Abstract:
A dialysis system includes: a portable device configured to be carried by a patient and to read a marking displayed on a dialysis fluid container, the device obtaining data concerning at least one of a dialysis fluid type and a dialysis fluid volume from the marking; the device defined dialysate dwell time, alert patients for the next exchange and further configured to transfer the data to a computer; and wherein the computer is configured to use the data to track therapy progress of the product.

Description:
PRIORITY CLAIM 
       [0001]    This application claims priority to and the benefit of U.S. Provisional Patent Application Ser. No. 61/252,363 filed on Oct. 16, 2009, the entire disclosure of which is hereby incorporated by reference. 
     
    
     BACKGROUND 
       [0002]    The present disclosure relates to medical fluid delivery and in particular to a peritoneal dialysis (“PD”) therapy. 
         [0003]    Due to various causes, a person&#39;s renal system can fail. Renal failure produces several physiological impairments and difficulties. The balance of water, minerals and the excretion of daily metabolic load is no longer possible and toxic end products of nitrogen metabolism (urea, creatinine, uric acid, and others) can accumulate in blood and tissue. Kidney failure and reduced kidney function have been treated with dialysis. Dialysis removes waste, toxins and excess water from the body that would otherwise have been removed by normal functioning kidneys. Dialysis treatment for replacement of kidney functions is critical to many people because the treatment is life saving. 
         [0004]    Hemodialysis and peritoneal dialysis are two types of dialysis therapies used commonly to treat loss of kidney function. A hemodialysis (“HD”) treatment utilizes the patient&#39;s blood to remove waste, toxins and excess water from the patient. The patient is connected to a hemodialysis machine and the patient&#39;s blood is pumped through the machine. Catheters are inserted into the patient&#39;s veins and arteries so that blood can flow to and from the hemodialysis machine. The blood passes through a dialyzer of the machine, which removes waste, toxins and excess water from the blood. The cleaned blood is returned to the patient. A large amount of dialysate, for example about 120 liters, is consumed to dialyze the blood during a single hemodialysis therapy. Hemodialysis treatment lasts several hours and is generally performed in a treatment center about three or four times per week. 
         [0005]    Peritoneal dialysis uses a dialysis solution, also called dialysate, which is infused into a patient&#39;s peritoneal cavity via a catheter. The dialysate contacts the peritoneal membrane of the peritoneal cavity. Waste, toxins and excess water pass from the patient&#39;s bloodstream, through the peritoneal membrane and into the dialysate due to diffusion and osmosis, i.e., an osmotic gradient occurs across the membrane. The spent dialysate is drained from the patient, removing waste, toxins and excess water from the patient. This cycle is repeated. 
         [0006]    There are various types of peritoneal dialysis therapies, including continuous ambulatory peritoneal dialysis (“CAPD”), automated peritoneal dialysis (“APD”), tidal flow APD and continuous flow peritoneal dialysis (“CFPD”). CAPD is a manual dialysis treatment. The patient manually connects an implanted catheter to a drain, allowing spent dialysate fluid to drain from the peritoneal cavity. The patient then connects the catheter to a bag of fresh dialysate, infusing fresh dialysate through the catheter and into the patient. The patient disconnects the catheter from the fresh dialysate bag and allows the dialysate to dwell within the peritoneal cavity, wherein the transfer of waste, toxins and excess water takes place. After a dwell period, the patient repeats the manual dialysis procedure, for example, four times per day, each treatment lasting about an hour. Manual peritoneal dialysis requires a significant amount of time and effort from the patient, leaving ample room for improvement. There is room for improvement in the selection of dwell times for each patient. 
         [0007]    Automated peritoneal dialysis (“APD”) is similar to CAPD in that the dialysis treatment includes drain, fill, and dwell cycles. APD machines, however, perform the cycles automatically, typically while the patient sleeps. APD machines free patients from having to manually perform the treatment cycles and from having to transport supplies during the day. APD machines connect fluidly to an implanted catheter, to a source or bag of fresh dialysate and to a fluid drain. APD machines pump fresh dialysate from a dialysate source, through the catheter, into the patient&#39;s peritoneal cavity, and allow the dialysate to dwell within the cavity, and allow the transfer of waste, toxins and excess water to take place. The source can be multiple sterile dialysate solution bags. 
         [0008]    APD machines pump spent dialysate from the peritoneal cavity, though the catheter, to the drain. As with the manual process, several drain, fill and dwell cycles occur during APD. A “last fill” occurs at the end of CAPD and APD, which remains in the peritoneal cavity of the patient until the next treatment. Both CAPD and APD are batch type systems that send spent dialysis fluid to a drain. Tidal flow systems are modified batch systems. With tidal flow, instead of removing all of the fluid from the patient over a longer period of time, a portion of the fluid is removed and replaced after smaller increments of time. 
         [0009]    Continuous flow, or CFPD, systems clean or regenerate spent dialysate instead of discarding it. These systems pump fluid into and out of the patient, through a loop. Dialysate flows into the peritoneal cavity through one catheter lumen and out another catheter lumen. The fluid exiting the patient passes through a reconstitution device that removes waste from the dialysate, e.g., via a urea removal column that employs urease to enzymatically convert urea into ammonia. The ammonia is then removed from the dialysate by adsorption prior to reintroduction of the dialysate into the peritoneal cavity. 
         [0010]    In each of the kidney failure treatment systems discussed above, it is important to control ultrafiltration, which is the process by which water (with electrolytes) moves across a membrane, such as a dialyzer or peritoneal membrane. For example, ultrafiltration in peritoneal dialysis is a result of transmembrane and osmotic pressure differences between blood and dialysate across the patient&#39;s peritoneal membrane. It is also important to control the concentration of metabolic substances in the patient&#39;s bloodstream, such as urea concentration, β 2 -microglobulin, creatinine concentration, and so forth. Each of these, along with many other variables, constitutes a peritoneal dialysis outcome. 
         [0011]    Each patient is different, possessing for instance, a unique peritoneal membrane, its own separation characteristics, and its unique response to peritoneal dialysis. Each patient is also different with respect to body surface area (“BSA”) and total body water volume, which also have an effect on transport characteristics. Each patient is different in terms of transport characteristics that relate to the ultrafiltration rate. Each patient is also different in terms of response to dialysis, that is, the amount of water and waste removed in a given time period, using a given fill volume, a particular dialysis fluid, and so forth. What is needed is a way to better control the particular dialysis therapy offered to each patient, so that the treatment will yield the best therapy outcome for that patient, for one or more dialysis input parameters 
         [0012]    While APD frees the patient from having to manually performing the drain, dwell, and fill steps, a need still exists for CAPD. Some patients prefer the control that CAPD offers. Since the patient is awake during CAPD, the patient can adjust himself/herself during drain to produce more complete drains. Further, many patients who perform APD also perform a midday exchange using a CAPD technique. 
         [0013]    In optimizing the therapy for both APD and CAPD, the dwell period becomes important. If spent dialysate is permitted to dwell in the patient&#39;s peritoneal cavity too long, solutes and water that have been removed from the patient into the dialysate can reenter the patient&#39;s body. It is accordingly desirable to provide an apparatus and method that prevents such a situation from occurring. 
       SUMMARY 
       [0014]    The present disclosure provides a system, method and device for optimizing a peritoneal dialysis therapy and in particular a dwell period during which a dialysis fluid or solution, sometimes termed dialysate, is allowed to dwell within the patient&#39;s peritoneal cavity. As discussed in the BACKGROUND, if the dialysis fluid is allowed to dwell too long within the patient, solutes and water that the dialysis fluid has removed can reenter the patient. On the other hand, the dialysis fluid should be allowed to dwell within the patient until it is used fully or until the osmotic gradient provided by the dialysis fluid is fully spent. 
         [0015]    The present disclosure sets forth systems, methods and apparatuses for selecting a dwell time for peritoneal dialysis based on an individual patient&#39;s response to dialysis, and also based on one or more peritoneal dialysis input parameters. The dwell time is selected to yield the maximum fluid toxin (e.g. urea, creatinine) removal for that patient based on the dialysis parameters. The embodiments set forth herein allow the optimal dwell time to be determined based on patient&#39;s transport type, gender, height, fill volume and dialysate type, for example. The system alerts the patient to the optimal dwell time. The alert signals to the patient when to drain the spent dialysate to achieve optimal clearance and ultrafiltration (“UF”) removal. 
         [0016]    The system also logs the treatment information and makes such information available to a doctor or clinician, so that (i) the effectiveness of the patient&#39;s prescription and (ii) the patient&#39;s compliance can be identified and monitored, and (iii) the patient&#39;s therapy prescription can modified if needed. In this manner, the system and method of the present disclosure optimizes the patient&#39;s treatment on a local (therapy) level and on integrated (e.g., monthly visits to doctor or clinician) level. 
         [0017]    In one embodiment, the system includes a portable reader, such as key ring, key fob, necklace or device that can be worn on a patient, patient&#39;s belt or be carried in the patient&#39;s pocket. The portable reader includes an optical scanner, such as a barcode scanner, a wireless receiver or reader, such as a radio-frequency (“RFID”) or Bluetooth™ receiver, an output device, such as an audio, visual, mechanical or audiovisual output device, processing and memory. The patient holds the portable reader next to a marking on the dialysis fluid supply container or bag. The marking can for example be a barcode or RFID tag. The barcode identifies the solution type (e.g. dextrose level and/or other chemical characteristics) and/or the solution volume. The wireless receiver of the portable reader also receives the patient&#39;s pre-therapy weight from a weigh scale configured to weigh the patient and send a weight signal, e.g., wirelessly via patient Bluetooth™ emitter to the receiver. Alternatively or additionally, wireless receiver of the portable reader also receives the patient&#39;s pre-therapy blood pressure from a blood pressure cuff or bioimpedance measurement form a bioimpedance device. 
         [0018]    The processing and memory receive the solution and use an algorithm to determine the optimal dwell period, which the output device then communicates to the patient. For example, the portable reader can sound an alarm at the end of the dwell or count down a timer, so that the patient can know during dwell how much time remains before drain. 
         [0019]    The processing and memory also store data for each day&#39;s treatment, such as the solution used, how many bags or total volume and pre- and post-therapy patient weight, blood pressure, blood glucose levels, and therapy dwell times. In a first primary embodiment, the patient brings the portable reader to the doctor&#39;s or clinician&#39;s office every month or periodically. At the office the data from the portable reader is downloaded to the clinician&#39;s/doctor&#39;s computer, e.g., via (i) wireless communication, in which case the portable reader also includes a wireless communication (e.g., Bluetooth™) emitter, or (ii) by plugging the portable reader into the clinician&#39;s computer, in which case the portable reader can include a connector (e.g., retractable) for a computer port (e.g. universal serial bus (“USB”) port). 
         [0020]    In a second primary embodiment, the portable reader records the dialysis solution bag and sends data wirelessly to the patient&#39;s cellular phone, personal electronic mail device or combined device (referred to herein collectively as a personal communication device (“PCD”)). The weight scale sends patient weight data wirelessly to the personal communication device. The PCD includes processing and memory to calculate the optimal dwell. The cellular phone can notify the patient when it is time for drain or send a signal back to the portable reader to alert the patient as described above. In a variation of this second embodiment, the portable reader accepts both solution and weight scale data and stores the algorithm necessary to determine the optimal dwell. The portable reader sends appropriate data wirelessly to the PCD. The PCD downloads the appropriate data to the doctor&#39;s/clinician&#39;s computer and/or to a supply ordering service on a periodic basis, e.g., daily, for patient therapy tracking. Communication between the personal communication device and the doctor&#39;s/clinician&#39;s computer can be via satellite, e.g., via text message. 
         [0021]    In a third primary embodiment, a base station replaces the PCD of the second primary embodiment. Again, the weight scale data, blood pressure, and blood glucose levels can be sent wirelessly to the base station or to the portable reader. One of the base station or the portable reader includes processing and memory configured to determine the optimal dwell time. In one embodiment, the base station signals the portable reader to alert the patient of the optimal dwell time. The base station communicates the appropriate data to the doctor&#39;s/clinician&#39;s computer periodically, e.g., daily. Communication between the base station and the doctor&#39;s/clinician&#39;s computer and, if desired, a supply ordering service, can be via an internet connection. The base station can also serve to charge the portable reader, and thus it is contemplated to have communication between the portable reader and the base station be via direct computer, e.g., via USB link. 
         [0022]    In a fourth primary embodiment, the patient&#39;s PCD replaces the portable scanner of the first three primary embodiments. The personal communication device uses a built-in camera to (i) scan the bag marking and (ii) receive weigh scale data, blood pressure, blood glucose level, bioimpedance measurement, e.g., wirelessly. The PCD communicates the optimal dwell or start drain time to the patient by sounding an alarm, vibrating, providing a visual countdown or some combination thereof. The personal communication device sends therapy log information to the doctor&#39;s/clinician&#39;s computer and/or a supply ordering service, e.g., via satellite communication, e.g., daily. 
         [0023]    It is contemplated that the systems and methods described herein be used with automated peritoneal dialysis (“APD”), however, APD machines typically control the dwell time and begin drain automatically. The therapy login feature is still applicable however, and, many patients who use APD still perform midday exchanges, for which optimal dwell times can be controlled as described above. Moreover, peritoneal dialysis or continuous ambulatory peritoneal dialysis (“CAPD”) is still used by many patients and is one primary modality envisioned for the systems and methods herein described. If the CAPD therapy uses multiple bags, it is contemplated that the patient scan each bag prior to use to ensure that the proper bag is matched with the proper dwell time. 
         [0024]    The present disclosure also includes multiple embodiments for therapy downloading and supply ordering systems and methods. Here, the doctor, nurse or clinician can determine a preferred therapy prescription for the patient and send the prescription to the server. The server manipulates the selected prescription into a bill of lading having the requisite supplies, e.g., solution type and volume amount, to enable patient  12  to perform the prescribed therapy. The server sends the bill of lading to a warehouse computer of a warehouse storing the supplies. A delivery person receives the supplies from the warehouse and delivers the supplies to the patient. The patient in turn uses one of the communication devices described herein to inform the server as to how many of the patient&#39;s stock of supplies have been used. This feedback of supply consumption information from the patient to the server enables the server to generate the bill of lading so as to only deliver the solution bags and other supplies that the patient actually needs before the next delivery is made. 
         [0025]    The server knowing the amount of supplies that the patient has actually used also allows the doctor, nurse or clinician to access the feedback data from the patient to evaluate the patient&#39;s compliance with the prescribed therapy. In a slight alternative embodiment, the delivery person also has a communication device that is used to communicate with the server the amount of supplies that are actually delivered to the patient. 
         [0026]    It is accordingly an advantage of the present disclosure to optimize peritoneal dialysis (“PD”) dwell times. 
         [0027]    It is a further advantage of the present disclosure to provide a convenient and portable device that enables a patient to optimize his/her PD therapy. 
         [0028]    It is another advantage of the present disclosure to provide therapy log data to a doctor or clinician to optimize a PD therapy over a longer term. 
         [0029]    It is yet another advantage of the present disclosure that supply ordering can be automated via a periodic communication of dialysate consumption to a supply ordering and inventory tracking system. 
         [0030]    It is still a further embodiment of the present disclosure to be able to readily monitor the patient&#39;s compliance with prescribed therapy. 
         [0031]    Additional features and advantages are described herein, and will be apparent from the following Detailed Description and the figures. 
     
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         [0032]      FIG. 1A  is a schematic illustration of one embodiment of a local therapy optimization system and method of the present disclosure. 
           [0033]      FIG. 1B  is a schematic illustration of one embodiment of an integrated therapy optimization system and method of the present disclosure. 
           [0034]      FIG. 2  is a schematic illustration of a second embodiment of a local therapy optimization system and method of the present disclosure. 
           [0035]      FIG. 3  is a schematic illustration of a third embodiment of a local therapy optimization system and method of the present disclosure. 
           [0036]      FIG. 4  is a schematic illustration of a fourth embodiment of a local therapy optimization system and method of the present disclosure. 
           [0037]      FIG. 5  is a schematic illustration of one embodiment of a therapy prescription downloading and ordering system and method of the present disclosure. 
           [0038]      FIG. 6  is a schematic illustration of a second embodiment of a therapy prescription downloading and ordering system and method of the present disclosure. 
       
    
    
     DETAILED DESCRIPTION 
       [0039]    Referring now to the drawings and in particular to  FIG. 1 , one embodiment of the therapy optimization system and method is illustrated by system  10   a . System  10   a  involves the interaction between a patient  12  and a doctor, nurse or clinician  14  (referred to herein collectively as medical professional  14 ). In any of the systems discussed herein, the patient performs a peritoneal dialysis (“PD”) treatment, which can be an automated peritoneal dialysis (“APD”) therapy or a manual PD therapy, which is sometimes called a continuous ambulatory peritoneal dialysis (“CAPD”). APD typically programs automated dwell times, such that the patient drains occur automatically, enabling the patient to sleep through the bulk of the PD therapy. Nevertheless, many APD treatments also involve midday exchanges that can take advantage of systems and associated methodology set forth herein. Even for the automated night exchanges, however, APD patients can use the information log features set forth herein. Certainly, the systems set forth herein are entirely applicable to CAPD. 
         [0040]    Regardless of whether APD or CAPD is used, the PD treatment typically involves one or more bags or containers  16  of fresh dialysate. Bagged dialysate can be provided in different varieties. For example, the assignee of the present disclosure markets bagged dialysate under the trade names Dianeal™, Dianeal-N™, Physioneal™, Extraneal™, and Nutraneal™. The dialysates differ in chemical composition and in particular dextrose level. A higher dextrose level dialysate pulls more water or ultrafiltration (“UF”) off of the patient. The higher dextrose level dialysate, however, has a higher caloric content, such that a balance is typically struck for the patient between how much effluent water the patient needs to remove over the treatment versus how much weight gain the patient may incur due to the dextrose level. 
         [0041]    Dialysate container  16  can also vary in volume, such as being provided in one, 1.5, two, and 2.5 liter bags. Dialysate container  16  can be completely premixed in a single chamber or be separated into components in a dual or multi-chamber bag separated by a seal that patient  12  breaks to mix the components prior to treatment. All of the above variables, including chemical composition, dextrose level and container volume affect how long the dialysate should optimally be allowed to dwell within the patient. That is, a higher dextrose level dialysate should be allowed to reside longer within the patients peritoneum to use its full osmotic potential. Also, a larger volume of fresh dialysate will also have more potential to remove solutes and excess water, and therefore should be allowed to remain in the patient&#39;s peritoneum longer. 
         [0042]    Dialysate container or bag  16  can be provided accordingly with a marker or barcode  18 , which designates at least one of dialysate composition, dextrose level and container solution volume. System  10   a  also includes a patient scale  20 , which the patient uses to weigh himself or herself. The tracking of the patient&#39;s weight assists the physician in monitoring the patient&#39;s weight trends, which may result in a prescription change, for example if the patient appears to be gaining weight from the therapy. Scale  20  is included with electronics in and particular a wireless emitter  22  for emitting a signal indicative of the weight of patient  12 . One suitable scale having a wireless output and system for addressing and accessing same is disclosed in U.S. patent application Ser. No. 12/469,371 (“&#39;371 Application”), entitled “System and Method for Automated Data Collection of 24 Hour Ultrafiltration and Other Patient Parameters Using Wired or Wireless Technology”, filed May 20, 2009, assigned it to the assignee of the present disclosure, the entire contents of which are incorporated by reference herein and relied upon. Wireless emitter  22  may use a known wireless communication technology, such as Bluetooth™, ZigBee™, or other protocol, e.g., one based on IEEE 802. 
         [0043]    System  10   a  further includes a portable reader  30   a , which can be formed as a key ring  32  or worn on a necklace  34 . Portable reader  30   a  includes a housing  36 , which can be formed via plastic injection molding. Housing  36  houses an optical scanner  38 , such as a laser scanner, which reads marking or barcode  18  placed on solution bag or container  16 . In one embodiment, when patient  12  holds portable reader  30   a  close enough to marking  18 , patient  12  presses an input device  40 , which causes scanner  38  to read marking  18 . Alternatively, scanner  38  reads marking  18  automatically when marking  18  is within range of portable reader  30   a.    
         [0044]    Portable reader  30   a  also includes a wireless receiver  42 , which accepts a wireless weight signal from wireless emitter  22  of weight scale  20 . One suitable protocol and addressing system for enabling wireless receiver  42  to accept a weight signal from wireless emitter  22  is discussed above in the &#39;371 Application. 
         [0045]    Housing  36  of portable reader  30   a  is further fitted with processing  44  and memory  46 , which receive and store the marking information from scanner  38 . Processing  44  and memory  46  are configured to in turn look-up and store solution data (e.g., chemical composition, dextrose level and volume) that is particular to a particular marking or barcode  18 . Processing  44  and memory  46  are further configured to accept the weight data received at wireless receiver  42  and store such data in memory  46 . 
         [0046]    Processing  44  and memory  46  store an algorithm that uses the solution data and the patient specific data to determine an optimal dwell time for patient  12  using fresh dialysate from container  16 . One suitable algorithm for determining the optimal dwell time is to generate a patient specific the time to achieve maximum ultrafiltration, urea removal or creatinine removal. All fluid and toxin (urea and creatinine) vs. dwell time curves have a maximum value at a certain dwell time. The curves can be generated from kinetic modeling (e.g. using PD Adequest™ provided by the assignee of the present disclosure) by varying patients&#39; transporter types, body surface area, type of solution, and fill volume. The maximum fluid and toxin removal values and related optimum dwell times can be recorded in look-up tables and are stored in memory  46  that cross references patient gender, weight (for calculating body surface area), fill volume, type of transporter and type of solution. Suitable algorithms for determining optimal dwell times is disclosed in copending U.S. patent application Ser. No. 12/431,458, entitled, “Optimizing Therapy Outcomes For Peritoneal Dialysis”, filed Apr. 28, 2009, assigned to the assignee of the present disclosure, the entire contents of which are incorporated herein by reference and relied upon. 
         [0047]    Housing  36  of portable reader  30   a  is further outfitted with an output device  48 , such as an audio output, a light or flashing light (e.g., light emitting diode (“LED”)) or display, such as a liquid crystal display (“LCD”). Output device  48  communicates the optimal dwell time determined by processing  44  and memory  46  to the patient  12 . Communication of the optimal dwell time can be via an alert or alarm when dwell has been completed. Alternatively, a display, e.g., LCD display, shows a countdown of remaining dwell time, such that patient  12  can gage how long the current dwell is from completion. It is contemplated for device  48  (for this and any of the embodiments discussed herein) to communicate information visually, audibly, tactilely and any combination thereof. 
         [0048]    In one embodiment, processing  44  and memory  46  determine a dwell duration. It is therefore necessary to know when the beginning of dwell occurs, so that a clock or timer can begin to run. In one embodiment, housing  36  of portable reader  30   a  includes a start dwell input device  50 , which communicates electrically with processing  44 , and which patient  12  presses as soon as filling from dialysate container  16  to the patient&#39;s peritoneum has been completed. Pressing input device  50  signals to processing  44  and memory  46  that the dwell has begun. A timer or counter then begins to run, and output device  48  is activated to show a count down and/or is activated upon completion of the optimized dwell to inform the patient to begin draining the spent dialysis fluid form the patient&#39;s peritoneal cavity. 
         [0049]    The PD therapy, and in particular a CAPD therapy, may involve the patient connecting to and disconnecting from multiple containers  16  of fresh dialysate manually. It is contemplated in one embodiment to have patient  12  read the appropriate marking  18  of each container  16  of dialysate just before that container is to be used. In this way, the optimal dwell time is determined and known for each container  16  just prior to its use. It is also contemplated, especially in instances in which the same dialysate type and volume is to be used multiple times in the same therapy, to enable patient  12  to scan each container  16  at the beginning of therapy, such that the patient does not have to scan a container  16  between each fill. It is quite likely than that the optimal dwell time will be the same for each container  16 , such that patient  12  does not have to keep track of which container  16  has been scanned first, second, third, and so on. If containers  16  contain different types or volumes or fresh dialysate, portable reader  30   a  can determine same and inform the patient that a particular container  16  needs to be used in the order in which it has been scanned. 
         [0050]    In one embodiment, patient  12  weights himself or herself on scale  20  prior to each fill and weighs the drain volume. From these data, UF trending can be done for both CAPD and APD patients. Using the UF trending, clinicians may check the patients compliance and potentially change solution to optimize the therapy such that the algorithm used in processing  44  and of memory  46  begins with a most current patient weight in determining the optimal dwell just prior to each patient fill. 
         [0051]    In an alternative embodiment in which patient  12  is not able to scan multiple containers  16  at the beginning of therapy, the patient&#39;s weight loss after each patient drain can be estimated using another algorithm, such that a new weight can be entered for each optimized dwell calculation or determination. The algorithm can for example use a certain percentage of the fill volume as the estimated UF removed over that cycle. For example, the percentage can be eight percent of the fill volume. The percentage is in one embodiment determined on a patient specific basis. 
         [0052]    Instead of a separate algorithm, processing  44  and memory  46  can further alternatively estimate or empirically determine the weight loss of the patient given the patient&#39;s beginning weight, total target weight loss, solution type and volume used over the previously optimized dwell time. 
         [0053]    Referring now to  FIG. 1B , one embodiment for downloading logged information from portable reader  30   a  of system  10   a  to a medical professional  14  for long term therapy optimization is illustrated. In one implementation, wireless receiver  42  is a wireless transceiver, e.g., using Bluetooth™, ZigBee™, or other wireless protocol, e.g., based on IEEE 802, which not only receives wireless information but also transmits wireless information. In the illustrated embodiment, patient  12  brings portable reader  30   a  to the office of the medical professional  14 . As soon as portable reader  30   a  is placed within wireless communication range of the medical professional&#39;s computer  52 , portable reader  30   a  automatically downloads the information read from weight scale  20 , solution container  16  and information determined at portable reader  30   a  for each container used over a period of time, such as a month or whatever the period exists between visits to medical professional  14 . 
         [0054]    In a further implementation, portable reader  30   a  includes a connector (not shown). In the operational position, the connector can be plugged into a port, such as a universal serial bus (“USB”) port, of the medical professional&#39;s computer  52 . The above described information is then downloaded to the computer. Once on the computer, medical professional  14  can review the results and change the patient&#39;s therapy prescription if needed.  FIGS. 1A and 1B  for system  10   a  accordingly illustrate that system  10   a  optimizes therapy on a local or daily basis and over an integrated basis spanning a period of time. It should be appreciated that in the illustrated embodiment, communication in system  10   a  takes place wirelessly over a local wireless network, both in the environment of patient  12  and medical professional  14  (which can alternatively be local wired communication). 
         [0055]    Referring now to  FIG. 2 , an alternative system  10   b  is illustrated. System  10   b  includes many of the features of system  10   a , which are numbered the same accordingly, such as scale  20  having wireless emitter  22 , solution container  16  having marking or barcode  18  and medical professional computer  52 . An alternative portable reader  30   b  is provided, which can again be provided on a key ring  32 , as a key fob and/or worn on a necklace  34  on patient  12 . 
         [0056]    Portable reader  30   b  includes scanner  38  that reads marking  18  either automatically or upon an activation of input  40 , as described above. In one implementation, portable reader  30   b  includes processing  44  and memory  46 , which again are housed in housing  36 . In one implementation, local wireless receiver or transceiver  42  is replaced with a local wireless emitter  54 , which can be the same or similar to emitter  22  located within scale  20 . Emitter  22  sends a wireless weight signal to the patient&#39;s cellular phone or portable email device (referred to herein and collectively as a personal communication device (“PCD”))  60 . Likewise, wireless emitter  54  of portable reader  30   b  emits a wireless signal representing solution data, as described above, to PCD  60 . PCD  60  can be configured to calculate the optimal dwell time using the above described algorithm or via an empirical method. PCD  60  includes a display device  62 , multiple input devices  64  and a speaker  66 . One or both of video screens  62  and speaker  66  can be used as an output device, which communicates the optimal dwell time to patient  12 . For example, display  62  can show a countdown of the optimal dwell time to patient  12 , so that the patient knows how much longer the optimized dwell will continue. Alternatively or additionally, PCD  60  calls patient  12  via speaker  66  when it is time for the patient to drain the spent dialysate at the end of the optimized dwell period. In an alternative implementation, wireless emitter  54  is a wireless transceiver, which can receive a wireless signal from PCD  60 , telling portable reader  30   b  to provide an audible and/or visual output to patient  12 . 
         [0057]    In yet another alternative embodiment, portable reader  30   a  (shown and described in connection with  FIG. 1A ) is used with system  10   b  instead of portable reader  30   b . All of the optimal dwell time computations are then performed on portable reader  30   a , which then sends the optimal dwell time and any other desired information to PCD  60  for communication with the medical professional&#39;s computer  52 . 
         [0058]    System  10   b , like system  10   a  also provides a long term therapy optimization feature, which involves communication between PCD  60  and medical professional&#39;s computer  52 . In an embodiment, on a periodic basis, such as daily or otherwise according to an application stored on PCD  60 , PCD  60  sends a text or satellite message to the medical professional&#39;s computer  52 , downloading any of the pertinent data described above in connection with system  10   a . The information allows medical professional  14  to evaluate the patient&#39;s therapy performance over time and make PD prescription changes if necessary. It is therefore contemplated that the portable reader  30   b  communicates with PCD  60  on a first periodic basis, e.g., after each reading taken by reader  30   b , and that PCD  60  communicates with the medical professional&#39;s computer  52  on a second periodic basis, e.g., daily. 
         [0059]    Referring now to  FIG. 3 , an alternative system  10   c  is illustrated. System  10   c  includes many of the features of systems  10   a  and  10   b , which are numbered the same accordingly, such as scale  20  having wireless emitter  22 , solution container  16  having marking or barcode  18  and medical professional computer  52 . Portable reader  30   a  is provided, which can again be provided on a key ring  32 , as a key fob and/or worn on a necklace  34  on patient  12 . As before, portable reader  30   a  includes scanner  38  that reads marking  18  either automatically or upon an activation of input  40 , as described above. Portable reader  30   a  is shown here including processing  44  and memory  46 , which again are housed in housing  36 , however, processing  44  and memory  46  may not be needed because the dwell calculations are done at base station  70  discussed below. Portable reader  30   a  includes local wireless transceiver  42 , to receive optimal dwell information from base station  70  for communication to patient via output device  48 . 
         [0060]    Base station  70  includes a wireless transceiver  72 , which receives a wireless weight signal from transmitter  22  of weight scale  20  and any of the above-described solution data from transceiver  42  of portable reader  30   a . Wireless transceiver  72  communicates dwell data to wireless transceiver  42  of portable reader  30   a  to provide an audible and/or visual output to patient  12 . 
         [0061]    Base station  70  includes processing  72  and memory  74  configured to calculate the optimal dwell time using the above described algorithm or via an empirical method. Base station  70  can include a display device  78 , multiple input devices  80 , and a speaker  82  if needed. One or both of video screens  78  and speaker  82  can be used, in addition to out device  48  of portable reader  30   a , as an output device to communicate the optimal dwell time to patient  12 . For example, device  48  and display  78  can show a countdown of the optimal dwell time to patient  12 , so that the patient knows how much longer the optimized dwell will continue. Alternatively or additionally, speaker  82  and/or device  48  alerts patient  12  when it is time for the patient to drain the spent dialysate at the end of the optimized dwell period. 
         [0062]    Base station  70  also includes a docking area  84  for holding portable reader  30   a , charging portable reader  30   a , and possibly downloading information from and importing information to portable reader  30   a , such that transceiver  42  of portable reader  30   a  may be replaced with a USB or other type of connector that is received by a data communication port at docking area  84  of base station  70 . 
         [0063]    System  10   c , like systems  10   a  and  10   b  also provides a long term therapy optimization feature, which involves communication between base station  70  and medical professional&#39;s computer  52 . In an embodiment, on a periodic basis, such as daily or otherwise according to an application stored on base station  70 , base station  70  sends a communication, e.g., via an internet connection, to the medical professional&#39;s computer  52 , downloading any of the pertinent data described above in connection with system  10   a . The information allows medical professional  14  to evaluate the patient&#39;s therapy performance over time and make PD prescription changes if necessary. It is therefore contemplated that the portable reader  30   a  communicates with base station  70  on a first periodic basis, e.g., after each reading taken by reader  30   a , and that base station  70  communicates with the medical professional&#39;s computer  52  on a second periodic basis, e.g., daily. 
         [0064]    Referring now to  FIG. 4 , an alternative system  10   d  is illustrated. System  10   d  includes many of the features of systems  10   a ,  10   b  and  10   c , which are numbered the same accordingly, such as scale  20  having wireless emitter  22 , solution container  16  having marking or barcode  18  and medical professional computer  52  personal communication device (“PCD”)  90  is provided, which can be worn on a necklace  34  on patient  12  but is most likely carried by the patient. Here, PCD  90  includes a camera  94  that takes a picture of marking  18  either automatically or upon an activation of an input  96 . PCD  90  in one embodiment is a smart phone, such as a Iphone™, Blackberry™ or other similar device which can have electronic mail and store various software applications. PCD includes a local wireless transceiver  92  to received a wireless weight signal from transmitter  22  of weight scale  20 . PCD  90  includes processing  98  and memory  100  that are configured to run software that converts the barcode picture into digital data. 
         [0065]    One suitable software is QuickMark, provided by SimpleAct, Inc., 6F., No. 24, Cingchen St., Songshan District, Taipei City, 105 Taiwan (R.O.C.), Telephone No. 886-2-87706690. The software uses the digital data in a look-up table to determine any of the solution information described above, such and type, volume, dextrose level, and chemical concentration. Processing  98  and memory  100  as further configured to calculate the optimal dwell time using the above described algorithm or via an empirical method using the patient weight and solution data. 
         [0066]    PCD  90  includes a display device  102 , multiple input devices  96 , and a speaker  104  if needed. One or both of video screen  102  and speaker  104  can be used as an output device to communicate the optimal dwell time to patient  12 . For example, display  102  can show a countdown of the optimal dwell time to patient  12 , so that the patient knows how much longer the optimized dwell will continue. Alternatively or additionally, speaker  104  alerts patient  12  when it is time for the patient to drain the spent dialysate at the end of the optimized dwell period. 
         [0067]    System  10   d , like systems  10   a  to  10   c  also provides a long term therapy optimization feature, which involves communication between PCD  90  and medical professional&#39;s computer  52 . In an embodiment, on a periodic basis, such as daily or otherwise according to an application stored on PCD  90 , PCD  90  sends a communication, e.g., via a satellite text protocol, to the medical professional&#39;s computer  52  and/or supply reordering system, downloading any of the pertinent data described above in connection with system  10   a . The information allows medical professional  14  to evaluate the patient&#39;s therapy performance over time and make PD prescription changes if necessary. System  10   d  is desirable in one respect because a separate portable reader is not needed. PCD  90 , which patient  12  uses for other purposes, such as personal email, phone usage, media storage, is also used for the optimization of the patient&#39;s dialysis therapy. 
         [0068]    Referring now to  FIG. 5 , system  110   a  illustrates one suitable therapy prescription downloading and supply ordering system using PCD  60 , PCD  90  or portable reader  30   a ,  30   b  or  30   c  discussed above. In the illustrated embodiment PCD  90  is shown, which includes all of the features and alternatives discussed above for PCD  90 . In a first step of the method or facet of system  110   a , medical professional  14  communicates with central server  120 , e.g., via a web browser and computer. Server  120  can be a server maintained by the company that provides solution bags  16  or by a company contracted by the solution bag company. Medical professional  14  enters patient specific information, such as gender, height, weight, transport type, and fill volume, into the doctor&#39;s web browser located at computer  52 , which can run a therapy prediction software, such as one described in U.S. patent application Ser. No. 12/170,184, entitled, “Dialysis System Having Regimen Generation Methodology”, filed Jul. 9, 2008, assigned to the assignee of the present disclosure, the entire contents of which are incorporated herein by reference. The prediction software presents medical professional  14  with one or more recommendations for a therapy prescription. The software allows the medical professional  14  to accept or modify the prescription. Medical professional  14  issues a “program” command via the browser, which causes server  120  to automatically and remotely program PCD  90  with the desired therapy prescription. The communication from PCD  90  to server  120  can be a one time communication or communication that occurs periodically after medical professional  14  reevaluates patient  12 . 
         [0069]    In a second step of the method or facet of system  110   a , server  120  communicates the medical professional&#39;s  14  prescription to a warehouse computer  116  located at a warehouse of the manufacturer of the solution and solution bags  16 . The communication from server  120  to warehouse computer  116  can be transparent or done automatically whenever medical professional  14  changes the therapy prescription for patient  14 . Warehouse computer  116  generates a supply order, e.g., a bill of lading. 
         [0070]    In a third step of the method or facet of system  110   a , warehouse computer  116  sends or prepares the bill of lading to/for delivery person  112 , which is done on a periodic basis, such as once a month. In a fourth step of the method or facet of system  110   a , delivery person  112  obtains the necessary supplies, e.g., solution bags  16 , connectors, etc., and delivers the supplies to patient  12 , which is also done on a periodic basis, such as once a month. It should be appreciated that steps one to four allow central server  120  to track the amount of supplies delivered from warehouse  116 . 
         [0071]    In a fifth step of the method or facet of system  110   a , patient  12  uses PCD  90  to scan barcodes off of solution bags  16 . PCD  90  receives patient data for patient  12 , such as patient weight, blood pressure and blood glucose levels, as discussed above. At one or more, e.g., predetermined or patient selected time of the day, PCD  90  communicates the bag scan (or other supply usage data) and patient data to a central server  120 . The communication from PCD  90  to server  120  is in one embodiment automatic and transparent to patient  12 . It should be appreciated that step five allows server  120  to know how much of the supplies or solution bags  16  delivered to patient  12  have actually been used by the patient. Knowing how many supplies have been delivered from the warehouse housing computer  116  and how many supplies have been used by patient  12 , system  110   a  at server  120  can determine when to deliver and how many supplies or solution bags  16  to deliver to patient  12 . And as discussed, server  120  orders supplies or patient  12  based on the therapy prescription sent from medical professional  14 . 
         [0072]    Knowing how many supplies have been used by patient  12  also enables medical professional  14  to track the patient&#39;s compliance with the prescribed therapy. If patient  12  is supposed to use twenty solution bags  16  of dialysate per week, but PCD  90  consistently reports back that the patient is using less than twenty bags, medical professional  14  upon viewing this compliance data, e.g., at computer  52 , can contact patient  12  to inquire as to why the patient&#39;s prescription is not being followed. Or, the compliance data can be discussed the next time patient  12  visits medical professional  14 . To this end, it is contemplated for medical professional  14  to be able to access patient therapy compliance data from server  120  and/or for server  120  to periodically send patient therapy compliance data reports to computer  52  of medical professional  14 . The report in one embodiment is copied to PCD  90  and patient  12 , so that patient  12  knows that medical professional  14  is seeing the patient&#39;s compliance reports, good or bad. 
         [0073]    Referring now to  FIG. 6 , system  110   b  illustrates another suitable therapy prescription downloading and supply ordering system using PCD  60 , PCD  90  or portable reader  30   a ,  30   b  or  30   c  discussed above. System  110   b  includes all of the steps and alternatives discussed above for system  110   a  of  FIG. 5 . In an additional step or facet of system  110   b , delivery person  112  is provided with a handheld device, such as PCD  60  or PCD  90 , which enables delivery person  112  to report back to server  120  how many supplies, such as supply bags  16 , have actually been delivered to patient  12 . System  110   b  closes the loop between server  120 , warehouse computer  116  and driver  112 . Unlike system  110   a , which assumes all supplies listed on the bill of lading are delivered to patient  12 , system  110   b  allows server  120  to receive the amount of supplies actually delivered from delivery person  112  to patient  12 . This information in combination with the amount of supplies used sent from patient PCD  90  enables server  120  to know when and how many supplies, such as solution bags  16  to order for the patient  12 . 
         [0074]    It should be understood that various changes and modifications to the presently preferred embodiments described herein will be apparent to those skilled in the art. Such changes and modifications can be made without departing from the spirit and scope of the present subject matter and without diminishing its intended advantages. It is therefore intended that such changes and modifications be covered by the appended claims.