluid connection block 75 into the fluid waste bag 72.

[0550] In a second direction, the fluid flows through a fifth valve 32 towards the valve circuit 37.

[0551] The valve circuit 37 is the mixing point 37.

[0552] At the mixing point 37 the first recirculation circuit 43 and the second recirculation circuit 44 meet.

[0553] In particular at the mixing point 37 and the two fluid connections get merged to one fluid connection.

[0554] From the mixing point 37 the one fluid connection leads over a second heater 38 towards the third reservoir 25 and into the third reservoir 25.

[0555] At this point the third circuit and the second circuit meet.

[0556] In particular the third circuit ends at that point.

[0557] The device comprises two concentrate containers 65, 67 which are connected to the recirculation paths 44, 43.

[0558] The fifth reservoir 65 comprises an acid solution 65.

[0559] The acid solution 65 flows from the fifth reservoir 65 through a first gas separator 51 through a third metering group 48 into the first recirculation path 43.

[0560] This fluid path is the acidic path. DTS Ref: 40247.ADT.P110PC

[0561] 02.12.2025

[0562] - 41 -

[0563] The acidic path starts at the fifth reservoir 65 and ends at the first recirculation circuit 43 between the first regeneration pump 39 and the eighth sensor 41 .

[0564] The seventh reservoir 67 comprises a base solution 67.

[0565] The base solution 67 flows from the seventh reservoir 67 through a second gas separator 52 through a second metering group 47 into the second recirculation path 44.

[0566] This fluid path is the alkaline path.

[0567] The alkaline path starts at the seventh reservoir 67 and ends at the second recirculation path 44 between the second regeneration pump 40 and the ninth sensor 42.

[0568] Between the acidic path and the alkaline path there is a switching mechanism 45, 46. The switching mechanism 45, 46 comprises two switching valves 45, 46.

[0569] The switching valve 45 is set between the second metering group 47 along the alkaline path and the second recirculation path 44, in particular between the ninth sensor 42 and the second regeneration pump 40.

[0570] The second switching valve 46 is set between the third metering group 48 along the acidic path and the first recirculation path 43, in particular between the eighth sensor 41 and the first regeneration pump 39.

[0571] A container 73 comprises a chamber for waste fluid 72, a chamber for permeate 70, a chamber for bicarbonate 69, a first powder bag 66 and another second powder bag 68.

[0572] The container 73 is on a scale 74.

[0573] The connections leading from the comprised chambers and bags of the container 73 towards other circuits are connected to a fluid connection block 75.

[0574] The fluid connection block 75 is outside the container 73 and on the side where the connections are leading out of the container 73.

[0575] The chamber for permeate 70 and the chamber for bicarbonate 69 are connected via a fluid connection 71.

[0576] The fluid connection 71 is inside the container 73.

[0577] The chamber for permeate 70 is connected to the powder bags 66, 68. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0578] - 42 -

[0579] The connection is inside the container 73.

[0580] The first powder bag 66 comprises acidic powder 66.

[0581] The electrolyte solution 66 of the first powder bag 66 flows over a gas seventh separator 57 into the acid path.

[0582] In particular the fluid connects between the acidic solution 65 and the first recirculation circuit 43.

[0583] In particular it connects between the first gas separator 51 and the third metering group 48.

[0584] The second powder bag 68 comprises alkaline powder 68.

[0585] The electrolyte solution 68 of the second powder bag 68 flows over a sixth gas separator 56 into the alkaline path.

[0586] In particular the fluid connects between the base solution 67 and the second recirculation circuit 44, in particular it connects between the second gas separator 52 and the second metering group 47.

[0587] The bicarbonate path leads from the chamber of bicarbonate 69 towards the alkaline path.

[0588] The fluid connection from the chamber for bicarbonate 69 leads out of the container 73 through the fluid connection block 75 along a bicarbonate path 53 through a third gas separator 53 towards a control mechanism 59.

[0589] The bicarbonate path leads over a fifth metering pump 50 and a tenth sensor 58 into the alkaline path.

[0590] In particular the bicarbonate path 53 connects with the alkaline path between the second metering pump 47 and the switching mechanism 45, 46.

[0591] At control mechanism 59, saturated bicarbonate solution is diluted with water.

[0592] Based on control mechanism 59, the ration between permeate and bicarbonate is regulated.

[0593] In particular the connection of the bicarbonate path 53 and the permeate path 54 is between the fourth gas separator 54 and the fourth metering pump 49. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0594] - 43 -

[0595] The fluid connection from the chamber of permeate 70 leads out of the container 73 through the fluid connection block 75 along the permeate path 54 through a fifth gas separator 55 further through a fourth metering pump 49 towards the acidic path.

[0596] Along the permeate path 54 between the gas fifth separator 55 and the fourth metering pump 49 the fluid flows through a third heater 62, through a seventh pump 60 and through a fourth gas separator 54.

[0597] The permeate path 54 comprises an eleventh sensor 61 that measures in a circuit 63 which connects on one end between the third heater 62 and the fifth gas separator 55 and on the other end at the fourth gas separator 54.

[0598] The permeate path 54 is connected with the waste path through a heat exchanger 64.

[0599] The connection is on one end along the waste path between the fluid connection block 75 and the second waste pump 36 and on the other end along the permeate path between the fifth gas separator 55 and the third heater 62.

[0600] The chamber for waste fluid 72 is within a fluid container 73.

[0601] The chamber for waste fluid 72 can be accessed by a fluid connection.

[0602] This fluid connection is the waste path.

[0603] In particular the waste path is split up and has further connections. One connection is a first waste path via the second fluid connection 76 and another connection is a second waste path via the first fluid connection 30.

[0604] The first waste path leads along the second fluid connection 76 starting from the second circuit - in particular between the dialysate inlet 19 of the two dialyzers 10A, 10B and the first dialysate pump 18.

[0605] The first waste path - in particular the second fluid connection 76 - connects to the second waste path between the second recirculation circuit 44 and the fluid waste bag 72 - in particular between the fluid connection block 75 and the heat exchanger 64 along the second waste path.

[0606] Finally, at the connection point the first and second waste path flow together and flow through the fluid connection block 75 into the chamber for waste fluid 72. DTS Ref: 40247.ADT.P110PC

[0607] 02.12.2025

[0608] - 44 -

[0609] The second waste path starts between the first heater 23 of the second circuit and the third reservoir 25 and is leading towards a fluid waste bag 72.

[0610] The second waste path leads through a single pass outlet valve 29 along a first fluid connection 30.

[0611] The first fluid connection 30 splits up at a connection point from the main fluid connection 30.

[0612] The main fluid connection 30 flows directly into the fluid connection - along the waste path - between the second recirculation circuit 44 and the second waste pump 36, and further flows through the second waste pump 36, through the fluid connection block 75 into the fluid waste bag 72.

[0613] The split fluid connection 30 is split at the connection point and flows into a point between the first recirculation circuit 43 and the first filter pump 35.

[0614] The fluid flows further from the fluid connection point between first recirculation circuit 43 and the first waste pump 35, through a first waste pump 35 and then further into the fluid connection between the second waste pump 36 and the fluid connection block 75.

[0615] There, the split-up fluid connection 30 meets the main fluid connection 30.

[0616] Then the fluid further flows through the fluid connection block 75 into the fluid waste bag 72.

[0617] Features and / or elements and / or paths and / or connection points and / or connection lines of Fig. 4 indicated by dashed or dotted lines or light grey can be considered optional, including dialyzer 10B, fourth reservoir 26 (or infusion solution 26 or fluid bag 26), first metering pump 27, sensor system 28, fourth valve 31 , fifth valve 32, first switching valve 45 (or switching mechanism 45), second switching valve 46 (or switching mechanism 46), third metering pump 48, fourth metering pump 49, first gas separator 51 , fifth gas separator 55, sixth gas separator 56, seventh gas separator 57, acid powder 66 (or first powder bag 66 or electrolyte solution 66), alkaline powder 68 (or second powder bag 68 or eight reservoir 68 or electrolyte solution 68), heat exchanger 64, fifth reservoir 65 (or dialysis concentrate 65 or acid solution 65 or concentrate container 65) and / or second fluid connection 76. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0618] - 45 -

[0619] Figure 5 shows one embodiment of the claimed invention:

[0620] The embodiment comprises a patient 1 that is connected to a dialysis device 100, and in particular to a dialyzers 10A and 10B.

[0621] The embodiment of the invention comprises multiple circuits and fluid paths, in particular a first blood line 2, a second blood line 16, a first fluid connection 30, a second fluid connection 76, a first regeneration circuit 43, a second regeneration circuit 44, a circuit 63, a fluid connection block 75, a dialysate inlet 19 and a dialysate outlet 20.

[0622] Moreover, the system comprises a plurality of reservoirs and chambers, including a first reservoir 4, a second reservoir 13, a third reservoir 25, a fourth reservoir 26, a fifth reservoir 65, a sixth reservoir 66, a seventh reservoir 67, an eighth reservoir 68, a ninth reservoir 69 and a tenth reservoir 70, a first fluid compartment 71 , a fluid compartment 72 and a fluid bag 73A.

[0623] Additionally, the device comprises multiple pumps, as a first metering pump 27, a second metering pump 47, a third metering pump 48, a fourth metering pump 49, a fifth metering pump 50, a seventh pump, a first regeneration pump 39, a second regeneration pump 40, a first infusion pump 6, a second infusion pump 15, a first dialysate pump 18, a second dialysate pump 21 , a first waste pump 35 and a second waste pump 36.

[0624] Furthermore, the system comprises multiple sensors, in particular a first sensor 5, a second sensor 7, a third sensor 9, a fourth sensor 11 , a fifth sensor 14, a sixth sensor 17, an eighth sensor 41 , a ninth sensor 42, a tenth sensor 58, and an eleventh sensor 61.

[0625] The device comprises a valve circuit 37 and additionally multiple valves, as a first bypass valve 22, a fourth valve 31 , a fifth valve 32, a first switching valve 45, a second switching valve 46, and a single pass outlet valve 29.

[0626] Additionally, the system comprises several gas separators, a first gas separator 51 , a second gas separator 52, a third gas separator 53, a fourth gas separator 54, a fifth gas separator 55, a sixth gas separator 56 and a seventh gas separator 57. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0627] - 46 -

[0628] Furthermore, the system comprises heating elements as a first heater 23, a second heater 38, a third heater 62 and a heat exchanger 64.

[0629] Moreover, the system comprises a container 73, a scale 74 and a control mechanism 59.

[0630] The device comprises multiple circuits and fluid paths.

[0631] A first circuit comprises extracorporeal blood lines 2,16 connecting a patient 1 to two dialyzers 10A, 10B.

[0632] A second circuit connects the two dialyzers 10A, 10B to a third reservoir 25.

[0633] A third circuit connects the third reservoir 25 to recirculation paths 43, 44.

[0634] Further fluid paths, in particular acidic, alkaline, waste, permeate and bicarbonate paths are connected to the circuits.

[0635] A Patient 1 is connected via an extracorporeal first blood line 2 to two dialyzers 10A, 10B and further from the two dialyzers 10A, 10B via an extracorporeal second blood line 16 back to the patient 1 building a first circuit.

[0636] The first circuit comprises a feeding first blood line 2 that starts at the patient 1 and ends at the two dialyzers 10A, 10B.

[0637] The first blood line 2 comprises a first blood line infusion connection 3 between the patient 1 and the two dialyzers 10A, 10B.

[0638] This connection point 3 connects the first blood line 2 to a first infusion solution fluid bag 4.

[0639] Between the first blood line infusion connection 3 and the first infusion solution fluid bag 4 is a first infusion pump 6.

[0640] Between the first infusion pump 6 and the first infusion solution fluid bag 4 is a first sensor 5.

[0641] The infusion solution of the first infusion solution fluid bag 4 is supplied into the extracorporeal first blood line 2 via first blood line infusion connection 3 via the first infusion pump 6. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0642] - 47 -

[0643] Between the first blood line infusion connection 3 and the two dialyzers 10A, 10B along the extracorporeal first blood line 2 is a second sensor 7, further upstream a blood pump 8 and a further upstream a third sensor 9.

[0644] The blood line 2 splits into two directions between the sensor 9 and the two dialyzers 10A, 10B.

[0645] In one direction the blood flows through one dialyzer 10A and in one direction the blood flows through another dialyzer 10B.

[0646] The fluid enters, passes through and leaves the dialyzer 10A on one side and enters, passes through and leaves the dialyzer 10B on the other side.

[0647] The fluid lines leaving dialyzer 10A and dialyzer 10B merge at a connection point to the second blood line 16.

[0648] The dialyzers 10A, 10B are connected to the second circuit in a way that the fluid splits up into two directions.

[0649] The first circuit comprises a blood line 16 leading back to the patient 1 .

[0650] This second blood line 16 starts at the two dialyzers 10A, 10B and ends at the patient 1.

[0651] Between the two dialyzers 10A, 10B and the patient 1 along the second blood line 16 there is a second blood line infusion connection 12.

[0652] Between the second blood line infusion connection 12 and the two dialyzers 10A, 10B there is a fourth sensor 11 .

[0653] The second blood line infusion connection 12 connects the second blood line 16 to an second infusion solution fluid bag 13.

[0654] Between the second blood line infusion connection 12 and the second infusion solution fluid bag 13 is a second infusion pump 15.

[0655] Between the second infusion pump 15 and the second infusion solution bag 13 there is a fifth sensor 14.

[0656] The infusion solution of the second infusion solution fluid bag 13 is supplied into the extracorporeal second blood line 16 via second blood line infusion connection 12 via the second infusion pump 15. DTS Ref: 40247.ADT.P110PC

[0657] 02.12.2025

[0658] - 48 -

[0659] The two dialyzers 10A, 10B are on one side directly connected to the extracorporeal blood lines 2, 16.

[0660] In particular one end of this one side of the two dialyzers 10A, 10B is directly connected to the first blood line 2 coming from the patient and the other end of this one side is connected with the blood line 16 leading back to the patient.

[0661] Therefore, the two dialyzers 10A, 10B are on one side connected to the first circuit.

[0662] On the other side the two dialyzers 10A, 10B are connected to the second circuit.

[0663] The second circuit starts at the two dialyzers 10A, 10B and leads over the reservoir 25 and ends at the two dialyzers 10A, 10B. Further fluid paths split off from the second circuit.

[0664] Between the two dialyzers 10A, 10B and the third reservoir 25 the dialysate flows through a dialyzer connection 20A from the two dialyzers 10A, 10B through a second dialysate pump 21 , through a seventh sensor 24 and further through a first heater 23 towards the third reservoir 25.

[0665] Between the first heater 23 and the third reservoir 25 is a first fluid connection 30 leading towards the fluid waste bag 72.

[0666] In particular the fluid connection is a waste path.

[0667] Between the first heater 23 and the third reservoir 25 - in particular between the first fluid connection 30 of the waste path and the third reservoir 25 - is a fluid connection leading to a third circuit.

[0668] The dialysate flow is partially or completely flowing into the dialysate third reservoir 25 or is partially or completely flowing into the third circuit or into the waste path.

[0669] The fluid flow from the reservoir to the two dialyzers 10A, 10B leads through a sixth sensor 17, through a first dialysate pump 18 towards a dialyzer connection 19A at the two dialyzers 10A, 10B

[0670] Between the first dialysate pump 18 and the dialyzer connection 19A there is a second fluid connection 76.

[0671] In particular the second fluid connection 76 is a waste path. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0672] - 49 -

[0673] The dialyzer connection 19A and the dialyzer connection 20A can be connected in a way, that the blood flow 2,10,16 and the dialysate flow entering, passing through and leaving the two dialyzers 10A, 10B lead in the same direction or in the opposite direction.

[0674] In parallel to the two dialyzers 10A, 10B there is a first bypass valve 22 and fluid path.

[0675] The fluid path is connecting to the second fluid circuit on one end between the two dialyzers 10A, 10B and the second dialysate pump 21 and on the other end between the two dialyzers 10A, 10B and the first dialysate pump 18.

[0676] Along this fluid path there is the first bypass valve 22.

[0677] The third circuit, starts from the fluid flow of the second circuit and flows over pumps 39, 40 and ends at the third reservoir 25.

[0678] Between the one end of the third circuit - between the third reservoir 25 and the first heater 23 - and the regeneration pumps 39, 40 is a connection point 79.

[0679] This connection point 79 is connecting the dialysate flow with a fourth reservoir 26.

[0680] The infusion solution 26 from the fourth reservoir 26 flows through a sensor system 26 through a first metering pump 27 to the fluid connecting point 79.

[0681] Further upstream the connecting point 79 towards the pumps 39, 40 the flow is split into two directions.

[0682] In one direction the flow leads towards the first regeneration pump 39, building a fluid path 43 and a first recirculation circuit 43.

[0683] In the other direction the flow leads towards the second regeneration pump 40, building a fluid path 44 and a second recirculation circuit 44.

[0684] The first recirculation path 43 leads further from the first regeneration pump 39 through the eighth sensor 41 towards a mixing point 37.

[0685] The fluid splits at a connection point along the first recirculation path 43 between the eighth sensor 41 and the mixing point 37 in two directions.

[0686] In one direction the fluid flows through a first waste pump 35 into the fluid connection between the second recirculation path 44 and the fluid waste bag 72. DTS Ref: 40247.ADT.P110PC

[0687] 02.12.2025

[0688] - 50 -

[0689] In particular the fluid connects between a second waste pump 36 and the fluid connection block 75.

[0690] The fluid further flows through the fluid connection block 75 into the fluid waste bag 72.

[0691] In a second direction, the fluid flows through a fourth valve 31 towards a valve circuit 37.

[0692] The valve circuit 37 is a mixing point 37.

[0693] The second recirculation path 44 leads further from the second regeneration pump 40 through the ninth sensor 42 towards a mixing point 37.

[0694] The fluid splits at a connection point along the second recirculation path 44 between the ninth sensor 42 and the mixing point 37 in two directions.

[0695] In one direction the fluid flows through the second waste pump 36 and further flows through the fluid connection block 75 into the fluid waste bag 72.

[0696] In a second direction, the fluid flows through a fifth valve 32 towards the valve circuit 37.

[0697] The valve circuit 37 is the mixing point 37.

[0698] At the mixing point 37 the first recirculation circuit 43 and the second recirculation circuit 44 meet.

[0699] In particular at the mixing point 37 and the two fluid connections get merged to one fluid connection.

[0700] From the mixing point 37 the one fluid connection leads over a second heater 38 towards the third reservoir 25 and into the third reservoir 25.

[0701] At this point the third circuit and the second circuit meet.

[0702] In particular the third circuit end at that point.

[0703] The device comprises two concentrate containers 65, 67 which are connected to the recirculation paths 44, 43.

[0704] The fifth reservoir 65 comprises an acid solution 65. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0705] - 51 -

[0706] The acid solution 65 flows from the fifth reservoir 65 through a first gas separator 51 through a third metering group 48 into the first recirculation path 43.

[0707] This fluid path is the acidic path.

[0708] The acidic path starts at the fifth reservoir 65 and ends at the first recirculation circuit 43 between the first regeneration pump 39 and the eighth sensor 41 .

[0709] The seventh reservoir 67 comprises a base solution 67.

[0710] The base solution 67 flows from the seventh reservoir 67 through a second gas separator 52 through a second metering group 47 into the second recirculation path 44.

[0711] This fluid path is the alkaline path.

[0712] The alkaline path starts at the seventh reservoir 67 and ends at the second recirculation path 44 between the second regeneration pump 40 and the ninth sensor 42.

[0713] Between the acidic path and the alkaline path there is a switching mechanism 45, 46.

[0714] The switching mechanism 45, 46 comprises two switching valves 45, 46.

[0715] The first switching valve 45 is set between the second metering group 47 along the alkaline path and the second recirculation path 44, in particular between the ninth sensor 42 and the second regeneration pump 40.

[0716] The second switching valve 46 is set between the third metering group 48 along the acidic path and the first recirculation path 43, in particular between the eighth sensor 41 and the first regeneration pump 39.

[0717] A container 73 comprises a chamber for waste fluid 72, a chamber for permeate 70, a chamber for bicarbonate 69, a first powder bag 66 and second powder bag 68.

[0718] The container 73 is on a scale 74.

[0719] The connections leading from the comprised chambers and bags of the container 73 towards other circuits are connected to a fluid connection block 75.

[0720] The fluid connection block 75 is outside the container 73 and on the side where the connections are leading out of the container 73. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0721] - 52 -

[0722] The chamber for permeate 70 and the chamber for bicarbonate 69 are connected via a fluid connection 71.

[0723] The fluid connection 71 is inside the container 73.

[0724] The chamber for permeate 70 is connected to the powder bags 66, 68.

[0725] The connection is inside the container 73.

[0726] The first powder bag 66 comprises acidic powder 66.

[0727] The electrolyte solution 66 of the first powder bag 66 flows over a seventh gas separator 57 into the acid path.

[0728] In particular the fluid connects between the acidic solution 65 and the first recirculation circuit 43.

[0729] In particular it connects between the first gas separator 51 and the third metering group 48.

[0730] The second powder bag 68 comprises alkaline powder 68.

[0731] The electrolyte solution 68 of the second powder bag 68 flows over a sixth gas separator 56 into the alkaline path.

[0732] In particular the fluid connects between the base solution 67 and the second recirculation circuit 44, in particular it connects between the second gas separator 52 and the second metering group 47.

[0733] The bicarbonate path leads from the chamber of bicarbonate 69 towards the alkaline path.

[0734] The fluid connection from the chamber for bicarbonate 69 leads out of the container 73 through the fluid connection block 75 along a bicarbonate path 53 through a third gas separator 53 towards a control mechanism 59.

[0735] The bicarbonate path leads over a fifth metering pump 50 and a tenth sensor 58 into the alkaline path.

[0736] In particular the bicarbonate path 53 connects with the alkaline path between the second metering pump 47 and the switching mechanism 45, 46.

[0737] At control mechanism 59, saturated bicarbonate solution is diluted with water. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0738] - 53 -

[0739] Based on control mechanism 59, the ration between permeate and bicarbonate is regulated.

[0740] In particular the connection of the bicarbonate path 53 and the permeate path 54 is between the fourth gas separator 54 and the fourth metering pump 49.

[0741] The fluid connection from the chamber of permeate 70 leads out of the container 73 through the fluid connection block 75 along the permeate path 54 through a fifth gas separator 55 further through a fourth metering pump 49 towards the acidic path.

[0742] Along the permeate path 54 between the fifth gas separator 55 and the fourth metering pump 49 the fluid flows through a third heater 62, through a seventh pump 60 and through a fourth gas separator 54.

[0743] The permeate path 54 comprises an eleventh sensor 61 that measures in a circuit 63 which connects on one end between the third heater 62 and the fifth gas separator 55 and on the other end at the fourth gas separator 54.

[0744] The permeate path 54 is connected with the waste path through a heat exchanger 64.

[0745] The connection is on one end along the waste path between the fluid connection block 75 and the second waste pump 36 and on the other end along the permeate path between the fifth gas separator 55 and the third heater 62.

[0746] The chamber for waste fluid 72 is within a fluid container 73.

[0747] The chamber for waste fluid 72 can be accessed by a fluid connection.

[0748] This fluid connection is the waste path.

[0749] In particular the waste path is split up and has further connections.

[0750] One connection is a first waste path via the second fluid connection 76 and another connection is a second waste path via the first fluid connection 30.

[0751] The first waste path leads along the second fluid connection 76 starting from the second circuit - in particular between the dialyzer connection 19A of the two dialyzers 10A, 10B and the first dialysate pump 18.

[0752] The first waste path - in particular the second fluid connection 76 - connects to the second waste path between the second recirculation circuit 44 and the fluid waste bag DTS Ref: 40247.ADT.P110PC

[0753] 02.12.2025

[0754] - 54 -

[0755] 72 - in particular between the fluid connection block 75 and the heat exchanger 64 along the second waste path.

[0756] Finally, at the connection point the first and second waste path flow together and flow through the fluid connection block 75 into the chamber for waste fluid 72.

[0757] The second waste path starts between the heater 23 of the second circuit and the third reservoir 25 and is leading towards a fluid waste bag 72.

[0758] The second waste path leads through a single pass outlet valve 29 along a first fluid connection 30.

[0759] The first fluid connection 30 splits up at a connection point from the main fluid connection 30.

[0760] The main fluid connection 30 flows directly into the fluid connection - along the waste path - between the second recirculation circuit 44 and the second waste pump 36, and further flows through the second waste pump 36, through the fluid connection block 75 into the fluid waste bag 72.

[0761] The split fluid connection 30 is split at the connection point and flows into a point between the first recirculation circuit 43 and the first filter pump 35.

[0762] The fluid flows further from the fluid connection point between first recirculation circuit 43 and the first waste pump 35, through a first waste pump 35 and then further into the fluid connection between the second waste pump 36 and the fluid connection block 75.

[0763] There, the split-up fluid connection 30 meets the main fluid connection 30.

[0764] Then the fluid further flows through the fluid connection block 75 into the fluid waste bag 72.

[0765] Features and / or elements and / or paths and / or connection points and / or connection lines of Fig. 5 indicated by dashed or dotted lines or light grey can be considered optional, including dialyzer 10B, fourth reservoir 26 (or infusion solution 26 or fluid bag 26), first metering pump 27, sensor system 28, fourth valve 31 , fifth valve 32, first switching valve 45 (or switching mechanism 45), second switching valve 46 (or switching mechanism 46), third metering pump 48, fourth metering pump 49, first gas separator 51 , fifth gas separator 55, sixth gas separator 56, seventh gas separator 57, acid powder 66 (or first powder bag 66 or electrolyte solution 66), alkaline powder 68 DTS Ref: 40247.ADT.P110PC

[0766] 02.12.2025

[0767] - 55 -

[0768] (or second powder bag 68 or eight reservoir 68 or electrolyte solution 68), heat exchanger 64, fifth reservoir 65;(or dialysis concentrate 65 or acid solution 65 or concentrate container 65) and / or second fluid connection 76.

[0769] DTS Ref: 40247.ADT.P110PC

[0770] 02.12.2025

[0771] - 56 -

[0772] Figure 6 shows one embodiment of the claimed invention:

[0773] The embodiment comprises a patient 1 that is connected to a dialysis device 100, and in particular to a dialyzer 10.

[0774] The embodiment of the invention comprises multiple circuits and fluid paths, in particular a first blood line 2, a second blood line 16, a first fluid connection 30, a second fluid connection 76, a first regeneration circuit 43, a second regeneration circuit 44, a circuit 63, a fluid connection block 75, a dialysate inlet 19 and a dialysate outlet 20.

[0775] Moreover, the system comprises a plurality of reservoirs and chambers, including a first reservoir 4, a second reservoir 13, a third reservoir 25, a fourth reservoir 26, a fifth reservoir 65, a sixth reservoir 66, a seventh reservoir 67, an eighth reservoir 68, a ninth reservoir 69 and a tenth reservoir 70, a first fluid compartment 71 , a fluid compartment 72 and a fluid bag 73A.

[0776] Additionally, the device comprises multiple pumps, as a first metering pump 27, a second metering pump 47, a third metering pump 48, a fourth metering pump 49, a fifth metering pump 50, a sixth pump 77, a seventh pump 60, a first regeneration pump 39, a second regeneration pump 40, a first infusion pump 6, a second infusion pump 15, a first dialysate pump 18, a second dialysate pump 21 , a first waste pump 35 and a second waste pump 36.

[0777] Furthermore, the system comprises multiple sensors, in particular a first sensor 5, a second sensor 7, a third sensor 9, a fourth sensor 11 , a fifth sensor 14, a sixth sensor 17, an eighth sensor 41 , a ninth sensor 42, a tenth sensor 58, an eleventh sensor 61 , and a twelfth sensor 78.

[0778] The device comprises a valve circuit 37 and additionally multiple valves, as a first bypass valve 22, a fourth valve 31 , a fifth valve 32, a first switching valve 45, a second switching valve 46, and a single pass outlet valve 29.

[0779] Additionally, the system comprises several gas separators, a first gas separator 51 , a second gas separator 52, a third gas separator 53, a fourth gas separator 54, a fifth gas separator 55, a sixth gas separator 56 and a seventh gas separator 57.

[0780] Furthermore, the system comprises heating elements as a first heater 23, a second heater 38, a third heater 62 and a heat exchanger 64. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0781] - 57 -

[0782] The system further comprises a first filter 33, a second filter 34.

[0783] Moreover, the system comprises a container 73, a scale 74 and a control mechanism 59.

[0784] The device comprises multiple circuits and fluid paths.

[0785] A first circuit comprises extracorporeal blood lines 2,16 connecting a patient 1 to a dialyzer 10.

[0786] A second circuit connects the dialyzer 10 to a third reservoir 25.

[0787] A third circuit connects the third reservoir 25 with a detoxification unit 33, 34 over recirculation paths 43, 44.

[0788] Further fluid paths, in particular acidic, alkaline, waste, permeate and bicarbonate paths are connected to the circuits.

[0789] A Patient 1 is connected via an extracorporeal first blood line 2 to a dialyzer 10 and further from the dialyzer 10 via an extracorporeal second blood line 16 back to the patient 1 building a first circuit.

[0790] The first circuit comprises a feeding first blood line 2 that starts at the patient 1 and ends at the dialyzer 10.

[0791] The first blood line 2 comprises a first blood line infusion connection 3 between the patient 1 and the dialyzer 10.

[0792] This connection point 3 connects the first blood line 2 to an first infusion solution fluid bag 4.

[0793] Between the first blood line infusion connection 3 and the first infusion solution fluid bag 4 is a first infusion pump 6.

[0794] Between the first infusion pump 6 and the first infusion solution fluid bag 4 is a first sensor 5.

[0795] The infusion solution of the first infusion solution fluid bag 4 is supplied into the extracorporeal first blood line 2 via first blood line infusion connection 3 via the first infusion pump 6. DTS Ref: 40247.ADT.P110PC

[0796] 02.12.2025

[0797] - 58 -

[0798] Between the first blood line infusion connection 3 and the dialyzer 10 along the extracorporeal first blood line 2 is a second sensor 7, further upstream a blood pump 8 and a further upstream a third sensor 9.

[0799] The first blood line 2 splits into two directions between the third sensor 9 and the dialyzer 10.

[0800] In one direction the blood flows through one dialyzer 10 and in one direction the blood flows through another dialyzer 10, as the dialyzers 10 are set in parallel.

[0801] The fluid enters, passes through and leaves the dialyzer 10.

[0802] The fluid line leaving dialyzer 10 and dialyzer 10 merge at a connection point to the second blood line 16.

[0803] The first circuit comprises a second blood line 16 leading back to the patient 1.

[0804] This second blood line 16 starts at the dialyzer 10 and ends at the patient 1.

[0805] Between the dialyzer 10 and the patient 1 along the second blood line 16 there is a second blood line infusion connection 12.

[0806] Between the second blood line infusion connection 12 and the dialyzer 10 there is a sensor 11 .

[0807] The second blood line infusion connection 12 connects the blood line 16 to an second infusion solution fluid bag 13.

[0808] Between the second blood line infusion connection 12 and the second infusion solution fluid bag 13 is a second infusion pump 15.

[0809] Between the second infusion pump 15 and the second infusion solution bag 13 there is a fifth sensor 14.

[0810] The infusion solution of the second infusion solution fluid bag 13 is supplied into the extracorporeal second blood line 16 via second blood line infusion connection 12 via the second infusion pump 15.

[0811] The dialyzer 10 is on one side directly connected to the extracorporeal blood lines 2, 16. DTS Ref: 40247.ADT.P110PC

[0812] 02.12.2025

[0813] - 59 -

[0814] In particular one end of this one side of the dialyzer 10 is directly connected to the first blood line 2 coming from the patient and the other end of this one side is connected with the second blood line 16 leading back to the patient.

[0815] Therefore, the dialyzer 10 is on one side connected to the first circuit.

[0816] On the other side the dialyzer 10 is connected to the second circuit.

[0817] The second circuit starts at the dialyzer 10 and leads over the third reservoir 25 and ends at the dialyzer 10.

[0818] Further fluid paths split off from the second circuit.

[0819] Between the dialyzer 10 and the third reservoir 25 the dialysate flows through a dialysate outlet 20 from the dialyzer 10 through a second dialysate pump 21 , through a seventh sensor 24 and further through a first heater 23 towards the third reservoir 25.

[0820] Between the first heater 23 and the third reservoir 25 is a first fluid connection 30 leading towards the fluid waste bag 72.

[0821] In particular the fluid connection is a waste path.

[0822] Between the first heater 23 and the third reservoir 25 - in particular between the first fluid connection 30 of the waste path and the third reservoir 25 - is a fluid connection leading to a third circuit.

[0823] The dialysate flow is partially or completely flowing into the dialysate third reservoir 25 or is partially or completely flowing into the third circuit or into the waste path.

[0824] The fluid flow 19 from the reservoir to the dialyzer 10 leads through a sixth sensor 17, through a first dialysate pump 18 towards a dialysate inlet 19 at the dialyzer 10.

[0825] Between the first dialysate pump 18 and the dialysate inlet 19 there is a second fluid connection 76.

[0826] In particular the second fluid connection 76 is a waste path.

[0827] The dialysate inlet 19 and the dialysate outlet 20 can be connected in a way, that the blood flow 2, 10, 16 and the dialysate flow entering, passing through and leaving the dialyzer lead in the same direction or in the opposite direction. DTS Ref: 40247.ADT.P110PC

[0828] 02.12.2025

[0829] - 60 -

[0830] In parallel to the dialyzer 10 there is a first bypass valve 22 and fluid path.

[0831] The fluid path is connecting to the second fluid circuit on one end between the dialyzer 10 and the second dialysate pump 21 and on the other end between the dialyzer 10 and the dialysate pump 18.

[0832] Along this fluid path there is the first bypass valve 22.

[0833] The third circuit, starts from the fluid flow of the second circuit and flows over pumps 39, 40 and ends at the third reservoir 25.

[0834] Between the one end of the third circuit - between the third reservoir 25 and the first heater 23 - and the regeneration pumps 39, 40 is a connection point 79.

[0835] This connection point 79 is connecting the dialysate flow with a fourth reservoir 26.

[0836] The infusion solution 26 from the fourth reservoir 26 flows through a sensor system 26 through a first metering pump 27 to the fluid connecting point 79.

[0837] Further upstream the connecting point 79 towards the first and second regeneration pumps 39, 40 the flow is split into two directions.

[0838] In one direction the flow leads towards the first regeneration pump 39, building a fluid path 43 and a first recirculation circuit 43.

[0839] In the other direction the flow leads towards the second regeneration pump 40, building a fluid path 44 and a second recirculation circuit 44.

[0840] The first recirculation path 43 leads further from the first regeneration pump 39 towards the eighth sensor 41 to a first filter 33.

[0841] This first filter 33 is a first detoxification unit 33.

[0842] The fluid flows into the first detoxification unit 33, through the first detoxification unit 33 and out of the first detoxification unit 33.

[0843] The fluid flows out of the first detoxification unit 33 in two directions.

[0844] In one direction the fluid flows from the first detoxification unit 33 through a first waste pump 35 into the fluid connection between the fourth reservoir detoxification unit 34 and the fluid waste bag 72. DTS Ref: 40247.ADT.P110PC

[0845] 02.12.2025

[0846] - 61 -

[0847] In particular the fluid connects between a fourth reservoir waste pump 36 and the fluid connection block 75.

[0848] The fluid further flows through the fluid connection block 75 into the fluid waste bag 72.

[0849] In a second direction, the fluid flows from the first detoxification unit 33 through a fourth valve 31 towards a valve circuit 37.

[0850] The valve circuit 37 is a mixing point 37.

[0851] The second recirculation path 44 leads further from the second regeneration pump 40 towards the ninth sensor 42 to a second filter 34.

[0852] This second filter 34 is a second detoxification unit 34.

[0853] The fluid flows into the second detoxification unit 34, through the second detoxification unit 34 and out of the second detoxification unit 34.

[0854] The fluid flows out of the second detoxification unit 34 in two directions.

[0855] In one direction the fluid flows from the second detoxification unit 34 through the second waste pump 36 and further flows through the fluid connection block 75 into the fluid waste bag 72.

[0856] In a second direction, the fluid flows from the second detoxification unit 34 through a fifth valve 32 towards the valve circuit 37.

[0857] The valve circuit 37 is the mixing point 37.

[0858] At the mixing point 37 the first recirculation circuit 43 and the second recirculation circuit 44 meet.

[0859] In particular at the mixing point 37 the fluid flowing out of the first detoxification unit 33 and out of the second detoxification unit 34 meet and the two fluid connections get merged to one fluid connection.

[0860] From the mixing point 37 the one fluid connection leads over a second heater 38 towards the third reservoir 25 and into the third reservoir 25.

[0861] At this point the third circuit and the second circuit meet.

[0862] In particular the third circuit end at that point. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0863] - 62 -

[0864] The device comprises two concentrate containers 65, 67 which are connected to the recirculation paths 44, 43.

[0865] The fifth reservoir 65 comprises an acid solution 65.

[0866] The acid solution 65 flows from the fifth reservoir 65 through a first gas separator 51 through a third metering group 48, through a fifteenth sensor 82 and through a fourteenth sensor 81 into the first recirculation path 43.

[0867] This fluid path is the acidic path.

[0868] The acidic path starts at the fifth reservoir 65 and ends at the first recirculation circuit 43 between the first regeneration pump 39 and the eighth sensor 41 .

[0869] The seventh reservoir 67 comprises a base solution 67.

[0870] The base solution 67 flows from the seventh reservoir 67 through a second gas separator 52 through a second metering group 47, through a sixteenth sensor 83 and through a thirteenth sensor 80 into the second recirculation path 44.

[0871] This fluid path is the alkaline path.

[0872] The alkaline path starts at the seventh reservoir 67 and ends at the second recirculation path 44 between the second regeneration pump 40 and the ninth sensor 42.

[0873] Between the acidic path and the alkaline path there is a switching mechanism 45, 46.

[0874] The switching mechanism 45, 46 comprises two switching valves 45, 46.

[0875] The first switching valve 45 is set between the second metering group 47 along the alkaline path and the second recirculation path 44, in particular between the ninth sensor 42 and the second regeneration pump 40.

[0876] The second switching valve 46 is set between the third metering group 48 along the acidic path and the first recirculation path 43, in particular between the eighth sensor 41 and the first regeneration pump 39.

[0877] A container 73 comprises a chamber for waste fluid 72, a chamber for permeate 70, a chamber for bicarbonate 69, a first powder bag 66 and second powder bag 68. DTS Ref: 40247.ADT.P110PC

[0878] 02.12.2025

[0879] - 63 -

[0880] The container 73 is connected to a scale 74 on the side where no connections are leading out of the container 73.

[0881] The connections leading from the comprised chambers and bags of the container 73 towards other circuits are connected to a fluid connection block 75.

[0882] The fluid connection block 75 is outside the container 73 and on the side where the connections are leading out of the container 73.

[0883] The chamber for permeate 70 and the chamber for bicarbonate 69 are connected via a fluid connection 71.

[0884] The fluid connection 71 is inside the container 73.

[0885] The chamber for permeate 70 is connected to the powder bags 66, 68.

[0886] The connection is inside the container 73.

[0887] The first powder bag 66 comprises acidic powder 66.

[0888] The electrolyte solution 66 of the first powder bag 66 flows over a seventh gas separator 57 into the acid path.

[0889] In particular the fluid connects between the acidic solution 65 and the first recirculation circuit 43.

[0890] In particular it connects between the first gas separator 51 and the third metering group 48.

[0891] The second powder bag 68 comprises alkaline powder 68.

[0892] The electrolyte solution 68 of the second powder bag 68 flows over a sixth gas separator 56 into the alkaline path.

[0893] In particular the fluid connects between the base solution 67 and the second recirculation circuit 44, in particular it connects between the second gas separator 52 and the second metering group 47.

[0894] The fluid connection from the chamber for bicarbonate 69 leads out of the container 73 through the fluid connection block 75 along a bicarbonate path 53 through a third gas separator 53. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0895] - 64 -

[0896] The bicarbonate path 53 leads from the chamber for bicarbonate 69 towards the alkaline path.

[0897] The bicarbonate path leads further towards a control mechanism 59.

[0898] From the control mechanism 59 the bicarbonate path leads over a fifth metering pump 50 and a tenth sensor 58 into the alkaline path.

[0899] In particular the bicarbonate path connects with the alkaline path between the sixteenth sensor 83 and the thirteenth sensor 80.

[0900] At control mechanism 59, saturated bicarbonate solution is diluted with water.

[0901] Based on control mechanism 59, the ration between permeate and bicarbonate is regulated. The fluid connection from the chamber of permeate 70 leads out of the container 73 through the fluid connection block 75 along the permeate path 54 through a fifth gas separator 55.

[0902] At lest partially, the fluid connection from the chamber of permeate 70 leads out of the container 73 through the fluid connection block 75 along the permeate path 54 through a fifth gas separator 55, further through a fourth metering pump 49 towards the acidic path.

[0903] Along the permeate path 54 between the fifth gas separator 55 and the fourth metering pump 49 the fluid flows through a third heater 62, through a seventh pump 60 and through a fourth gas separator 54.

[0904] The permeate path 54 comprises an eleventh sensor 61 that measures in a circuit 63 which connects on one end between the third heater 62 and the fifth gas separator 55 and on the other end at the fourth gas separator 54.

[0905] The permeate path 54 is connected with the waste path through a heat exchanger 64.

[0906] The connection is on one end along the waste path between the fluid connection block 75 and the second waste pump 36 and on the other end along the permeate path between the fifth gas separator 55 and the third heater 62.

[0907] The chamber for waste fluid 72 is within a fluid container 73.

[0908] The chamber for waste fluid 72 can be accessed by a fluid connection.

[0909] This fluid connection is the waste path. DTS Ref: 40247.ADT.P110PC

[0910] 02.12.2025

[0911] - 65 -

[0912] In particular the waste path is split up and has further connections.

[0913] One connection is a first waste path via the second fluid connection 76 and another connection is a second waste path via the first fluid connection 30.

[0914] The first waste path leads along the second fluid connection 76 starting from the second circuit - in particular between the dialysate inlet 19 of the dialyzer 10 and the first dialysate pump 18.

[0915] The first waste path - in particular the second fluid connection 76 - connects to the second waste path between the second detoxification unit 34 and the fluid waste bag 72 - in particular between the fluid connection block 75 and the heat exchanger 64 along the second waste path.

[0916] Finally, at the connection point the first and second waste path flow together and flow through the fluid connection block 75 into the chamber for waste fluid 72.

[0917] The second waste path starts between the first heater 23 of the second circuit and the third reservoir 25 and is leading towards a fluid waste bag 72.

[0918] The second waste path leads through a single pass outlet valve 29 along a first fluid connection 30.

[0919] The first fluid connection 30 splits up at a connection point from the main fluid connection 30.

[0920] The main fluid connection 30 flows directly into the fluid connection - along the waste path - between the second detoxification unit 34 and the second waste pump 36, and further flows through the fluid connection block 75 into the fluid waste bag 72.

[0921] The split fluid connection 30 is split at the connection point and flows into a point between the first filter 33 and the first filter pump 35.

[0922] The fluid flows further from the fluid connection point between the first detoxification unit 33 and the first waste pump 35, through a first waste pump 35 and then further into the fluid connection between the second waste pump 36 and the fluid connection block 75.

[0923] There, the split-up fluid connection 30 meets the main fluid connection 30.

[0924] Then the fluid further flows through the fluid connection block 75 into the fluid waste bag 72. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0925] - 66 -

[0926] Features and / or elements and / or paths and / or connection points and / or connection lines of Fig. 6, indicated by dashed or dotted lines or light grey can be considered optional, including fourth valve 31 , fifth valve 32, first gas separator 51 , second gas separator 52, fifth gas separator 55, ffifth reservoir 65 (or; dialysis concentrate 65 or acid solution 65 or; concentrate container 65), seventh reservoir 67 (or dialysis concentrate 67 or; base solution 67 or concentrate container 67), heat exchanger 64, and / or second fluid connection 76, sixth pump 77, twelfth sensor 78, fifteenth sensor 82 and / or sixteenth sensor 83.

[0927] DTS Ref: 40247.ADT.P110PC

[0928] 02.12.2025

[0929] - 67 -

[0930] Figure 7 shows one embodiment of the claimed invention:

[0931] The embodiment comprises a patient 1 that is connected to a dialysis device 100, and in particular to a dialyzer 10.

[0932] The embodiment of the invention comprises multiple circuits and fluid paths, in particular a first blood line 2, a second blood line 16, a first fluid connection 30, a second fluid connection 76, a first regeneration circuit 43, a second regeneration circuit 44, a circuit 63, a fluid connection block 75, a dialysate inlet 19 and a dialysate outlet 20.

[0933] Moreover, the system comprises a plurality of reservoirs and chambers, including a first reservoir 4, a second reservoir 13, a third reservoir 25, a fourth reservoir 26, a fifth reservoir 65, a sixth reservoir 66, a seventh reservoir 67, an eighth reservoir 68, a ninth reservoir 69 and a tenth reservoir 70, a first fluid compartment 71 , a fluid compartment 72 and a fluid bag 73A.

[0934] Additionally, the device comprises multiple pumps, as a first metering pump 27, a second metering pump 47, a third metering pump 48, a fourth metering pump 49, a fifth metering pump 50, a sixth pump 77, a seventh pump 60, a first regeneration pump 39, a second regeneration pump 40, a first infusion pump 6, a second infusion pump 15, a first dialysate pump 18, a second dialysate pump 21 , a first waste pump 35 and a second waste pump 36.

[0935] Furthermore, the system comprises multiple sensors, in particular a first sensor 5, a second sensor 7, a third sensor 9, a fourth sensor 11 , a fifth sensor 14, a sixth sensor 17, an eighth sensor 41 , a ninth sensor 42, a tenth sensor 58, an eleventh sensor 61 , a twelfth sensor 78, a thirteenth sensor 80, a fourteenth sensor 81 , a fifteenth sensor 82, a sixteenth sensor 83 and a seventeenth sensor 84.

[0936] The device comprises a valve circuit 37 and additionally multiple valves, as a first bypass valve 22, a fourth valve 31 , a fifth valve 32, a first switching valve 45, a second switching valve 46, and a single pass outlet valve 29.

[0937] Additionally, the system comprises several gas separators, a first gas separator 51 , a second gas separator 52, a third gas separator 53, a fourth gas separator 54, a fifth gas separator 55, a sixth gas separator 56 and a seventh gas separator 57. DTS Ref: 40247.ADT.P110PC 02.12.2025

[0938] - 68 -

[0939] Furthermore, the system comprises heating elements as a first heater 23, a second heater 38, a third heater 62 and a heat exchanger 64.

[0940] The system further comprises a first filter 33, a second filter 34.

[0941] Moreover, the system comprises a container 73, a scale 74 and a control mechanism 59.

[0942] The device comprises multiple circuits and fluid paths.

[0943] A first circuit comprises extracorporeal blood lines 2, 16 connecting a patient 1 to a dialyzer 10.

[0944] A second circuit connects the dialyzer 10 to a third reservoir 25.

[0945] A third circuit connects the third reservoir 25 with a detoxification unit 33, 34 over recirculation paths 43, 44.

[0946] Further fluid paths, in particular acidic, alkaline, waste, permeate and bicarbonate paths are connected to the circuits.

[0947] A Patient 1 is connected via an extracorporeal first blood line 2 to a dialyzer 10 and further from the dialyzer 10 via an extracorporeal second blood line 16 back to the patient 1 building a first circuit.

[0948] The first circuit comprises a feeding first blood line 2 that starts at the patient 1 and ends at the dialyzer 10.

[0949] The blood line 2 comprises a first blood line infusion connection 3 between the patient 1 and the dialyzer 10.

[0950] This connection point 3 connects the first blood line 2 to a first infusion solution fluid bag 4.

[0951] Between the first blood line infusion connection 3 and the first infusion solution fluid bag 4 is a first infusion pump 6.

[0952] Between the first infusion pump 6 and the first infusion solution fluid bag 4 is a first sensor 5. DTS Ref: 40247.ADT.P110PC

[0953] 02.12.2025

[0954] - 69 -

[0955] The infusion solution of the first infusion solution fluid bag 4 is supplied into the extracorporeal first blood line 2 via first blood line infusion connection 3 via the first infusion pump 6.

[0956] Between the first blood line infusion connection 3 and the dialyzer 10 along the extracorporeal first blood line 2 is a second sensor 7, further upstream a blood pump 8 and a further upstream a third sensor 9.

[0957] The first blood line 2 splits into two directions between the third sensor 9 and the dialyzer 10.

[0958] In one direction the blood flows through one dialyzer 10 and in one direction the blood flows through another dialyzer 10, as the dialyzers 10 are set in parallel.

[0959] The fluid enters, passes through and leaves the dialyzer 10.

[0960] The fluid line leaving dialyzer 10 and dialyzer 10 merge at a connection point to the second blood line 16.

[0961] The first circuit comprises a second blood line 16 leading back to the patient 1 .

[0962] This second blood line 16 starts at the dialyzer 10 and ends at the patient 1.

[0963] Between the dialyzer 10 and the patient 1 along the second blood line 16 there is a second blood line infusion connection 12.

[0964] Between the second blood line infusion connection 12 and the dialyzer 10 there is a fourth sensor 11 .

[0965] The second blood line infusion connection 12 connects the second blood line 16 to a second infusion solution fluid bag 13.

[0966] Between the second blood line infusion connection 12 and the second infusion solution fluid bag 13 is a second infusion pump 15.

[0967] Between the second infusion pump 15 and the second infusion solution bag 13 there is a fifth sensor 14.

[0968] The infusion solution of the second infusion solution fluid bag 13 is supplied into the extracorporeal second blood line 16 via second blood line infusion connection 12 via the second infusion pump 15. DTS Ref: 40247.ADT.P110PC

[0969] 02.12.2025

[0970] - 70 -

[0971] The dialyzer 10 is on one side directly connected to the extracorporeal blood lines 2, 16.

[0972] In particular one end of this one side of the dialyzer 10 is directly connected to the first blood line 2 coming from the patient and the other end of this one side is connected with the second blood line 16 leading back to the patient 1.

[0973] Therefore, the dialyzer 10 is on one side connected to the first circuit.

[0974] On the other side the dialyzer 10 is connected to the second circuit.

[0975] The second circuit starts at the dialyzer 10 and leads over the third reservoir 25 and ends at the dialyzer 10.

[0976] Further fluid paths split off from the second circuit.

[0977] Between the dialyzer 10 and the third reservoir 25 the dialysate flows through a dialysate outlet 20 from the dialyzer 10, through a third bypass valve 22B, through a second dialysate pump 21 , through a seventh sensor 24 and further through a first heater 23 towards the third reservoir 25.

[0978] Between the first heater 23 and the third reservoir 25 is a first fluid connection 30 leading towards the fluid waste bag 72.

[0979] In particular the fluid connection is a waste path.

[0980] Between the first heater 23 and the third reservoir 25 - in particular between the first fluid connection 30 of the waste path and the third reservoir 25 - is a fluid connection leading to a third circuit.

[0981] The dialysate flow is partially or completely flowing into the dialysate third reservoir 25 or is partially or completely flowing into the third circuit or into the waste path.

[0982] The fluid flow 19 from the reservoir to the dialyzer 10 leads through a sixth sensor 17, through a first dialysate pump 18, through a second bypass valve 22A towards a dialysate inlet 19 at the dialyzer 10.

[0983] Between the second bypass valve 22A and the dialysate inlet 19 there is a second fluid connection 76.

[0984] In particular the second fluid connection 76 is a waste path. DTS Ref: 40247.ADT.P110PC

[0985] 02.12.2025

[0986] - 71 -

[0987] The dialysate inlet 19 and the dialysate outlet 20 can be connected in a way, that the blood flow 2, 10, 16 and the dialysate flow entering, passing through and leaving the dialyzer lead in the same direction or in the opposite direction.

[0988] In parallel to the dialyzer 10 there is a first bypass valve 22 and fluid path.

[0989] The fluid path is connecting to the second fluid circuit on one end between the third bypass valve 22B and the second dialysate pump 21 and on the other end between the second bypass valve 22A and the dialysate pump 18. Along this fluid path there is the first bypass valve 22.

[0990] The third circuit, starts from the fluid flow of the second circuit and flows over regeneration pumps 39, 40 and ends at the third reservoir 25.

[0991] Between the one end of the third circuit - between the third reservoir 25 and the first heater 23 - and the regeneration pumps 39, 40 is a connection point 79.

[0992] This connection point 79 is connecting the dialysate flow with a fourth reservoir 26. The infusion solution 26 from the fourth reservoir 26 flows through a sensor system 26 through a first metering pump 27 to the fluid connecting point 79.

[0993] Further upstream the connecting point 79 towards the regeneration pumps 39, 40 the flow is split into two directions.

[0994] In one direction the flow leads towards the first regeneration pump 39, building a fluid path 43 and a first recirculation circuit 43.

[0995] In the other direction the flow leads towards the second regeneration pump 40, building a fluid path 44 and a second recirculation circuit 44.

[0996] The first recirculation path 43 leads further from the first regeneration pump 39 towards the eighth sensor 41 to a first filter 33.

[0997] This first filter 33 is a first detoxification unit 33.

[0998] The fluid flows into the first detoxification unit 33, through the first detoxification unit 33 and out of the first detoxification unit 33.

[0999] The fluid flows out of the first detoxification unit 33 in two directions. DTS Ref: 40247.ADT.P110PC

[1000] 02.12.2025

[1001] - 72 -

[1002] In one direction the fluid flows from the first detoxification unit 33 through a first waste pump 35 into the fluid connection between the second detoxification unit 34 and the fluid waste bag 72.

[1003] In particular the fluid connects between a second waste pump 36 and the fluid connection block 75.

[1004] The fluid further flows through the fluid connection block 75 into the fluid waste bag 72.

[1005] In a second direction, the fluid flows from the first detoxification unit 33 through a fourth valve 31 towards a valve circuit 37.

[1006] The valve circuit 37 is a mixing point 37.

[1007] The second recirculation path 44 leads further from the second pump 40 towards the ninth sensor 42 to a second filter 34. This second filter 34 is a second detoxification unit 34.

[1008] The fluid flows into the second detoxification unit 34, through the second detoxification unit 34 and out of the second detoxification unit 34.

[1009] The fluid flows out of the second detoxification unit 34 in two directions.

[1010] In one direction the fluid flows from the second detoxification unit 34 through the second waste pump 36 and further flows through the fluid connection block 75 into the fluid waste bag 72.

[1011] In a second direction, the fluid flows from the second detoxification unit 34 through a fifth valve 32 towards the valve circuit 37.

[1012] The valve circuit 37 is the mixing point 37.

[1013] At the mixing point 37 the first recirculation circuit 43 and the second recirculation circuit 44 meet.

[1014] In particular at the mixing point 37 the fluid flowing out of the first detoxification unit 33 and out of the second detoxification unit 34 meet and the two fluid connections get merged to one fluid connection.

[1015] From the mixing point 37 the one fluid connection leads over a second heater 38 towards the third reservoir 25 and into the third reservoir 25. At this point the third circuit and the second circuit meet. DTS Ref: 40247.ADT.P110PC

[1016] 02.12.2025

[1017] - 73 -

[1018] In particular the third circuit end at that point.

[1019] The device comprises two concentrate containers 65, 67 which are connected to the recirculation paths 44, 43.

[1020] The fifth reservoir 65 comprises an acid solution 65.

[1021] The acid solution 65 flows from the fifth reservoir 65 through a first gas separator 51 through a third metering group 48 into the first recirculation path 43.

[1022] This fluid path is the acidic path.

[1023] The acidic path starts at the fifth reservoir 65 and ends at the first recirculation circuit 43 between the first regeneration pump 39 and the eighth sensor 41 .

[1024] The seventh reservoir 67 comprises a base solution 67.

[1025] The base solution 67 flows from the seventh reservoir 67 through a second gas separator 52 through a second metering group 47 into the second recirculation path 44.

[1026] This fluid path is the alkaline path.

[1027] The alkaline path starts at the seventh reservoir 67 and ends at the second recirculation path 44 between the second regeneration pump 40 and the ninth sensor 42.

[1028] Between the acidic path and the alkaline path there is a switching mechanism 45, 46.

[1029] The switching mechanism 45, 46 comprises two switching valves 45, 46.

[1030] The first switching valve 45 is set between the second metering group 47 along the alkaline path and the second recirculation path 44, in particular between the ninth sensor 42 and the second regeneration pump 40.

[1031] The second switching valve 46 is set between the third metering group 48 along the acidic path and the first recirculation path 43, in particular between the eighth sensor 41 and the first regeneration pump 39.

[1032] A container 73 comprises a chamber for waste fluid 72, a chamber for permeate 70, a chamber for bicarbonate 69, a first powder bag 66 and a second powder bag 68.

[1033] The container 73 is on a scale 74. DTS Ref: 40247.ADT.P110PC 02.12.2025

[1034] - 74 -

[1035] The connections leading from the comprised chambers and bags of the container 73 towards other circuits are connected to a fluid connection block 75.

[1036] The fluid connection block 75 is outside the container 73 and on the side where the connections are leading out of the container 73.

[1037] The fluid connection block 75 is on one end connected to a sixth valve 86 and a third filter 87.

[1038] The chamber for permeate 70 and the chamber for bicarbonate 69 are connected via a fluid connection 71.

[1039] The fluid connection 71 is inside the container 73.

[1040] The chamber for permeate 70 is connected to the powder bags 66, 68.

[1041] The connection is inside the container 73.

[1042] The first powder bag 66 comprises acidic powder 66.

[1043] The electrolyte solution 66 of the first powder bag 66 flows over a seventh gas separator 57 into the acid path.

[1044] In particular the fluid connects between the acidic solution 65 and the first recirculation circuit 43.

[1045] In particular it connects between the first gas separator 51 and the third metering group 48.

[1046] The second powder bag 68 comprises alkaline powder 68.

[1047] The electrolyte solution 68 of the second powder bag 68 flows over a sixth gas separator 56 into the alkaline path.

[1048] In particular the fluid connects between the base solution 67 and the second recirculation circuit 44, in particular it connects between the second gas separator 52 and the second metering group 47.

[1049] The bicarbonate path leads from the chamber of bicarbonate 69 towards the alkaline path. DTS Ref: 40247.ADT.P110PC

[1050] 02.12.2025

[1051] - 75 -

[1052] The fluid connection from the chamber for bicarbonate 69 leads out of the container 73 through the fluid connection block 75 along a bicarbonate path 53 through a third gas separator 53 towards a control mechanism 59.

[1053] The bicarbonate path 53 leads over a fifth metering pump 50 and a tenth sensor 58 into the alkaline path.

[1054] In particular the bicarbonate path 53 connects with the alkaline path between the second metering pump 47 and the switching mechanism 45, 46.

[1055] At control mechanism 59, saturated bicarbonate solution is diluted with water.

[1056] In particular, based on control mechanism 59, the ration between permeate and bicarbonate is regulated.

[1057] The fluid connection from the chamber of permeate 70 leads at least out of the container 73 through the fluid connection block 75 along the permeate path 54 through a fifth gas separator 55.

[1058] Along the permeate path 54 between the fifth gas separator 55 and the fourth metering pump 49 the fluid flows through a third heater 62, through a seventh pump 60 and through a fourth gas separator 54.

[1059] The permeate path 54 comprises an eleventh sensor 61 that measures in a circuit 63 which connects on one end between the third heater 62 and the fifth gas separator 55 and on the other end at the fourth gas separator 54.The permeate path 54 is connected with the waste path through a heat exchanger 64.

[1060] The connection is on one end along the waste path between the fluid connection block 75 and the second waste pump 36 and on the other end along the permeate path between the fifth gas separator 55 and the third heater 62.

[1061] In particular, the fluid connection from the chamber of permeate 70 leads out of the container 73 through the fluid connection block 75 along the permeate path 54 through a fifth gas separator 55 and at least partially further through a fourth metering pump 49 towards the acidic path. DTS Ref: 40247.ADT.P110PC 02.12.2025

[1062] - 76 -

[1063] The chamber for waste fluid 72 is within a fluid container 73.

[1064] The chamber for waste fluid 72 can be accessed by a fluid connection.

[1065] This fluid connection is the waste path.

[1066] In particular the waste path is split up and has further connections.

[1067] One connection is a first waste path via the second fluid connection 76 and another connection is a second waste path via the first fluid connection 30.

[1068] The first waste path leads along the second fluid connection 76 starting from the second circuit - in particular between the dialysate inlet 19 of the dialyzer 10 and the second bypass valve 22A.

[1069] The first waste path - in particular the second fluid connection 76 - connects to the second waste path between the second detoxification unit 34 and the fluid waste bag 72 - in particular between the fluid connection block 75 and the heat exchanger 64 along the second waste path.

[1070] Finally, at the connection point the first and second waste path flow together and flow through the fluid connection block 75 into the chamber for waste fluid 72.

[1071] Between the fluid connection block 75 and the connection point there is a seventeenth sensor 84 comprised.

[1072] The second waste path starts between the first heater 23 of the second circuit and the third reservoir 25 and is leading towards a fluid waste bag 72.

[1073] The second waste path leads through a single pass outlet valve 29 along a first fluid connection 30.

[1074] The first fluid connection 30 splits up at a connection point from the main fluid connection 30.

[1075] The main fluid connection 30 flows directly into the fluid connection - along the waste path - between the second detoxification unit 34 and the second waste pump 36, and further flows through the fluid connection block 75 into the fluid waste bag 72.

[1076] The split fluid connection 30 is split at the connection point and flows into a point between the first filter 33 and the first filter pump 35. DTS Ref: 40247.ADT.P110PC 02.12.2025

[1077] - 77 -

[1078] The fluid flows further from the fluid connection point between the first detoxification unit 33 and the first waste pump 35, through a first waste pump 35 and then further into the fluid connection between the second waste pump 36 and the fluid connection block 75.

[1079] There, the split-up fluid connection 30 meets the main fluid connection 30.

[1080] Then the fluid further flows through the fluid connection block 75 into the fluid waste bag 72.

[1081] Features and / or elements and / or paths and / or connection points and / or connection lines of Fig. 7 indicated by dashed or dotted lines or light grey can be considered optional, including fourth valve 31 , fifth valve 32, fifth gas separator 55, sixth gas separator 56, seventh gas separator 57, heat exchanger 64, acid powder 66 (or first powder bag 66 or sixth reservoir 66 or electrolyte solution 66), alkaline powder 68 or (second powder bag 68 or eighth reservoir 68 or electrolyte solution 68) and / or second fluid connection 76,

[1082] Figure 8 shows a further embodiment of the invention.

[1083] The embodiment shows a graph of the ADVOS RRT device.

[1084] Moreover, the graph shows the crea-clearance in ml / min against CVVHD, SLEDD and iHD.

[1085] Whereby, CVVHD stands for continues venovenous hemodialysis, SLEDD means sustained low-efficiency daily dialysis and iHD is intermittent haemodialysis.

[1086] The legend of the x-axis of the graph indicates that CVVHD is applied in case a patient is hemodynamically instable.

[1087] Additionally, the legend comprises that SLEDD is applied when a patient is hemodynamically stable.

[1088] Furthermore, iHD is applied when a patient is hemodynamically stable.

[1089] The measured crea-clearance levels of CVVHD, SLEDD and iHD are indicated by bars.

[1090] In this embodiment the bar and hence indicating level of crea-clearance is lowest for CVVHD and highest for iHD.

[1091] Further, the measured crea-clearance level of CVVHD is between 30ml / min and 40ml / min, in particular about 35 ml / min. DTS Ref: 40247.ADT.P110PC 02.12.2025

[1092] - 78 -

[1093] In addition, the measured crea-clearance level of SLEDD is between 90ml / min and 100ml / min, in particular about 95 ml / min.

[1094] Moreover, iHD comprises a measured crea-clearance level about 140 ml / min.

[1095] The threshold crea-clearance levels of CVVHD, SLEDD and iHD are illustrated by dashed lines.

[1096] Analogously to the measured values, the threshold values of the crea-clearance level are the lowest for the CVVHD and the highest for the iHD.

[1097] In this embodiment, the threshold crea-clearance level of CVVHD is set to about 30ml / min.

[1098] Furthermore, in this embodiment, the threshold crea-clearance level of SLEDD is set to about 80ml / min.

[1099] Moreover, the threshold crea-clearance level of iHD is set to about 150ml / min in this embodiment.

[1100] In this embodiment, the measured crea-clearance value of the CVVHD is crossing the threshold value of the CVVHD crea-clearance level.

[1101] Hence, the measured crea-clearance value of CVVHD is higher than the threshold value for CVVHD.

[1102] In particular the measured CVVHD crea-clearance value is about 5ml / min higher compared to the corresponding threshold value.

[1103] Furthermore, the measured crea-clearance value of the SLEDD is crossing the threshold value of the corresponding SLEDD crea-clearance level.

[1104] Therefore, the measured crea-clearance value of SLEDD is higher than the threshold value for SLEDD.

[1105] In particular the measured SLEDD crea-clearance value is about 15ml / min higher compared to the corresponding threshold value.

[1106] Additionally, the measured crea-clearance value of the iHD is not crossing the threshold value of the corresponding iHD crea-clearance level.

[1107] Therefore, the measured crea-clearance value of iHD is lower than the threshold value for iHD. DTS Ref: 40247.ADT.P110PC

[1108] 02.12.2025

[1109] - 79 -

[1110] In particular, the measured iHD crea-clearance value is about 10ml / min lower compared to the corresponding threshold value.

[1111] The disclosed device, as shown in Fig. 1 to Fig. 7 is preferably used as a platform for a variety of different combinations or assembly options that allow the user to perform different therapies. That means in detail, that by connecting different consumables to the device and choosing different SW modes of the device it allows the user to perform different treatment. Whereas the device itself needs no extra modification, and no change of the device is needed if changes in treatment moods are foreseen.

[1112] These varieties can be split up as follows:

[1113] I. A protein dialysis to remove water soluble and protein bound toxins and whereas the protein is preferably albumin, and the dialysis is performed with a continuous recirculation and purification of the albumin containing dialysate - this treatment is preferably performed with two dialyzers 10 or one single dialyzer 10A whereas the membrane areas is sufficient for toxin elimination.

[1114] II. Independent pH control of the dialysate passing through the dialyzers 10 and getting in contact with the patient 1 blood through the extracorporeal blood circuit - This option is preferably set to remove carbon dioxide CO2 from the patient’s blood and adjust the acid-base balance of the patient.

[1115] III. Independent adjustment of the Bicarbonate HCO3- / Bic concentration within the dialysate passing through the dialyzers 10 an getting in contact with the patients 1 blood through the extracorporeal blood circuit - remove carbon dioxide CO2 from the patients’ blood and adjust the acid-base balance of the patient.

[1116] IV. Independent adjustment of the buffering capacity of the dialysate by modifying the buffering agents and their concentrations therefore within the dialysate that passes through the dialyzers 10 and getting in contact with the patient 1 blood through the extracorporeal blood circuit - These options are preferably used to adapt the toxin extraction rates from the patient’s blood to the dialysate

[1117] V. A dialysis RRT including iHD, SLED, CVVHD where no extra protein is added to the dialysate and preferably mainly water-soluble toxins are removed. This DTS Ref: 40247.ADT.P110PC

[1118] 02.12.2025

[1119] - 80 - dialysis can be performed with single pass dialysate flow, partly single pass dialysate flow and / or recirculating dialysate flow where the recirculated dialysate could be diluted and partially removed. This treatment is preferably performed with one dialyzer 10A whereas the membrane area chosen for the treatment is preferably small but still sufficient for toxin elimination. For purifying the dialysate optionally additional filters 33 ,34 could be used but preferably the treatment is performed without additional filters.

[1120] VI. Dialysis with variation of the proportion of recycled dialysate from complete recirculation to single pass preferred for IHD

[1121] VII. One or two dialyzers and one or two filters can be used to purify the dialysate

[1122] Protein based dialysis I. including independent pH II. and independent bicarbonate III. adjustment, parts of WO2017084682A1 but there is no integrated bicarbonate adjustment

[1123] The core basis for removing carbon dioxide and adjust the acid-base balance of a patient is the following equation:

[1124] CO2+ H2O H2CO3^ HCO3- + H+

[1125] Carbon dioxide is transported in the humas blood as carbon dioxide and within its dissociation products mainly Bicarbonate HCO3- and Protons H+.

[1126] In contrast to state-of-the-art devices for removing carbon dioxide as a gas through a semipermeable membrane this device does it completely in liquid as it removes the dissociation products Bicarbonate HCO3- and Protons H+and dissolved carbon dioxide.

[1127] To remove the CO2 dissociation products Bicarbonate HCO3- and Protons H+via the dialysis fluid from the extracorporeal blood circuit the two parameters have to be controlled by the device. pH: The device can adjust the pH of the dialysate pumped by the first and second dialysate pumps 18 and 21 according to the set value and the measured value 17. While DTS Ref: 40247.ADT.P110PC 02.12.2025

[1128] - 81 - this dialysate with the set pH value is then pumped through dialysate inlet 19 through the dialyzer 10 and is in contact with the patient 1 blood pumped 8 out of the patient through a disposable first blood line 2 and returned back to the patient 1 via an additional return second blood line 16 after being in fluid contact via the semipermeable membrane of the dialyzerW. Whereby the dialysate pH measured by the sixth sensor 17 e.g. pH meter is set due to the ratio between the dialysate concentrate 67 and 65. This ratio is adjusted via the second and third metering pumps 47 and 48 whereby the ratio between these metering pumps / fluid flows is preferably between 40 - 60%. And whereby the dialysis concentrates for adjusting the dialysate pH are preferably and acid solution 65 and a base solution 67 whereby the acid solution 65 preferably contains HCI and a base solution 67 preferably contains NaOH. This allows to adjust the ratio between H+ and OH- within the dialysate. According to the pH dependent buffering capacity of the dialysate and its pH a gradient of H+ between the dialysate side of the dialysate entering the dialyzer 10 through the dialysate inlet 19 and being in fluid contact to the patients’ blood pumped 8 through the first blood line 2 from the patient 1 through the dialyzer is generated. This set pH resp. H+ and buffering capacity of the dialysate results in an adjustment of the H+ concentration within the extracorporeal blood.

[1129] To remove the second dissociation product of CO2 Bicarbonate HCO3- has to be removed from the patient blood. Therefore, the device can adjust the bicarbonate concentration of the dialysate pumped by the first and second dialysate pump 18 and 21 according to the set value and the measured value 17. While this dialysate with the set bicarbonate concentration is then pumped through dialysate inlet 19 through the dialyzer 10 and is in contact with the patient 1 blood pumped 8 out of the patient through a disposable first blood line 2 and returned back to the patient via an additional return second blood line 16 after being in fluid contact via the semipermeable membrane of the dialyzer 10. Therefore, the device is connected to a disposable bicarbonate bag 69 which contains bicarbonate powder preferably NaHCOs- ~190g between preferably 100 and 340 g. A disposable Fluid bag is placed within a container 73 that contains different chambers for liquids 70 for permeate, 72 for waste fluid, 69 for bicarbonate powder and optional additional compartments for fluids and or powders preferably and acidic powder 66 and an alkaline powered 68. Whereby the powder bags 69, 68, 66 are in fluid contact with the permeate bag 70. To suck a bicarbonate solution into the device, permeate is DTS Ref: 40247.ADT.P110PC 02.12.2025

[1130] - 82 - sucked from permeate compartment 70 within the disposable fluid bag by a fifth suction metering pump 50 through a fluid connection 71 into the bicarbonate bag 69. This disposable is in fluid connection with the device through a fluid connection block 75. Gases sucked into the device are removed from the fluid within a third gas separator 53. The aim is to have a solution that is as fully saturated as possible, which can be aspirated from the BIC bag. Therefor a minimum flowrate is necessary to achieve bicarbonate concentrations between 0 - 45 mmol / l within the supply solution. These low flow rates are necessary to minimize the suction pressure, or the suction required to draw in the bicarbonate solution. Such a low pressure is preferable in order to minimize the unwanted formation of gases. The formation of gases could affect the balancing of the liquid volumes on the one hand and the composition and concentration of the substances in the saturated solution on the other hand. The volume of the liquid phase and the gas phase within the third gas separator 53 has to be kept at a constant level to avoid unwanted changes in liquid volume which would result in misbalancing of the patient. The amount of dissolved bicarbonate solution added to the device circuit is then adjusted according to the bicarbonate set value for bicarbonate within the supply solutions pumped into the device via the supply pumps 47, 48, 49, 50. The suction pump 50 pumps fluid into the device. A control mechanism 59 preferably proportional valves adjust the amount of fluid pumped on the one hand from the bicarbonate path 53 and on the other hand from the permeate path 54 whereby the ratio of bicarbonate solution and bicarbonate solution is adjusted according to a tenth sensor 58 preferably a conductivity sensor measuring the conductivity of the fluid. As the conductivity of the fluid is in direct relation to the amount of dissolved bicarbonate. To ensure that there is no additional conductivity influence on the fluid due to other substances an addition sensor 61 preferably a conductivity sensor can be considered. If there is a conductivity within the permeate solution this value could be subtracted from the measured value 58. As an alternative option the bicarbonate solution could also be sucked into the device through another sixth suction pump 77 and the bicarbonate concentration could be measured by a tenth sensor 78 preferably a conductivity sensor measuring the conductivity of the fluid. These option results in a more direct adjustment of the bicarbonate concentration within the dialysate as it is directly pumped into the dialysate circuit prior to the first dialysate pump 18 but this extra addition of electrolytes has to be taken into account with the addition of the other electrolytes via the second and third DTS Ref: 40247.ADT.P110PC

[1131] 02.12.2025

[1132] - 83 - metering pumps 47, 48 and the partially removal of this liquid via the first and second waste pumps 35, 36.

[1133] RRT dialysis including iHD, SLED, CVVHD see Fig. 8 for comparison of flows and clearances

[1134] Within state-of-the-art dialysis devices the clearance K is influenced by the dialyzer, extracorporeal blood flow, ultrafiltration and dialysate flow through the dialyzers.

[1135] The dialyzer 10 can be adapted according to standard devices except it could be chosen to use one or two dialyzers. The extracorporeal blood flow and the ultrafiltration rate are also similar to standard devices. But the dialysate flow is different to standard single pass dialysis devices except the ADVOSmulti ADVITOS. Within this device it is possible to adjust the dialysate flow through the dialyzers 10 by adjusting the dialysate pumps 18, 21 . Within the standard configuration of this device the dialysate passed through the dialysate outlet port 20 through the dialysate out pump 21 is not going to the drain but is instead recirculated. Therefore, partes of the dialysate could go to the mixing third reservoir 25 and / or completely and / or partly to the recirculation circuit by adjusting the regeneration pumps 39, 40. The dialysate is then pumped through the recirculation circuit and back to the third reservoir 25. From there it could go back the the dialyzers by adjusting the first dialysate pump 18. Within the recirculation circuit fresh supply solution is added to the dialysate by the supply pumps 47, 48, 49, 50. This added amount of fluid is removed by the filtrate pumps 35, 36 whereby the flow rate of the filtrate pumps 35, 36 is similar to the supply pumps plus or minus the surplus or ultrafiltration of liquid set by the user. So compared to standard devices this device has two different flows - dialysate flow and supply flow - to adjust the clearance compared to just the single pass dialysate flow of standard devices.

[1136] This device therefore covers a much wider range of setting options compared to existing devices. Traditionally, intermittent treatments with high dialysate flow rates are carried out using dialysis machines that are connected to the ring circuit or receive their osmosis water externally. However, this usually makes them difficult to use in intensive care units DTS Ref: 40247.ADT.P110PC

[1137] 02.12.2025

[1138] - 84 - without a central water supply. These machines have significantly higher clearance rates but are usually only used for short periods. Due to the high rate of removal of water-soluble substances, some unwanted substances are also removed. Machines with fluid bags are usually used for continuous dialysis treatments. These devices can be used flexibly, regardless of location. However, the fluid available for the treatment is usually limited by the bags or requires a great deal of human effort when changing the fluid bags. This usually results in significantly lower flow rates in the dialysate, resulting in comparatively low clearance.

[1139] The claimed device allows a dialysate fluid flow completely independent from the fluid consumption of the device as it is a recirculation flow.

[1140] As a result, a very wide range of therapies can be covered with a single device simply by adjusting or varying the flow rates of the individual dialysate, supply and filtrate circuits.

[1141] As can be seen from Fig. 8, it is possible to set the clearance with this device over the entire range and it is not necessary to change the device.

[1142] Typically, patients in the intensive care unit must initially be treated with significantly higher flow rates in order to remove toxins, e.g. K+, as quickly as possible in a critical condition. Until now, this has only been possible with devices and high clearance rates, e.g. iHD devices. However, if such high extraction rates were to be continued for a longer period of time, this would lead to so-called overdialysis, which in turn can have critical consequences for the patient. It is therefore important to slowly reduce the rates for the extraction of toxins. This continuous slow reduction to a constant low extraction rate is crucial for the patient.

[1143] In addition, every machine change or new extracorporeal tubing set is a risk and a burden for critically ill patients. It is therefore preferable to use a dialysis machine with a single extracorporeal circuit, which can be used for long-term therapy that is individually adapted to the patient's needs.

[1144] The clearance rate of the claimed device is preferably between 15 - 180 ml / min whereas the clearance rate of a CVVHD device is typically in the range of 20 - 50 ml / min. DTS Ref: 40247.ADT.P110PC 02.12.2025

[1145] - 85 -

[1146] Various forms of therapy are used to dialyze patients or to remove water-soluble toxins and / or to remove or add fluid volumes and / or to improve the patient's haemodynamic stability via an extracorporeal blood circuit. CVVHD “continuous veno-venous hemodialysis”, SLEDD “slow efficiency daily dialysis” or iHD “intermittent hemodialysis” are mainly used here. These procedures differ in terms of the technical equipment required, the consumables needed for therapy and the applicability and necessary infrastructure in clinics. The outcome of these different therapies with these different devices differs significantly. This can be illustrated by the achievable clearance, e.g. for creatinine. The mean rates of creatinine clearance of the respective forms of therapy and the associated devices can be seen from the dashed horizontal lines in Fig. 8. Whereby CVVHD -50 ml / min, SLEDD -80 ml / min and iHD -150 ml / min are used on average. This also depends strongly on the blood flow and dialysate flow set in each case. Furthermore, CVVHD is preferably used in hemodynamically unstable patients with volume overload where volume correction and toxin removal is performed, SLEDD is preferably used in hemodynamically stable patients with volume overload where volume correction and toxin removal is performed and iHD is preferably used in hemodynamically stable patients where volume correction and very high toxin removal is performed. In other words, depending on the required clearance rate or toxins to be removed from the extracorporeal circulation, the hemodynamic stability of the patient and the degree of adjustments to the patient's volume overload, different technical devices and the infrastructure and treatment materials required for their use must be used. Since the factors of the required elimination rate of toxins, hemodynamic stability and fluid removal in critically ill or intensive care patients can change very quickly and regularly, the form of therapy and thus also the associated device and its setup must often be changed at short intervals. On the one hand, this leads to a very high risk for the patient and, on the other, to high costs and personnel effort. Fig. 8 shows with the three dotted bars that the mean clearance rates for creatinine can be achieved with the claimed system. This was achieved solely by varying the parameters blood flow, supply flow and dialysate flow. The entire therapy range, for which different devices, infrastructures and therapies are otherwise necessary, was achieved with just a single device by varying the parameters preferably blood flow, supply flow and dialysate flow via the display. This leads to a significant reduction in risks for the patient by avoiding the need to change devices and use a new extracorporeal blood circuit, faster patient DTS Ref: 40247.ADT.P110PC 02.12.2025

[1147] - 86 - individualized adjustment of therapy settings and therapeutic outcome, and a significant reduction in the resources required. To achieve the crea clearance levels in Fig. 8, the system according to the present disclosure, and a dialyzer with a surface area of 1.1 m2 were used. The blood flow was set via the blood pump 8 preferably between 50 ml / min and 600 ml / min, more preferably between 100 ml / min and 300 ml / min. The supply flow was set between 10 ml / min and 600 ml / min, more preferably between 40 ml / min and 300 ml / min, by the addition via the pumps 47-50. The toxin-loaded dialysate was removed from the recirculation circuit 43, 44 by means of the pumps 35, 36. It can thus be shown that this enables the entire therapeutic range of extracorporeal dialysis to be covered by the setup claimed here with just a single device without changing the device or the consumables purely by varying the parameters on the controller.

[1148] A citrate & calcium anticoagulant is preferred for the extracorporeal dialysis used. The additions for this local anticoagulation depend on the blood flow. However, parts of the citrate accumulate in the blood or patients are metabolized into bicarbonate via the citrate cycle. 1 mol citrate to 2-3 mol bicarbonate. Prolonged therapy with this form of anticoagulation can therefore lead to an accumulation of bicarbonate in the body, resulting in alkalosis. This means that the blood flow must be reduced - as a result, the addition of citrate can be reduced - and the dialysate flow must be increased in order to remove some of the bicarbonate from the blood. This means that with the current machines, patients are over buffered with bicarbonate and over dialysis occurs due to the adjustment of the dialysate flow. This in turn means that important or desired substances are increasingly removed from the patient to an excessive extent.

[1149] The device claimed here offers the unique possibility of fully integrated and patient individually adjustable dialysis with integrated and blood flow-dependent anticoagulation with citrate and calcium as well as the individually adjustable concentration of bicarbonate in the dialysate. Furthermore, it is possible to prevent the patient from over dialyzing by recirculating the dialysate or parts of it.

[1150] Continuous and demand-oriented patient-specific removal of water-soluble toxins with integrated anticoagulation is made possible by the claimed device. DTS Ref: 40247.ADT.P110PC

[1151] 02.12.2025

[1152] - 87 -

[1153] The claimed device offers a high variety of fluid flow rates due to the different circuits. But compared to existing fluid bag-based devices treatment for up to to 24 hours are made possible without any user interactions. This is made possible due to the specific Liquids used for this treatment. The Permeate used to produce the dialysate within the device is stored in a fluid bag compartment 70 which is transported in a mobile container 73 and has a capacity of 60 - 120 liters preferably 75 - 90 liters. This container 73 contains an additions fluid bag compartment for the waste fluid and ultrafiltration fluid sucked from the device 72 that could collect 70 - 130 liters preferably 85 - 110 liters of waste fluid. The electrolytes are made available through a dialysis concentrate containing different concentrations of electrolytes within a concentrate container 67 and are pumped into the device via a second metering pump 47 If necessary for a longer treatment without user interactions and fluid change optionally a second dialysis concentrate container 65 can be placed on the device and is pumped into the device via a third metering pump 48. The recirculated, diluted and toxin loaded dialysate is then pumped through the recirculation circuit by regeneration pumps 39, 40 and partially removed by the filtrate pumps 35, 36 so that the fluid volume of the patient is kept to a dedicated level. If the clearance level hast to be adjusted and or increased and the amount of toxin loaded dialysate removed from the device prior to dilution with fresh supply fluid this can be controlled via two options. First option is to use the single pass outlet valve 29 and remove the toxin loaded dialysate through the first fluid connection 30 by the filtrate pumps 35, 36 prior to adding the fresh supply fluids. This results in significantly higher toxin removal rates which are similar to high flow single pass dialysis devices. The second option is to add the supply fluid just on the one fluid path e.g. 44 via the second and fifth metering pumps 47, 50 and run the recirculation pump 40 at a very low flow rate or shut it off and in addition run the second recirculation pump 39 at a flow rate similar to the flow rate of the dialysate pumps 18, 21 and remove all the waste fluid just via the filtrate and first waste pump 35. If the first dialysis concentrate container 67 is empty and the second dialysis concentrate container 65 has to be used, then the fluid path 43 has to be the one to be supplied with fresh supply solution via the pumps 48, 49 and run the recirculation pump 39 at a very low flow rate or shut it off and in addition run the second recirculation pump 40 at a flow rate similar to the flow rate of the dialysate pumps 18, 21 and remove all the waste fluid just via the filtrate and second waste pump 36. If bicarbonate from the compartment 69 has to be added to the supply DTS Ref: 40247.ADT.P110PC

[1154] 02.12.2025

[1155] - 88 - solution than the supply pump 50 has to be used to supply permeate and / or bicarbonate instead of the supply and fourth metering pump 49. To mix this solution with the dialysis concentrate coming from the third metering pump 48 the switching mechanism 45, 46 hast to be used to supply the mixed supply flow within the correct fluid path of the recirculating circuit. By changing the flow rates of the recirculation pumps 39, 40, the supply flows 47 - 50 the switching mechanism 45, 46 and the fluid removal rates of the different filtrate pumps 35, 36 the ratio of removing toxin loaded dialysate, dilution of toxin loaded dialysate and the supply of fresh supply solution can be adjusted individually according to the flow rates and the toxin removal rates. This option also results in a verry high toxin removal rate but is partially limited by the amount of fluid that could be freshly supplied to the dialysate circuit and the amount of toxin loaded filtrate / waste fluid that is withdrawn from the dialysate circuit.

[1156] Therefore, the claimed device offers integrated options - additionally to the independent flow rates - adjust the toxin removal rates by adjusting the amount of toxin loaded dialysate that is in a single pass and directly removed from the circuit and the amount of dialysate that is recirculates and / or diluted prior to the removal of parts of it.

[1157] If additional electrolytes and / or nutrients are necessary for the treatment they could be supplied to the dialysate circuit via the additional and integrated first metering pumps 27.

[1158] The integrated local anticoagulation is offered by the infusion pumps 6, 15 which are preferably peristaltic pumps and / or syringe pumps collect the disposable Infusions solution fluid bags 4, 13 and its disposable fluid connection lines to the extracorporeal blood line 2, 16. An additional sensor system 5, 14 is used to prevent air infusions to the blood lines via the blood line infusion connections 3, 12 for the Infusion solutions. The sensor system detects and or avoids air bubbles passing through the infusion pumps 6, 15 by detecting air bubbles optical and or via ultrasonic and or measuring the liquid level within a drip chamber at a dedicated level. Additionally, the sensor system 5, 14 includes a flow sensor which measures the infusion solution flow optically, via temperature, ultrasonic or counting the drips within a drip chamber. This flow rate is then preferably brought into relation to the flow of the infusion pumps 6, 15 to ensure a correct flow rate as this additional flow rate has to be taken into account to the balancing DTS Ref: 40247.ADT.P110PC

[1159] 02.12.2025

[1160] - 89 - of the patient and additionally hast to be removed by the filtrate pumps 35, 36 to keep the patient volume at least at a constant level.

[1161] If the physician prefers countercurrent to direct current, the connections 19A and 20A on the dialyzers 10 can also be connected in opposite directions. This option can be performed with the connection of one 10A or two dialyzers 10B in parallel

[1162] Anticoagulation

[1163] The claimed device has integrated infusion pumps 6, 15 for a local Citrate and Calcium anticoagulation. This option is preferred as the anticoagulation is directly coupled to the blood flow 8 and the amount of fluid added to the extracorporeal circuit is considered for the balancing of the patient. Additionally, the used blood lines and the options within the SW and device allow the user to use different anticoagulation modes e.g. systemic anticoagulation with heparin. Thereby the mode is selected within the user interface and the infusion pumps 6, 15 will not be used and the liquid for anticoagulation is added directly into the patient or extracorporeal circuit.

[1164] Addition liquid preferably protein stabilizers

[1165] In addition to the infusion pumps 6, 15 the device preferably has a third infusion pump 27 which is preferably a peristaltic pump and or a syringe pump. This first metering pump 27 collects the disposable additional solution fluid bag 26 and its disposable fluid connection line which is directly connected to the dialysate fluid circuit via a connector 79. This connector is preferably placed before the toxin loaded dialysate is brought into the regeneration circuit to be treated with acidic and alkaline solutions as the added liquid could contain protein stabilizers preferably a stabilizer from the group of caprylate. An additional sensor system 28 is used to prevent air infusions to the dialysate fluid via the connector 79 for the additional solution. The sensor system detects and or avoids air bubbles passing through the first pump 27 by detecting air bubbles optical and or via ultrasonic and or measuring the liquid level within a drip chamber at a dedicated level. Additionally, the sensor system 28 includes a flow sensor which measures the infusion solution flow optically, via temperature, ultrasonic or counting the drips within a drip chamber. This flow rate is then preferably brought into relation to the flow of the first DTS Ref: 40247.ADT.P110PC 02.12.2025

[1166] - 90 - pump 27 to ensure a correct flow rate as this additional flow rate has to be considered to the balancing of the patient and additionally hast to be removed by the filtrate pumps 35, 36 to keep the patient volume at least at a constant level. The preferably added additional solution preferably contains a nutrient solution which is preferably glucose if the dialysate concentrates 67 and 65 are an acidic and alkaline solution to treat and regenerate the protein containing dialysate solution. As glucose is difficult to dissolve and keep stable in solution as such high concentrations of acidic and alkaline solutions as used to treat continuously with a protein containing dialysis solution for at least 6-8 hours without user interaction. Additionally, the added solution preferably contains a protein stabilizer preferably a stabilizer from the group of caprylate. The flow rate of the third infusion pump and first metering pump 27 is preferably adjusted in accordance with the supply flow pumps 47, 48, 49, 50 to keep the level of glucose and protein stabilizer at a dedicated and constant level during the whole treatment.

[1167] Dialysis concentrates:

[1168] The claimed device has at least two connectors for dialysis concentrates 67, 65. Depending on the chosen therapy and its length the composition of the dialysates and the number of dialysis concentrates might change.

[1169] For performing a protein dialysis preferably two different dialysis concentrates, preferably an acid preferably from the HCI group and preferably an alkali preferably from the NaOH group dialysis concentrate are used. Whereas the acid concentrate 65 is preferably available in two different compositions, whereas the one contains calcium and might therefore not be used with the integrated citrate and calcium anticoagulation and whereas the other one is without calcium and might therefore be used with the integrated citrate and calcium anticoagulation. And whereas the alkaline concentrate 67 is preferably available in at least two different compositions, whereas these might differ in the concentration of potassium whereas at least a potassium concentration of 2 and 4 optionally 0 are made available. Optionally the bicarbonate concentration within the alkaline concentrate might differ between 0 mmol / l and higher rates up to 45 mmol / l within the diluted supply solution added to the recirculation path 44. DTS Ref: 40247.ADT.P110PC 02.12.2025

[1170] - 91 -

[1171] While performing a dialysis treatment without protein RRT to remove water soluble toxins a single dialysis concentrate - for longer therapies, two canisters can be attached and automatically emptied sequentially - could be connected as one of the concentrate containers 67, 65. Whereas there might be at least four different combinations and compositions of dialysis solutions combining Calcium and Potassium. Whereas the one contains calcium and might therefore not be used with the integrated citrate and calcium anticoagulation and whereas the other one is without calcium and might therefore be used with the integrated citrate and calcium anticoagulation. And whereas each of this one might be available with different concentration of potassium whereas at least a potassium concentration of 2 and 4 optionally 0 are made available for each one. Optionally the bicarbonate concentration within these concentrates might differ between 0 mmol / l and higher rates up to 45 mmol / l within the diluted supply solution added to the recirculation path 44, 43.

[1172] The balancing of the patient is preferably done by measuring the weight of the patient by having all the liquids and electrolytes on a scale 74. But if the dialysis concentrates are used as additional liquid cans 65, 67 their volume and weight hast to be considered for the balancing. Optionally there a no extra concentrates 65, 67 and the concentrates and or electrolytes are provided as additional compartment within the container and or fluid bag 73. Preferably the electrolytes are made available as powders so that by sucking liquid from the permeate bag compartment 70 through a fluid connection 79 through the additional electrolyte compartments 66, 68 into the dialysis device as dissolved electrolyte solution. The suction pumps 47, 48 pump the dissolved fluids into the device. The flow rate of the electrolyte concentrate pumps 47, 48 and the ratio between this flow rate and the flow rate of the permeate pumps 50, 49 controls the dilution of the electrolyte and the concentration of the electrolytes within the supply solutions.

[1173] Whereby the ratio of electrolyte solution and permeate is adjusted according to a thirteenth and fourteenth sensor 80, 81 preferably a conductivity sensor measuring the conductivity of the fluid. As the conductivity of the fluid is in direct relation to the amount of dissolved electrolytes. To ensure that there is no additional conductivity influence on the fluid due to other substances an additional eleventh sensor 61 preferably a conductivity sensor can be considered. If there is a conductivity within the permeate DTS Ref: 40247.ADT.P110PC 02.12.2025

[1174] - 92 - solution this value could be subtracted from the measured value 80, 81. Optionally it is possible to measure the dissolved and saturated electrolyte solution directly after sucking it into the device by a fifteenth and sixteenth sensor 82, 83 preferably a conductivity sensor measuring the conductivity of the fluid.

[1175] The option to have the additional concentrates and or electrolyte powders available within an additional compartment within the fluid bags has the user benefit of simple handling and automatically considering for the weight balancing within the scale 74.

[1176] Gases sucked into the device are removed from the fluids within a gas separator 51-57. The formation of gases could affect the balancing of the liquid volumes on the one hand and the composition and concentration of the substances in the saturated solution on the other hand. The volume of the liquid phase and the gas phase within the gas separators 51 - 57 has to be kept at a constant level to avoid unwanted changes in liquid volume which would result in misbalancing of the patient.

[1177] Fluid connection block

[1178] The claimed device preferably has a connection block 75 for the connection of most liquids - inputs or outputs. Osmosis water 70 and filtrates or waste liquid 72 are preferably connected here in a bundle. Optionally, further solutions or their containers, preferably a bicarbonate solution 69 and optionally further electrolyte solutions 66, 68 are connected. Preferably, a single fluid bag with different compartments is connected here, whereby the connection can be made via a single common connection with separate fluid channels for the individual inlets or compartments in the fluid bag or also via individual fluid connections for the respective fluid compartments. This enables the separate supply and / or discharge of fluids to the dialysis circuit. By means of an integrated switching mechanism, the connection block enables both the intake of fresh fluids by the input pumps 47 - 50 and the recirculation of the fluids from the circuit by the first and second waste pumps 35, 36 back to the input. DTS Ref: 40247.ADT.P110PC 02.12.2025

[1179] - 93 -

[1180] However, this design is preferably only used during cleaning, rinsing and disinfection processes. This enables safe, thorough and fast processes within the appliance compared to the otherwise often used hose connections, which represent very long fluid lines that do not have the correct throughflow. Furthermore, the connection block 75 is preferably made of metal or a material that has a very high thermal conductivity. This ensures fast and complete temperature adjustment of the respective connections, fluid channels and cross-connections. The connection points for the respective fluid compartments 66, 68, 69, 71 , 72 are preferably very short branch lines with a very small volume of liquid. Furthermore, further sensors 84, 85 are preferably present at the inlet of the permeate 70 and at the outlet of the filtrate 72. On the one hand, these sensors are preferably temperature sensors. This is intended to ensure that the temperature of the liquids is maintained and to ensure the target values for disinfection. Furthermore, pressure sensors 84, 85 are also preferably used, which ensure that the containers are correctly sealed and that no overpressures or under pressures occur when the fluids are being pumped, which would detect incorrect connection of the compartments 66, 68, 69, 71 , 72.

[1181] Furthermore, an additional valve 86 is preferably attached to the connection block 75 fluid channel. This valve should enable a targeted supply of air via a third filter 87. This targeted air intake enables the system to be completely emptied for service, maintenance and transportation. Furthermore, it offers a clear advantage for cleaning and disinfection following therapy with proteins. This is because a pure rinsing process would result in constant and slow dilution of the protein solution. This is time-consuming and would result in very high water consumption. Complete emptying significantly reduces the concentration of remaining protein. This leads to faster cleaning and disinfection with less consumption of resources such as liquid and electricity.

[1182] Heatexchanger

[1183] The claimed device contains a heat exchanger 64. This is intended to conduct fresh osmosis water, which is pumped into the device by the seventh pump 60 or fourth or fifth metering pumps 49, 50, against waste or filtrate waste water - which is pumped out of the device by the waste pumps 35, 36 - in order to exchange the heat of these two liquids for each other. The aim is to recover as much energy as possible from the liquids DTS Ref: 40247.ADT.P110PC 02.12.2025

[1184] - 94 - that are fed into and removed from a recirculating system. Preferably, the efficiency of the heat exchanger is included in the temperature control in order to make it as effective as possible. For this purpose, the temperature of the fluid fed out of the system is taken into account, namely its temperature via the eighth and ninth sensors 41 , 42 and the flow rate 36, 36 as well as the temperature of the osmosis water fed in 85 and the flow rate of the water fed in 49, 50. This enables the third heater 62 to be controlled as effectively as possible and the target temperature of the supply liquids fed into the recirculating circuit to be reached consistently.

[1185] In the event of a brief interruption in therapy and / or an error and / or a change of liquids, no liquid is fed into the circuit by the pumps 47 - 50. In other words, no fresh permeate is removed from the bag 70. Depending on the time, this could lead to cooling / overheating of the liquid in the heater 60 and / or reservoir 54. Therefore, the seventh pump 60 can deliver liquid continuously in the circuit 63, which is measured by the eleventh sensor 61 , which can preferably also measure the temperature of the liquid. This ensures that no fluctuations in temperature occur when the liquid is pumped back into the circuit. Such fluctuations could have negative effects on the measurement of temperature dependent measured values like the pH and / or conductivity value 17, 24, 41 , 42, negatively influence the folding and detoxification of the protein or have a critical impact on the patient's 1 condition.

[1186] Cross Switch

[1187] A prior switch is disclosed in W02009071103A1.

[1188] Compared to previous applications such as W02009071103A1 , the device claims a significant improvement in the continuous and long-term purification of dialysate with proteins, in particular albumin.

[1189] The aim is to improve the regeneration of the dialysate, preferably the albumin in the dialysate.

[1190] The switch mechanism described so far has the following disadvantages: DTS Ref: 40247.ADT.P110PC

[1191] 02.12.2025

[1192] - 95 -

[1193] The valve circuit 37 & 38 described there has a very small dead space for proteincontaining dialysate - although this is small, this volume adds up over the therapy due to the regular switching of the valves 37 & 38 - the very small volumes of fluid in each valve - here preferably two-three-way valves - are in conditions that are harmful to the albumin over a longer period of time - switching cycle. The albumin-containing dialysate is deliberately mixed with an acid - preferably hydrochloric acid - and an alkali, preferably sodium hydroxide solution, in order to influence the folding of the protein in such a way that specific binding sites for toxins that are to be removed from the blood are changed and the toxins bound to the protein are released into solution again. The protein-bound toxins are thus dissolved in liquid by changing the folding of the protein and can be removed. However, this process is only reversible to a very limited extent. Among other things, reversibility is time-dependent.

[1194] For a continuous and recirculating dialysis circuit, however, it is necessary that this process is reversible. The valve circuit described there 37 & 38 is located in the recirculating dialysis circuit, which contains protein-containing dialysate loaded with toxins. There is therefore a dead space for protein-containing dialysate, which results in a certain volume of proteins remaining within the conditions harmful to the protein for the duration of a switching cycle, leading to irreversible denaturation of the protein. This continuous denaturation of some of the protein-containing dialysate has two negative effects. Firstly, the concentration of proteins in the dialysate, which can absorb toxins from the extracorporeal blood and thus remove them, is continuously reduced, which in turn would lead to a reduction in detoxification performance. Secondly, the denatured protein precipitates in the recycling circuit and can lead to deposits or blockages there, which in turn can lead to negative influences such as clogging of the membranes of the filters 33, 34 or the dialyzer 10. In order to counteract these disadvantages, the device claimed here has a switching mechanism 45, 46 within the supply lines. More precisely, the additions of the liquids which are added by the pumps 47, 50 are continuously and regularly exchanged with the additions of the liquids by the third and fourth pumps 48, 49 in such a way that the ninth sensor 42 in the path 44 alternately receives liquids from DTS Ref: 40247.ADT.P110PC 02.12.2025

[1195] - 96 - the second and fifth pumps 47, 50, whereby the eighth sensor 41 in the path 43 alternately receives liquids from the pumps 48, 49. This is exchanged in regular cycles. Since the high concentrations of electrolytes can lead to deposits in the addition paths, on the eighth and ninth sensors 41 , 42 and the fluid paths 43, 44, such deposits are prevented by regularly exchanging the additions, in particular the acid 65 and alkali 67 used. The sensors 41 , 42 used are also regularly cleaned by this process, which again significantly improves the response time and sensitivity of the sensors.

[1196] This switching mechanism 45, 46 means that there are no areas within the recycling dialysis circuit, in particular within the two fluid-carrying branches for the purification of the protein-containing dialysate, in which the protein-containing dialysate is not in continuous flow. The critical constant contact time between the addition of the acid or alkali-containing dialysis concentrates 65, 67 to the recycling dialysate in the two paths 43, 44 up to their mixing at the point 37 is therefore influenced by the hydraulic length or volume of the component used and the delivery rate of the two recirculation pumps 39, 40.

[1197] The challenge here, however, is the constant control of pH, temperature 41 , 42 and time in the respective paths 43, 44 and filters 33, 34, as the measured variables to be controlled at the eighth and ninth sensors 41 , 42 also change regularly and have a certain response time due to the changes in the addition of dialysis concentrates.

[1198] Preferably, the lengths and volumes of the fluid-carrying paths between the switch mechanism 45, 46 of the supply fluids, the eighth and ninth sensors 41 , 42 of the two pathways 43, 44, the first and second filters 33, 34 of the fourth and fifth valves 31 , 32 up to the remixing 37 are completely identical in order to have a recirculating dialysis fluid that is as constant as possible in the fluid after the mixing point 37.

[1199] To improve the control and increase safety, the conductivity and pH are preferably measured by the eighth and ninth sensors 41 , 42, although only one of the two could be used. Furthermore, the eighth and ninth sensors 41 , 42 preferably also continuously measure the temperature and the pressure. Since the recirculated dialysis fluid has a buffer capacity, the reaction time between the addition of the electrolyte-containing DTS Ref: 40247.ADT.P110PC

[1200] 02.12.2025

[1201] - 97 - supply fluid by the supply pumps 47 - 50 to the dialysate mixed with buffers and the measuring point 41 , 42 for conductivity / pH must be as short as possible so as not to cause unwanted denaturation, but still long enough to allow the buffers to react and to obtain a correct measured value by the eighth and ninth sensors 41 , 42 of the two paths

[1202] 43, 44. This is necessary to influence the folding of the protein in such a way that the binding sites for the proteins change within the first and second filters 33, 34 and the bound toxins can be dissolved and removed.

[1203] Adjustment of Filtration over the Filtermembrane

[1204] The two recirculation pumps 39, 40 adjust the volume flow through the two paths 43,

[1205] 44. The flow resistance and thus the pressure at the filter can be varied by means of the fourth and fifth valves 31 , 32, preferably pressure control and or variable proportional valves. This pressure is continuously measured and monitored via the pressure sensors 41 , 42. The first and second waste pumps 35, 36 downstream of the first and second filters 33, 34 can be used to set what proportion of liquid is removed via the filter membrane and what proportion of liquid is recirculated further in the system. The valves used here therefore enable pressure regulation via the first and second filter membranes 33, 34. Such pressure regulation via the first and second filter membranes 33, 34, preferably a positive pressure, which means that the first and second waste pumps 35, 36 do not create suction via the membranes, increases the lifetime of the filters. This effectively prevents clogging of the membrane, as proteins, among other things, would be drawn into the membrane by strong suction from the first and second waste pumps 35, 36. Positive pressures are therefore preferably generated by the fourth and fifth valves 31 , 32 or short pressure pulses to remove the deposits on the membranes of the first and second filters 33, 34. The flow direction of the recirculation pumps 39, 40 can be briefly reversed using a dedicated sequence for treating the filters and a suitable pressure level can be set, which leads to the removal of any filter cake from the first and second filters 33, 34 or their membranes. This enables a continuous, constant and high filtration rate for toxins and therefore long-term therapy without changing the device or the first and second filters 33, 34. DTS Ref: 40247.ADT.P110PC

[1206] 02.12.2025

[1207] - 98 -

[1208] Delta Calculation of Elimination values

[1209] The claimed device has a sixth sensor 17 in the fluid flow 19 which leads through the first dialysate pump 18 to the dialyzers 10, which sensor can preferably measure pH and or conductivity and or temperature and or pressure. Furthermore, there is a seventh sensor 24 in the fluid flow 20 which leads through the second dialysate pump 21 from the dialyzers 10 to the third reservoir 25 or to the recirculation circuit 43, 44. This seventh sensor 24 is preferably a pH and or conductivity and or temperature and or pressure sensor. There is thus preferably one sensor 17, 21 each at the inlet and outlet of the dialysate from the dialyzer 10. These sensors enable the device to measure the composition of the dialysate before it enters the dialyzer 10 and comes into contact with the extracorporeal blood through the dialysis membrane and to measure it again after it exits the dialyzer 10 and comes into contact with the extracorporeal blood through the dialysis membrane. Considering the known composition of the dialysate, e.g. its buffer capacity and the additions by the Supply pumps 47 - 50, the exchange of toxins and substances, in particular urea, electrolytes and H+ ions, can be determined and measured. By alternating peaks of the concentrations of certain electrolytes and / or H+ ions by varying the additions of the Supply pumps 47 - 50, their interaction with the patient's blood within the dialyzers 10 can be measured. Within a recirculating or partially recirculating RRT dialysis system, this makes it possible to measure the clearance, KTV or acidosis correction online directly in the device and accordingly to adjust the addition by the Supply pumps 47 - 50 or the ratio of the addition and / or the filtration rates by the filtrate pumps 35, 36 individually for the patient. The recirculating system offers a significant advantage here in that the effects of the device on the extracorporeal blood circulation can be measured quickly and more accurately by simply varying the volume flows and additions or withdrawals from the recirculating system, thus enabling a more targeted response. In order to increase safety and to continuously calibrate the two sensors, they can be short-circuited via a bypass 22, 22A, 22B and thus directly calibrated using the same fluid from the pumps 18, 21. This process of calibrating the sensors can take place alternately and for very short periods of time DTS Ref: 40247.ADT.P110PC

[1210] 02.12.2025

[1211] - 99 - during treatment or only at the start of treatment. This calculation can also be made for the change in temperature caused by the blood. This can then be used to calculate the required energy input into the recirculating dialysate, which must then be introduced by the heaters 23, 38, 62 individually or in combination into the recirculating dialysate or the added fluids in order to ensure that the blood in the extracorporeal circuit does not cool down or heat up unintentionally and thus have a negative effect on the patient.

[1212] Regarding the pH measurement, reference is also made to WO2018215918A1.

[1213] Placement of Dialyzers and Filters on the housing:

[1214] The dialyzers 10 and / or first and second filters 33, 34 are preferably attached directly to the housing of the device. This has the advantage that the supply and discharge lines are kept as short as possible. As a result, the respective volumes are significantly reduced, the calculation of the transmembrane pressure is more accurate, which improves the detoxification performance of the membranes, handling is significantly simplified, and disinfection can be carried out more effectively. Depending on the therapy option selected in the software, e.g. protein dialysis or RRT, the user can choose whether one or two dialyzers 10 and one, two or no filters 33, 34 are used for the individual patient and their extracorporeal blood circuit.

[1215] Detailed description of the components of the device:

[1216] A Patient 1 is connected via disposable extracorporeal blood lines to the device to remove water soluble and / or protein bound toxins and / or remove and / or add electrolytes. The fluid connection is implemented via a feeding blood line 2 whereas this blood line has a connection point 3 close to the patient blood line connection to add a first infusion solution 4. This Infusion solution is preferably Natrium Citricum within a concentration of 110 mmol / l to 1.500 mmol / l and more preferably between 1.000 and 1.300 mmol / l and whereas the volume of the disposable infusion solution is preferably within a volume of 150 ml to 2.500 ml and more preferably between 1.600 to 2.200 ml. This infusion solution is supplied into the extracorporeal blood line via the connection DTS Ref: 40247.ADT.P110PC

[1217] 02.12.2025

[1218] - 100 - point 3 via a first infusion pump 6 whereas this Infusion pump is preferably a syringe pump and more preferably a peristaltic pump. Whereas at least up stream or downstream of the first infusion pump 6 there is a first sensor 5. This sensor system 5 is used to prevent air infusions to the first blood line 2 via the blood line infusion connection 3. The sensor system detects and / or avoids air bubbles passing through the first infusion pump 6 by detecting air bubbles optical and / or via ultrasonic and / or measuring the liquid level within a drip chamber at a dedicated level. Additionally, the sensor system 5 includes a flow sensor which measures the infusion solution flow optically, via temperature, ultrasonic or counting the drips within a drip chamber. This flow rate is then preferably brought into relation to the flow of the infusion pump 6 to ensure a correct flow rate as this additional flow rate has to be considered to the balancing of the patient to keep the patient volume at least at a constant level ore remove a surplus. Further downstream the extracorporeal blood line is connected to a blood pump 8 whereas this blood pump is a centrifugal pump or ore preferably a peristaltic pump directly connected to the disposable blood line. The flow rate of the blood pump is preferably in the range of 0 ml / min and 10 ml / min - 1.200 ml / min. Upstream and downstream of the blood pump there are additional second and third sensors 7, 9 to measure the blood pressure and detect weather the suction connection 2 to the patient 1 is blocked and the blood ingoing pressure of the dialyzer 10. The device could be equipped with one or two disposable dialyzers 10 which are directly connected to the blood lines coming from the patient 2 and going back to the patient 16. And on the other side of the membrane are directly connected to the dialysis circuit whereas the dialysate ingoing fluid connection 19 and the dialysate outgoing connection 20 can be connected in a way, that the blood flow and the dialysate flow entering passing through and leaving the device are going completely in the same direction ore are entering, passing through and leaving the dialyzers in the opposite direction. Downstream of the blood pump 8 and the dialyzer 10 there are additional fourth sensors 11 to measure the blood pressure and detect whether the back-flow connection 16 to the patient 1 is blocked. Additionally, there is a bubble sensor 11 to detect, weather there is any air that might be infused to the patient and therefore should be removed and the blood pump 8 has to be stopped. Further downstream of the dialyzer 10 and the fourth sensors 11 there is an infusion port 12 to add a second infusion solution 13 DTS Ref: 40247.ADT.P110PC

[1219] 02.12.2025

[1220] - 101 - to the extracorporeal blood flow, prior the blood is then returned to the patient 1 via the return line 16.

[1221] This further second infusion solution 13 is preferably Calciumchlorid-Dihydrat within a concentration of 0,2 mmol / ml to 1 mmol / ml and more preferably between 0,4 and 0,6 mmol / ml and whereas the volume of the disposable infusion solution is preferably within a volume of 50 ml to 1 .000 ml and more preferably between 100 to 800 ml. This infusion solution is supplied into the extracorporeal blood line via the second blood line infusion connection point 12 via a second infusion pump 15 whereas this second infusion pump 15 is preferably a syringe pump and more preferably a peristaltic pump. Whereas at least up stream or downstream of the second infusion pump 15 there is a fifth sensor 14. This sensor system 14 is used to prevent air infusions to the second blood line 16 via the second blood line infusion connection 12. The sensor system detects and / or avoids air bubbles passing through the second infusion pump 15 by detecting air bubbles optical and / or via ultrasonic and / or measuring the liquid level within a drip chamber at a dedicated level. Additionally, the fifth sensor system 14 includes a flow sensor which measures the infusion solution flow optically, via temperature, ultrasonic or counting the drips within a drip chamber. This flow rate is then preferably brought into relation to the flow of the second infusion pump 15 to ensure a correct flow rate as this additional flow rate has to be considered to the balancing of the patient to keep the patient volume at least at a constant level ore remove a surplus. The device consists of a recirculating dialysis circuit with a first dialysate pump 18 upstream of the dialyzer 10 to recirculate the regenerated and / or fresh dialysate from the dialysate third reservoir 25 through the dialysate sensors 17 through the dialyzer inlet fluid connection 19 through the dialyzer 10. Downstream of the dialyzer 10 there is preferably an additional second dialysate pump 21 to recirculate the dialysate through the dialyzer outlet fluid connection 20 from the dialyzer 10 through the seventh dialysate sensors 24 and a first heater 23 partially and / or completely into the dialysate third reservoir 25 and or partially and ore completely into the dialysate regeneration circuit consisting of the regeneration pumps 39, 40 and / or through a single pass outlet valve 29 into the waste bag 72. In parallel to the dialyzer 10 there is a first bypass valve 22 and fluid path. This could be switched in combination with the other valves 22A, 22B if the recirculated dialysate should not be passed through the dialyzer but still be run in circulation. Upstream of the DTS Ref: 40247.ADT.P110PC 02.12.2025

[1222] - 102 - dialysate inlet pump 18 and downstream of the dialysate outlet pump there are sensors 17, 24. These sensors are preferably pH meters and / or conductivity sensors and / or temperature sensors. These sensors are used to control and adjust the dialysate fluid composition according to the set values and the patients’ needs. In additions these sensors could be connected to the flow of dialysate through the dialyzers and the flow through the bypass valve. Therefore, it is possible to measure the influence on the recirculating dialysate due to the direct fluid connection and substance exchange within the dialyzer and compare this to the difference of measuring the fluids directly without blood contact. In addition, the seventh sensor 24 preferably contains a further blood detector to measure whether there is a blood leak through the membrane of the dialyzer into the dialysate solution. If a blood leak is detected, the device switches the bypass valve mechanism 22, 22A, 22B and no further blood could leak from the blood circuit into the dialysate circuit. The device consists of at least three heaters 23, 38, 62 where the complete heating power of these heaters is at least 300 - 3.500 Watts and more preferably between 800 and 2.100 Watts. These heaters increase the temperature of the recirculating dialysate and / or the freshly added supply solution to ensure a fluid temperature between 21 and 45 degrees Celsius within the circuit during the treatment and a temperature between 45 and 93 degrees Celsius during cleaning and disinfection. The dialysate third reservoir 25 is the main connection between the recirculation dialysate circuit run by the pumps 18, 21 and the dialysate regeneration circuit run by the regeneration pumps 39, 40. This third reservoir 25 decouples these both circuits to allow different flow rates and on the other hand allow to separate the liquid, foam and gas phase into separate levels whereas the liquid phase is at the bottom and the gas phase is at the top. Therefore, it is possible to remove the gas phase if occurred within the circuits to remove these gases out of the circuit through the top outlet. Before the toxin loaded dialysate is completely and or partially passed to the regeneration circuit upstream of the regeneration pumps 39, 40 there is a fluid connection point 79 which allows the addition of further fluid to the dialysate circuit if necessary. Therefore, a further infusion solution 26 is used. This further infusion solution 26 is preferably a mixture of a stabilizer which is preferably a fatty acid and a nutrient which is preferably a sugar solution. DTS Ref: 40247.ADT.P110PC 02.12.2025

[1223] - 103 -

[1224] Fatty acids can exert antimicrobial effects and, thus, prevent the growth of pathogenic microbes in the dialysis device. Preferably, the stabilizer is selected from the group consisting of caprylic acid, capric acid, lauric acid, oleic acid and palmitic acid and salts or derivatives thereof. More preferably, the stabilizer is selected from the group consisting of caprylic acid, capric acid, lauric acid and oleic acid and salts or derivatives thereof. Even more preferably the stabilizer is selected from the group consisting of caprylic acid, capric acid and lauric acid and salts or derivatives thereof. Most preferably, the stabilizer is selected from the group consisting of caprylic acid and capric acid and salts or derivatives thereof; in particular from the group consisting of caprylate, caprylic acid, caprate, capric acid, caproic acid and caproate. Particularly preferably the stabilizer is a caprylate, for example sodium caprylate CsHisNaCh. In other words, in view of prevention of denaturation, biocompatibility, solubility and improvement of detoxification, caprylate is the most preferred protein stabilizer. In addition, caprylate prevents bacterial growth at least during 24 hours treatment in a recirculating dialysis fluid. Preferably, the concentration of the stabilizer for a carrier protein, such as the infusion solution 26, it is in the range from 1 to 2500 mmol / l, preferably from 37 to 2020 mmol / l, more preferably from 50 to 1500 mmol / l, even more preferably from 100 to 1000 mmol / l and most preferably from 150 to 500 mmol / l.

[1225] It is also preferred that the infusion solution 26 according to the present invention comprises a nutrient. The term "nutrient", as used herein, refers to a substance used in an organism's metabolism. Preferred examples of nutrients include proteins or amino acids, trace elements, vitamins such as lipo-soluble or water-soluble vitamins, carbohydrates such as sugars and combinations thereof. Preferred nutrient amino acids are, for example, the essential amino acids phenylalanine, valine, threonine, tryptophan, methionine, leucine, isoleucine, lysine and histidine. A "trace element", as used herein, refers to a dietary element that is needed in very minute quantities for the proper growth, development and physiology of an organism. More preferably, the infusion solution 26 according to the present invention comprises a sugar. The term "sugar", as used herein, refers to short-chain carbohydrates, which are typically soluble. The term "sugar" includes monosaccharides such as glucose, fructose and galactose, disaccharides such as sucrose, maltose, trehalose and lactose; and oligosaccharides, which are saccharide polymers having a small number ” typically three to nine ” of DTS Ref: 40247.ADT.P110PC 02.12.2025

[1226] - 104 - monosaccharides. The infusion solution 26 according to the present invention may comprise one or more of the above sugars, i.e. alone or combinations thereof. Moreover, if the infusion solution 26 according to the present invention comprises one or more sugars, it preferably further comprises one or more proteins or amino acids as described above. Moreover, if the infusion solution 26 according to the present invention comprises one or more sugars, it preferably further comprises one or more trace elements as described above. Moreover, if the infusion solution 26 according to the present invention comprises one or more sugars, it preferably further comprises one or more vitamins. Preferably, the sugar comprised by the infusion solution according to the present invention is glucose. More preferably, glucose is the only sugar comprised by the infusion solution 26 according to the present invention.

[1227] Even more preferably, glucose is the only nutrient comprised by the infusion solution according to the present invention. Most preferably, the glucose is D-glucose. The concentration of the nutrient, preferably sugar, in particular glucose, in particular when comprised by a composition such as the nutrient infusion solution 26 or the stabilizer / nutrient infusion solution 26, is preferably in the range from 100 to 3800 mmol / l, more preferably in the range from 160 to 3180 mmol / l, even more preferably in the range from 200 to 2900 mmol / l and most preferably in the range from 250 to 2880 mmol / l. And whereas the volume of the disposable infusion solution is preferably within a volume of 100 ml to 2.400 ml and more preferably between 900 to 1.900 ml. This infusion solution is supplied into the toxin loaded dialysate via the connection point 79 via an infusion pump 27 whereas this Infusion pump is preferably a syringe pump and more preferably a peristaltic pump. Whereas at least up stream or downstream of the first metering pump 27 there is a sensor system 28. This sensor system 28 is used to prevent air infusions to the dialysate fluid via the connection 79. The sensor system detects and / or avoids air bubbles passing through the infusion / first metering pump 27 by detecting air bubbles optical and / or via ultrasonic and / or measuring the liquid level within a drip chamber at a dedicated level. Additionally, the sensor system 28 includes a flow sensor which measures the infusion solution flow optically, via temperature, ultrasonic or counting the drips within a drip chamber. This flow rate is then preferably brought into relation to the flow of the infusion pump 27 to ensure a DTS Ref: 40247.ADT.P110PC

[1228] 02.12.2025

[1229] - 105 - correct flow rate as this additional flow rate has to be considered to the balancing of the patient to keep the patient volume at least at a constant level ore remove a surplus.

[1230] The dialysate regeneration circuit comprises of at least two recirculating and regenerating pumps 39, 40 for transporting the toxin loaded dialysate through the two flow paths 43, 44. Preferably, two separate pumps are used for the transport of the toxin loaded dialysis fluid, because the resistance of the fluid can be different in the acidic flow path and in the alkaline flow path. For example, a carrier substance like e.g. albumin might have a different shape in acidic or alkaline conditions and therefore different flow characteristics for different pH and or temperature and or conductivity values. Each of the two flow paths 43, 44 comprises a detoxification unit 33, 34 adapted for filtering or dialysing the toxin loaded dialysate, and for removing toxins from the dialysate. The detoxification units 33, 34 might e.g. be implemented as regeneration dialyzers, ultrafiltration units, diafiltration units, etc. The first regeneration pump 39 of the first flow path 43 and the second regeneration pump 40 of the second flow path 44 transfer the dialysate downstream to one of two detoxification units 33, 34 of the dialysate regeneration unit. The dialysate is supplied to the detoxification units 33, 34 via a fluid insertion point where fluids from the upstream valve mechanism comprising switching valves 45, 46 is continuously or intermittent added to the toxin loaded dialysate and further downstream measured by the eighth and ninth sensors 41 , 42.

[1231] In the detoxification unit through which alkaline solution is flowing, alkaline soluble toxins like e.g. bilirubin can be removed by filtration or dialysis. Under alkaline conditions, the concentration of alkaline soluble toxins in solution is increased. Due to this concentration increase of free toxins, removal of the free toxins is facilitated. In the other detoxification unit through which acidic solution is flowing, these alkaline soluble toxins may e.g. be precipitated and thereby removed from the dialysis fluid.

[1232] With regard to acidic soluble toxins like e.g. magnesium, a similar effect is observed. In an acidic solution, the concentration of acidic soluble toxins in solution is increased, and hence, acidic soluble toxins may be removed at an increased rate. In contrast, in the DTS Ref: 40247.ADT.P110PC

[1233] 02.12.2025

[1234] - 106 - detoxification unit through which alkaline solution is flowing, the acidic soluble toxins are precipitated, e.g. as magnesium hydroxide, and thereby removed from the dialysis fluid.

[1235] The switching valve mechanism 45, 46 is adapted for changing the insertion of alkaline and acidic supply solution to the toxin loaded dialysate.

[1236] Therefore the toxin loaded dialysate transported by the first regeneration pump 39 through the fluid path 43 to the first detoxification unit 33 is within the one switching position of the switching mechanism 45, 46 an acidified dialysis fluid and in the other position of the switching mechanism 45, 46 an alkalized dialysis fluid and the dialysate transported by the second regeneration pump 40 through the fluid path 44 to the second detoxification unit 34 is within the one switching position of the switching mechanism 45, 46 an alkalized dialysis fluid and in the other position of the switching mechanism 45, 46 an acidified dialysis fluid. However, change of acidification or alkalization of the dialysis fluids may occur every 1 to 60 min depending on the acid and base used and the mechanism applied. Switching may be performed automatically or individually by the user. Change of supplied solution every 1 to 25, preferably every 1 to 14 min may be preferred for certain applications.

[1237] Depending on the filtration type, the precipitated substances can cause an occlusion of the detoxification units 33, 34 by blocking the pores of the detoxification unit 33, 34. To avoid this, the detoxification units 33, 34 are alternated: the detoxification unit that is in one time period e.g. for 30 min the acidic detoxification unit is in the following time period e.g. 30 min used in the alkaline flow path. This means that then precipitated substances are solved and removed with high concentration by filtration or dialysis. This also enables continuous use of the detoxification units over a long time period.

[1238] The switching of the detoxification units 33, 34 may e.g. be done manually, or by a valve mechanism that is electronically controlled. The switching may be performed at different locations in the fluid circuit, e.g. being directly upstream of the detoxification units 33, 34 or within the supply flow paths 47 - 50.

[1239] For removing fluids and toxins from the detoxification units 33, 34, the system comprises at least two filtrate pumps 35, 36 operative to remove discharge fluids 72 from the detoxification units 33, 34. For balancing the volumes of the different fluids, the system DTS Ref: 40247.ADT.P110PC 02.12.2025

[1240] - 107 - may comprise a plurality of scales 74 adapted for constantly measuring the fluid volume - weight and known density - of the discharge fluids 72 and of the added fluids 66, 68, 69, 70 comprised within a fluid bag and or container 73. And considering the flow and density of the added acid 65 and of the added base 67. Downstream of the detoxification units 33, 34 the flow of regenerated acidified dialysate obtained at the outflow of one of the detoxification units is merged 37 with the flow of regenerated alkalized dialysate obtained at the outflow of the other detoxification unit. Prior the merging point 37 mechanisms to adjust the pressure 31 , 32 within the detoxification units 33, 34, are placed. These mechanisms are preferably proportional valves or variably adjustable flow resistors 31 , 32. By adjusting the flowrates of the pumps 39, 40, 47 - 50 of the fluids going into the detoxification units 33, 34 and the flowrates of the fluids going out 35, 36 and adjusting the pressure within the detoxification units 33, 34 the pressure over the membrane could be adjusted. This has and influence on the removal of toxins and liquid from the dialysis fluid. By merging the acidified flow with the alkalized flow, the acid and the base neutralize each other, and a flow of regenerated dialysate with a pH in the range between 6 and 11 more preferably 6.8 and 10.5 is generated. The regenerated dialysate may be supplied to the dialyzers 10. Preferably, in the first regeneration flow path 43 and in the second flow path 44, acids or bases are added whose conjugate bases or acids are ions that occur naturally in the human organism. Thus, it is made sure that the regenerated dialysate obtained by merging the acidified flow of dialysate and the alkalized flow of dialysate does not contain any non- physiological substances. Upstream of the supplied permeate there is optionally a fifth gas separator 55, a heat exchanger 64, third heater 62, a seventh pump 60 preferably including a upstream orifice, a de aeration and recirculation reservoir 54 a recirculation circuit 63 including and an eleventh sensor 61 preferably a temperature, conductivity and pressure sensor. The goal is to suck fresh supply water into the device, generate a goal temperature of the liquid, remove remaining gases and supply it to the device.

[1241] The supplied and treated fresh water is then mixed with the dialysis concentrates 65, 67 and or optionally 66, 68 each in a flow path prior to the switching mechanism 45 ,46 by setting the flow rates of the supply pumps 47 - 50 to a dedicated mixing ratio flow rate. Whereas the dialysis concentrates 65, 66 are preferably an acidic solution, and the dialysis concentrates 67, 68 are preferably an alkaline solution. Whereas the dialysis DTS Ref: 40247.ADT.P110PC 02.12.2025

[1242] - 108 - concentrates 65, 67 and or optionally 66, 68 could also be a neutral electrolyte solution for dialysis and weather there might just be one connected solution necessary. Prior to mixing the treated fresh water 70 with the dialysis concentrates 67 and or optionally 68 a saturated electrolyte solution 69 could be added via the mixing point 59. Whereas the ratio between treated fresh water 70 and saturated electrolyte solution 69 is adjusted via a mixing mechanism 59 preferably proportional valves and whereas the saturated electrolyte solution 69 is preferably a bicarbonate solution. Preferably the added liquids to the device are all passed through gas separators 51 - 57 to avoid the addition of any gasses to the dialysis fluids. The fluids 66, 68, 69, 71 , 72 are preferably within one single and disposable fluid bag 73 whereas this fluid bag 73 preferably contains different compartments within this single fluid bag for each of the liquids. Whereas the fluids 66,68, 69 might be placed as powders within the fluid bag and then mixed within the bag by sucking water through the fluid connections 71 , 79 into the powder compartment and therefore generation a saturated solution. This fluid bag preferably has the capacity to contain fluids for 6 hours, more preferably for 8, 12, 24, 72 hours depending on the flowrates of the pumps and fluid being exchanged with the device. As the weight and size of the flid bag might be too big for carrying it by hand it might preferably be carried within a movable container 73. This container is preferably be placed on a scale 74 and / or a plurality of scales to measure the weight and change of weight and volume of the fluids placed within the disposable fluid bag and container 73. This measured values therefore control the balancing of the patient 1.

[1243] DTS Ref: 40247.ADT.P110PC 02.12.2025

[1244] - 109 -

[1245] Reference Numerals

[1246] 1 patient

[1247] 2 first blood line

[1248] 3 first blood line infusion connection

[1249] 4 first reservoir; citric solution; first infusion solution fluid bag

[1250] 5 first sensor; sensor system

[1251] 6 first infusion pump

[1252] 7 second sensor

[1253] 8 blood pump; blood flow

[1254] 9 third sensor

[1255] 10 dialyzer

[1256] 10A dialyzer

[1257] 10B dialyzer

[1258] 11 fourth sensor

[1259] 12 second blood line infusion connection; dialysate pump

[1260] 13 second reservoir; calcium solution; second infusion solution; fluid bag

[1261] 14 fifth sensor; sensor system

[1262] 15 second infusion pump

[1263] 16 second blood line

[1264] 17 sixth sensor; value

[1265] 18 first dialysate pump

[1266] 19 dialysate inlet; fluid flow

[1267] 19A dialysate connection

[1268] 20 dialysate outlet DTS Ref: 40247.ADT.P110PC 02.12.2025

[1269] - 110 -

[1270] 20A dialysate connection

[1271] 21 second dialysate pump; sensor

[1272] 22 first bypass valve

[1273] 22A second bypass valve

[1274] 22B third bypass valve

[1275] 23 first heater

[1276] 24 seventh sensor; value

[1277] 25 third reservoir

[1278] 26 fourth reservoir, infusion solution; fluid bag

[1279] 27 first metering pump

[1280] 28 sensor system

[1281] 29 single pass outlet valve

[1282] 30 first fluid connection

[1283] 31 fourth valve

[1284] 32 fifth valve

[1285] 33 first filter, first detoxification unit

[1286] 34 second filter, second detoxification unit

[1287] 35 first waste pump; filtrate pump

[1288] 36 second waste pump; filtrate pump

[1289] 37 valve circuit; mixing point

[1290] 38 valve circuit; second heater

[1291] 39 first regeneration pump

[1292] 40 second regeneration pump

[1293] 41 eighth sensor; value

[1294] 42 ninth sensor; value DTS Ref: 40247.ADT.P110PC 02.12.2025

[1295] - 111 -

[1296] 43 first regeneration circuit; fluid path

[1297] 44 second regeneration circuit; fluid path

[1298] 45 first switching valve; switching mechanism

[1299] 46 second switching valve; switching mechanism

[1300] 47 second metering pump

[1301] 48 third metering pump

[1302] 49 fourth metering pump

[1303] 50 fifth metering pump

[1304] 51 first gas separator

[1305] 52 second gas separator

[1306] 53 third gas separator; bicarbonate path

[1307] 54 fourth gas separator; permeate path; recirculation reservoir

[1308] 55 fifth gas separator

[1309] 56 sixth gas separator; reservoir

[1310] 57 seventh gas separator

[1311] 58 tenth sensor; value

[1312] 59 control mechanism; mixing mechanism

[1313] 60 seventh pump; heater

[1314] 61 eleventh sensor

[1315] 62 third heater

[1316] 63 circuit

[1317] 64 heat exchanger

[1318] 65 fifth reservoir; dialysis concentrate; acid solution; concentrate container

[1319] 66 acid powder; first powder bag; sixth reservoir; electrolyte solution

[1320] 67 seventh reservoir; dialysis concentrate; base solution; concentrate container DTS Ref: 40247.ADT.P110PC 02.12.2025

[1321] - 112 -

[1322] 68 alkaline powder; second powder bag; eighth reservoir; electrolyte solution

[1323] 69 chamber for bicarbonate; third powder bag; ninth reservoir

[1324] 70 chamber for permeate; permeate bag; tenth reservoir

[1325] 71 fluid connection; first fluid compartment

[1326] 72 fluid compartment; chamber for waste fluid

[1327] 73 container; balancing device; fluid bag

[1328] 73A receiving space; fluid bag

[1329] 74 scale; weighing means, load cell

[1330] 75 fluid connection block

[1331] 76 second fluid connection

[1332] 77 sixth pump

[1333] 78 twelfth sensor

[1334] 79 connection point

[1335] 80 thirteenth sensor; value

[1336] 81 fourteenth sensor; value

[1337] 82 fifteenth sensor

[1338] 83 sixteenth sensor

[1339] 84 seventeenth sensor

[1340] 86 sixth valve

[1341] 87 third filter

[1342] 100 dialysis device

Claims

DTS Ref: 40247.ADT.P110PC 02.12.2025- 113 -Claims1 . A fluid treatment patient system for a patient (1 ), comprising at least one protein dialysis circuit to remove water soluble and protein bound toxins, especially wherein the protein is preferably albumin, wherein the dialysis circuit comprises at least one or two dialyzers (10A, 10), wherein the circuit is configured to perform the dialysis at least such that a continuous recirculation and purification of the protein containing dialysate, preferably albumin containing dialysate, is performed, especially wherein these treatments are preferably performed with two dialyzers (10) or one single dialyzer (10A), and wherein the membrane areas is sufficient for toxin elimination.

2. A fluid treatment patient system for a patient (1 ), according to claim 1 , comprising an independent pH control module, wherein the pH control module is configured to regulate the pH of a patient (1) by carbon dioxide level of the patient (1) in the blood.

3. A fluid treatment patient system for a patient (1), according to claim 1 or claim 2, comprising an independent adjustment module, the adjustment module being configured and arranged for the adjustment of the Bicarbonate (HCO3- / Bic) concentration within the dialysate passing through the dialyzers (10) an getting in contact with the patients (1) blood through the extracorporeal blood circuit - remove carbon dioxide (CO2) from the patients’ blood and adjust the acid-base balance of the patient (1).

4. A fluid treatment patient system for a patient (1), according to one of the preceding claims, comprisingDTS Ref: 40247.ADT.P110PC 02.12.2025- 114 - an independent adjustment module of the buffering capacity of the dialysate by modifying the buffering agents and their concentrations therefore within the dialysate that passes through the dialyzers (10) and getting in contact with the patient (1) blood through the extracorporeal blood circuit - wherein the system is preferably used to adapt the toxin extraction rates from the patient’s blood to the dialysate.

5. A fluid treatment patient system for a patient (1), according to one of the preceding claims, characterized in that the system is capable to perform a dialysis (RRT including iHD, SLED, CVVHD) where no extra protein is added to the dialysate and preferably mainly water- soluble toxins are removed.

6. A fluid treatment patient system for a patient (1), according to one of the preceding claims, characterized in that the dialysis is performed with single pass dialysate flow, partly single pass dialysate flow and / or recirculating dialysate flow where the recirculated dialysate could be diluted and partially removed.

7. A fluid treatment patient system for a patient (1), according to one of the preceding claims, characterized in that the treatment is performed with one dialyzer (10A) whereas the membrane area chosen for the treatment is preferably small but still sufficient for toxin elimination.

8. A fluid treatment patient system for a patient (1), according to one of the preceding claims, characterized in thatDTS Ref: 40247.ADT.P110PC 02.12.2025- 115 - the purifying the dialysate is performed optionally additional filters (33, 34, 87) but preferably the treatment is performed without additional filters (33, 34, 87).

9. A fluid treatment patient system for a patient (1), according to one of the preceding claims, characterized in that the treatment is performed with variation of the proportion of recycled dialysate from complete recirculation to single pass preferred for iHD.

10. A fluid treatment patient system for a patient (1), according to one of the preceding claims, characterized in that the treatment is performed with one or two dialyzers (10) and one or two filters (33, 34) can be used to purify the dialysate.

11. A fluid treatment patient system for a patient (1), according to one of the preceding aspects, characterized in that the system comprises at least one switch system, especially a cross switch for regeneration of at least a part of the fluids, especially of the dialysate, preferably the albumin in the dialysate and / or to clean at least partially filter membranes.

12. A fluid treatment patient system for a patient (1), according to one of the preceding claims, characterized in that the system comprises at least one control mechanism preferably proportional valves adjust the amount of fluid pumped on the one hand from the bicarbonate path (53) and on the other hand from the permeate path (54), especially whereby the ratio of bicarbonate solution and bicarbonate solution is adjusted according to a sensor (5, 7, 9, 11 , 14, 17, 21 , 24, 28, 41 , 42, 58, 61 , 78, 80, 81 , 82, 83, 84)DTS Ref: 40247.ADT.P110PC 02.12.2025- 116 - preferably a conductivity sensor (17, 24, 58, 61 , 80, 81 , 82, 83, 84) measuring the conductivity of the fluid.

13. A fluid treatment patient system for a patient (1), according to one of the preceding claims, characterized in that the system comprises at least one sensor (5, 7, 9, 11 , 14, 17, 21 , 24, 28, 41 , 42, 58, 61 , 78, 80, 81 , 82, 83, 84) preferably a conductivity sensor (17, 24, 58, 61 , 80, 81 , 82, 83, 84) measuring the conductivity of the fluid.

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