Dialysis Treatment

&
NUC-18 Online HDF Machine

NIPRO CORPORATION, JAPAN

Mahendra Gunatilake
Regional Technical Manager,
Nipro Asia Pte Ltd, Singapore

21 Dec 2018, Jakarta

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Providing intelligent therapy for all
Patient
• Treatment efficacy and safety
• Fluid balance and hypotension management
• Comfort and Quality of life

Nephrologist
• Treatment efficacy and safety
• Innovative treatment options
• Medical staff satisfaction

Nurses and Medical staff

• Advance monitoring options
• Patient safety
• User friendly

Biomedical Engineer
• Reliability
• Machine assistance troubleshooting
• Easy maintenance

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Background of dialysis
treatment
➢Uremic Toxins
➢Optimisation of treatment
➢Treatment techniques

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Uremic toxins

Dr. Lemke at ExcorLab, Germany

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 Options and variables
Technology
 Low Flux dialysis
 High Flux dialysis
 Single use dialyzer
 Length of dialysis
 Frequency of dialysis
 Dialysis Dose (Kt/V)
 Intradialytic length
 Ultrafiltration rate
 Dialysis membrane – dialyzer
 Purification of dialysate (ultrapure dialysate)
 High volume online HDF

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 Hemo-dialysis
 Most popular blood purification method
 4 to 5 hours per treatment
 3 times per week
 Conducted by two principals using a dialyzer
Diffusion
Ultrafiltration.
 Solutes remove by concentration difference & molecular weight
 High removal rate of small molecules

透析液

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 Hemo-filtration
 Conducted by ultrafiltration.
 Using Hemofilter (relatively large pore size of membrane.)
 Solutes remove by large pores with ultrafiltration force.
 Higher removal of middle molecules than HD.
 Large volume of replacement fluid.
 HF commonly used for acute & multiple organ failure
conditions.
P

濾過液
補充液
P

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 Hemo-diafiltration (HDF)
 Combination of HD and HF.
 Using High-flux dialyzer.
 Higher removal rate of small and middle molecules.
 Relatively popular in general dialysis centers in developed
countries.
 Commonly used for patient who has amyloidosis,
cardiovascular disease and hemodynamically unstable.
P

透析液
補充液

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 Hemodiafiltration
HDF Methods
Type of replacement

 Online HDF
 Off Line HDF or conventional HDF

Dilution Method

 Pre Dilution
 Post Dilution

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 Hemodiafiltration
Online & Offline HDF
Pre dilution 前希釈

後希釈 Post dilution

• On-line HDF • Off-line HDF

Replacement fluid is taken from Replacement fluid is taken from
dialysate. ready made bags.

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 Hemodiafiltration
Pre & Post dilution

補充液

補充液

• Pre dilution • Post dilution

• Replacement fluid is infused • Replacement fluid is infused
before filter. after filter.

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 Hemodiafiltration
Difference between Pre & Post dilution

Pre dilution On-line HDF

➢ High volume of replacement fluid can be infused.

Advantage
➢ Filter performance will be maintain throughout treatment.
➢ Reduce blood coagulation.

Disadvantage
➢ Low removal efficiency due to low concentration difference.

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 Hemodiafiltration
Difference between Pre & Post dilution

Post dilution On-line HDF

Volume of replacement fluid is limited (5～30L)

Advantages
➢ Higher solute removal
➢ Better clearance

Disadvantages
➢ Higher possibility of deterioration of filter throughout treatment

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 Hemodiafiltration
Advantages of online HDF treatment
➢ Higher reduction of amyloidosis
Joint pain
Nervous
Sleeping difficulties
Less appetite
Anemia.

➢ Improve anemia condition

Removal of anti EPO response substances
Increase of RBC life time.

➢ Improve of nutrition condition

Removal of anti appetite substances.

➢ Stable blood pressure during treatment

Hypertensive drugs can be reduced.
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 Hemodiafiltration
Advantages of online HDF treatment

• Online HDF will improve quality of life for the patients

• Online HDF machines

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Nipro online HDF
machine

NCU-18

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Nipro online HDF machine NCU-18

 Flexibility
 User friendly & Safety
 Hygiene and disinfection
 Automatic priming & reinfusion
 IC card & Network system

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 Basic design

Available as Blood Pump

HD
and Sub Pump

HDF
Machine

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 Flexibility
• HD double needle
• HD single needle
• Online HDF double needle
Pre or post dilution
• Online HDF single needle
Pre or post dilution
• Online HF
Pre or post dilution
• SQUF (Sequential UF)

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 Flexibility
• Dialysate flow
100ml/min to 800ml/min

• Advanced accurate Kt/V calculation

"Dose finder“

• Profiling UF, Na and Bicarbonate

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 User Friendly
• Easy selection of treatments
HD, OHDF, OHF, SLED
• Auto preparation process
• Auto priming and reinfusion
• Assisted blood line changes
• Bicarbonate cartridge change in all
phases of operation
• Auto on/off
• Emergency button ✚

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 Automatic priming & reinfusion

Automatic function by saline

or dialysate

• Automatic priming
• Automatic reinfusion
• Automatic drainage

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 Unique Feature
CTS – Clean Treatment Starts

• No fluid intake for patient

• Simultaneous Arterio-Venous patient connection

Conventional CTS
connection (Clean Treatment Start)

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Smart Option for Acute Therapy

One single machine in

acute dialysis centers can provide
• SLED (Sustained Low Efficiency Dialysis)
• HDF / HF

with
• Dialysate flow 100 mL/min ～
• Substitution flow 10ml/min ～
• Treatment up to 24 hours

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Dose Finder
• Data input for Female
Size[cm]
Weight[kg]

• Data input for Male

Size[cm]
Weight[kg]
Age[years]

• 8 patients can be registered

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 Dose Finder
To predict real Kt/V at the end of treatment

Daugirdas Dose Finder (Kt/V)

•Patented dynamic correction
Dose Finder

Calculated
factors for optimal accuracy
•No pre-set data from
dialyzers used…
•Results validated in-vivo
(>1000 treatments)
•Kt/V prediction after 5 min

Kt/V variation depending on measurement methods

Kt/Vd: Gaussian distribution for Kt/V values ​calculated according to Daugirdas
Kt/Vkk: Gaussian distribution for Kt/Vk - values ​corrected with the dose factors Finder
Kt/Vk: Gaussian distribution for Kt/V calculation with the set machine blood flow (QBN)

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 Profiling

 7 patterns can be stored

 A pro and B pro can be used at a same time
 SQUF is available during UF profile

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Automatic Blood Pressure Monitor
•Periodical & Manual activation
•Quick emergency function
Constant measurement in case of emergency
•Automatic feedback control
associated with:
•UF Rate
•Blood pump speed
•Bypass
•Alarm/Nurse call

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Network Interface

• Output data to PC via network cable

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Patient Card

• Patient prescription settings will be stored in

patient card.

• Treatment settings will be transferred to NCU-

18 via patient card.

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 Hygiene & disinfection

• Arterial and venous drip chamber level control*

• ETRF filter for dialysate, CF-609N*
• Leak check function for Online HDF filter CF-609N*
• Bicarbonate cartridge function*
• Heat disinfection
• Automatic disinfection programs
• Sheath-type dialysis concentration suction

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Hygiene & disinfection
Endotoxin Filter

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Hygiene & disinfection
Bicarbonate Cartridge

• cartridge change in all phases of

operation .

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Disinfection

Disinfectant:
• Hot Citric acid (39 min)
• Sodium hypochlorite (41 min)

Features:
• Weekly disinfection program
• In-line heat
• Disinfection history
• Low disinfectant consumption

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 TERIMA KASIH
for your kind attention!

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