Dialysate Sodium Regimen for Hypotension and Overhydration Control
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Solution Overview
Problem
During hemodialysis, the rapid removal of fluid from the blood can lead to a decrease in blood pressure, and intradialytic salt administration to counteract this results in increased thirst and overhydration, necessitating larger fluid removal in subsequent sessions, creating a cycle that is difficult to manage.
Innovation Solution
A method and system for determining and adjusting the diffusive sodium balance between the blood and dialysis liquid to achieve a target sodium balance over multiple sessions, using a control device to manage the sodium concentration in the dialysis liquid and ultrafiltration volume, allowing for stepwise reduction of sodium balance and ultrafiltration volume to stabilize blood pressure and fluid balance.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Quantity of substance
If fluid is rapidly removed from blood during dialysis to treat overhydration, then overhydration is reduced, but blood pressure decreases and may drop critically
Solution Approach 1:
The system performs preliminary actions by adjusting treatment parameters before critical blood pressure drops occur. It monitors blood pressure trends and proactively modifies ultrafiltration rates or dialysis liquid composition to prevent hypotension, rather than waiting for critical drops to occur
Solution Approach 2:
The system implements continuous feedback control by monitoring blood pressure, fluid balance, and patient symptoms in real-time. This feedback loop allows dynamic adjustment of ultrafiltration rates and dialysis parameters to maintain blood pressure within safe ranges while still achieving fluid removal goals
2Stress or pressure
If salt concentration in dialysis liquid is increased to counteract blood pressure drop, then blood pressure is stabilized, but thirst increases and overhydration worsens
Solution Approach 1:
The system dynamically adjusts dialysis liquid composition and ultrafiltration parameters based on real-time patient status. Rather than using fixed high salt concentrations, it modulates sodium levels and fluid removal rates adaptively to stabilize blood pressure without causing excessive thirst or overhydration
Solution Approach 2:
The system changes multiple treatment parameters simultaneously and dynamically, including ultrafiltration rate, dialysis liquid flow rate, and sodium concentration, to achieve blood pressure stabilization through coordinated parameter optimization rather than relying solely on salt administration
3Stress or pressure
If intradialytic salt administration is used to maintain blood pressure, then blood pressure drops are counteracted, but thirst increases leading to increased liquid ingestion and overhydration
Solution Approach 1:
The system replaces the mechanical/chemical approach of salt administration with a control-based approach. It uses automated monitoring and adjustment of ultrafiltration rates and dialysis parameters to stabilize blood pressure through physiological control rather than pharmacological or chemical intervention
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
This approach helps stabilize blood pressure, reduces intradialytic complications, and minimizes the need for intradialytic salt administration, allowing for more controlled fluid management and reduced patient vulnerability to symptoms like blood pressure drops and convulsions.
Implementation Method 1
The blood filter comprises a blood chamber through which blood is led, and a dialysis liquid chamber, through which dialysis liquid is led. Both chambers are separated from each other by a semi-permeable membrane.
Implementation Method 2
Blood and dialysis liquid are mostly guided by the counter current principle through the blood filter.
Implementation Method 3
In addition to the dialysate, the fluid to be discarded also comprises filtrate, which comprises water which was withdrawn from the blood in the blood filter.
Implementation Method 4
This may be partially counteracted by increasing the salt concentration in the blood diffusive salt transfer in the dialyzer.
Data Source
AI summary
A method for determining a treatment regimen for altering the treatment parameters when dialyzing a patient over a plurality of treatment sessions taking place on future days includes determining a diffusive total target sodium balance; and determining a transitional treatment regimen by which the diffusive total target sodium balance is achieved over the plurality of future treatment sessions. A control device or closed-loop control device is configured to control a blood treatment apparatus using the method.