Method for the determination of at least one characteristic figure relating to a patient's glucose metabolism, and apparatus therefor

Patent metadata

Field	Value
Publication number	US-10226562-B2
Application number	US-74241508-A
Country	US
Kind code	B2
Filing date	Nov 11, 2008
Priority date	Nov 12, 2007
Publication date	Mar 12, 2019
Grant date	Mar 12, 2019

Abstract

The present invention relates to a method for detecting at least one characteristic relating to a patient's glucose metabolism, having steps to be performed during an extracorporeal treatment of the patient's blood, particularly during a dialysis treatment, of the extracorporeal addition of glucose and/or insulin and extracorporeal measurement of a glucose concentration and/or an insulin concentration. The invention further proposes a corresponding device. In addition, the invention proposes a method for determining the composition of the dialysate for the extracorporeal treatment of a patient's blood having the steps of determining a glucose level in the patient's blood during the dialysis session and adapting the amount of glucose added to the dialysate or blood based on the glucose level determined. To this end, the invention proposes a corresponding device. The invention further proposes a blood treatment device.

First claim

The invention claimed is:

1. A method, comprising:
starting a hemodialysis, hemofiltration, or hemodiafiltration treatment of a patient using a blood treatment apparatus, a dialysate circuit, and an extracorporeal blood circuit;
adding, during the treatment, a particular quantity of glucose to the extracorporeal blood circuit to mix with blood of the patient;
after the adding, measuring glucose concentration values at different points in time during the treatment, wherein the measuring is performed at least in part by one or more sensors measuring the blood of the patient at one or more locations along the extracorporeal blood circuit;
adjusting, during the treatment, a glucose concentration of a dialysate liquid within the dialysate circuit such that a glucose shift across a dialysis filter is reduced;
characterizing, using the blood treatment apparatus, the patient's metabolization of the particular quantity of glucose based on: (i) the measured glucose concentration values, (ii) the different points in time that the glucose concentration values were measured, and (iii) the particular quantity of glucose added to the extracorporeal blood circuit;
outputting, using the blood treatment apparatus, a result of the characterizing; and
detecting diabetes or a pathological glucose tolerance of the patient based on the result of the characterizing.

2. The method according to claim 1 , further comprising:
changing the glucose concentration of the dialysate liquid while monitoring the measured glucose concentration.

3. The method according to claim 2 , wherein a change in the glucose concentration of the dialysate liquid is used to determine at least one characteristic figure relating to the patient's metabolization of the particular quantity of glucose.

4. The method according to claim 1 , wherein the characterizing the patient's metabolization of the particular quantity of glucose includes determining a glucose shift across the dialysis filter after the extracorporeal addition of glucose, wherein the glucose shift across the dialysis filter is used to determine at least one characteristic figure relating to the patient's metabolization of the particular quantity of glucose.

5. The method according to claim 1 , wherein the extracorporeal addition of glucose includes an addition on at least one of a dialysate side and on a substituate side.

6. The method according to claim 1 , wherein at least one of a) the addition of the particular quantity of glucose and b) the measuring of the glucose concentration values is automated.

7. The method according to claim 1 , wherein the adjusting the glucose concentration of the dialysate liquid comprises:
adjusting the glucose concentration of the dialysate liquid within the dialysate circuit in coordination with the measured glucose concentration of the blood of the patient such that the glucose shift across the dialysis filter is reduced.

8. A method, comprising:
starting a hemodialysis, hemofiltration, or hemodiafiltration treatment of a patient using a blood treatment apparatus, a dialysate circuit, and an extracorporeal blood circuit;
adding, during the treatment, a particular quantity of at least one of a) glucose and b) insulin to the extracorporeal blood circuit to mix with blood of the patient;
after the adding, measuring at different points in time during the treatment a concentration of at least one substance comprised of at least one of a) glucose and b) insulin, wherein the measuring is performed at least in part by one or more sensors measuring the blood of the patient at one or more locations along the extracorporeal blood circuit;
adding, during the treatment, at least one of a) glucose and b) insulin to the dialysate circuit such that a glucose shift or an insulin shift across a dialysis filter is reduced;
characterizing, via the blood treatment apparatus, the patient's metabolization of the particular quantity of the at least one of a) glucose and b) insulin by evaluation of a curve over time that is based on: (i) the measured concentration of the at least one substance, (ii) the different points in time that the concentration of the at least one substance was measured, and (iii) the particular quantity of the at least one of a) glucose and b) insulin added to the extracorporeal blood circuit;
outputting, using the blood treatment apparatus, a result of the characterizing; and
detecting diabetes or a pathological glucose tolerance of the patient based on the result of the characterizing.

9. The method according to claim 8 , further comprising:
changing a dialysate glucose concentration while monitoring the measured concentration.

10. The method according to claim 9 , wherein a change in the dialysate glucose concentration is used for determination of at least one characteristic figure relating to the characterizing the patient's metabolization of the particular quantity of the at least one or a) glucose and b) insulin.

11. The method according to claim 9 , further comprising:
determining the glucose shift across the dialysis filter after the adding of the particular quantity of at least one of a) glucose and b) insulin, wherein the glucose shift across the dialysis filter is used for determination of at least one characteristic figure relating to the characterizing the patient's metabolization of the particular quantity of the at least one or a) glucose and b) insulin.

12. The method according to claim 8 , wherein at least one of a) the addition of the particular quantity of at least one of glucose and insulin, and b) the measuring the concentration of at least one substance comprised of at least one of glucose and insulin is automated.

13. The method according to claim 8 , further comprising:
displaying at least one determined characteristic figure relating to the result of the characterizing.

14. A hemodialysis, hemofiltration, or hemodiafiltration system, comprising:
an extracorporeal blood circuit for circulating blood of a patient during a hemodialysis, hemofiltration, or hemodiafiltration treatment;
a dialysate circuit for circulating dialysate liquid during the hemodialysis, hemofiltration, or hemodiafiltration treatment;
a dialyzer comprising a dialyzer membrane and defining a blood chamber in fluid communication with the extracorporeal blood circuit and a dialysate chamber in fluid communication with the dialysate circuit;
a measurement instrument configured to extracorporeally measure, at different points in time during the hemodialysis, hemofiltration, or hemodiafiltration treatment, at least one of glucose concentration and insulin concentration of the blood of the patient at one or more locations along the extracorporeal blood circuit;
a first input line configured for extracorporeally adding at least one of glucose and insulin during the hemodialysis, hemofiltration, or hemodiafiltration treatment to the extracorporeal blood circuit to mix with the blood of the patient;
a second input line configured for adding at least one of glucose and insulin to the dialysate circuit such that a glucose shift or an insulin shift across the dialyzer membrane is reduced;
a blood treatment apparatus configured for characterizing the patient's metabolization of a particular quantity of glucose or insulin added to the extracorporeal blood circuit based on: (i) glucose or insulin concentrations measured by the measurement instrument, (ii) differing points in time at which the glucose or insulin concentrations were measured by the measurement instrument, and (iii) the particular quantity of glucose or insulin added to the extracorporeal blood circuit; and
an output for p

Assignees

• Schulte Elke
• Mueller Carsten
• Fresenius Medical Care Deutschland Gmbh

Inventors

• Schulte Elke
• MüLLER CARSTEN

Classifications

• A61M1/1609

  after use, i.e. downstream of dialyser · CPC title

• C12Q1/54

  involving glucose or galactose · CPC title

• A61M1/3434

  with pre-dilution and post-dilution · CPC title

• A61M1/34

  Filtering material out of the blood by passing it through a membrane, i.e. hemofiltration or diafiltration · CPC title

• A61M1/3437

  downstream of the filter, e.g. post-dilution with filtrate · CPC title