Patent Publication Number: US-2021170084-A1

Title: Combined extracorporeal and drug delivery system and method

Description:
PRIORITY CLAIM 
     This application claims priority to and the benefit of U.S. Provisional Application No. 62/946,205, filed Dec. 10, 2019, entitled “Combined Extracorporeal and Drug Delivery System and Method”, the entire contents of which are incorporated herein by reference and relied upon. 
    
    
     BACKGROUND 
     Acute kidney injury (“AKI”) is more common than most people know and is under-recognized in hospital patients, especially in certain countries. It has been reported that worldwide, twenty percent of hospitalized patients have AKI. A larger number of intensive care unit (“ICU”) patients have AKI, where fifteen to twenty-five percent of such patients receive some form of renal replacement therapy (“RRT”). Approximately twenty-seven percent of pediatric and young adult ICU patients develop AKI during the first week after admission to the hospital. 
     Major contributors to AKI include septic shock (˜47% of instances), major surgery (˜34% of instances), cardiogenic shock (˜27% of instances), hypovolaemia (˜25% of instances), drug induced (˜19% of instances), hepatorenal syndrome (˜6% of instances) and obstructive uropathy (˜3% of instances). 
     RRT for patients with AKI includes both intermittent hemodialysis (“IHD”) and continuous renal replacement therapy (“CRRT”). IHD may treat the patient over three to four hours every other day for example. CRRT instead treats the patient continuously using much slower blood and treatment fluid flowrates. Certain studies have shown that CRRT is preferable to IHD for treating AKI. For example, fluid accumulation after a few days in the hospital may be lower for patients receiving CRRT versus IHD. Additionally, CRRT may be preferable to IHD regarding the frequency of patients ultimately developing chronic kidney disease (“CKD”), i.e., less patients treated with CRRT develop CKD versus patients treated with IHD. 
     CRRT is performed using a CRRT machine. CRRT machines perform different types of CRRT therapies, for example, slow continuous ultrafiltration (“SCUF”) for fluid removal only, continuous veno-venous hemodialysis (“CVVHD”), continuous veno-venous hemodiafiltration (“CVVHDF”), and continuous veno-venous hemofiltration (“CVVH”). CRRT machines may perform other types of therapies, such as therapeutic plasma exchange (“TPE”), which typically involves plasmafilters and multiple indications, such as for auto-immune diseases, hemoperfusion involving adsorption devices, MARS therapy for liver support, and extracorporeal CO 2  removal (“ECCO 2 R”), such as for lung support using an oxygenator. CRRT machines also allow for different types of anticoagulation modalities, such as systemic anticoagulation (e.g., heparin) and regional citrate anticoagulation (“RCA”). 
     Hospitalized patients with AKI often require a multitude of drugs to treat other ailments, which are delivered at precise intervals and concentrations to ensure proper recovery. Such patients are therefore simultaneously connected to a CRRT or IHD machine. Both machines remove blood from the patient, run the blood through a filter to remove solutes, thereby upsetting the concentrations or pharmokinetics of other therapies, drugs, or solutions being applied to the patient during the same hospital stay. 
     To compensate for the effects of the essential extracorporeal therapies, physicians have to manually calculate changes as one therapy is added or changed, resulting potentially in underdelivery or overdelivery of medications and risk to the patient. An improved overall regime for treating hospitalized patients with AKI is needed accordingly. 
     SUMMARY 
     The present disclosure sets forth a combined extracorporeal and drug delivery system and method, which provides a coordinating logic implementor that coordinates operation of a CRRT machine or an IHD machine (e.g., chronic-type hemodialysis machine) with one or more infusion pump simultaneously delivering a drug to the same patient. The synchronized operation may include: (i) electronically and/or data connecting to all infusion and extracoporeal devices treating the patient, (ii) registering treatment settings, including blood flow rates, treatment fluid flow rates, fluid removal rates, drug types and doses for the drugs, (iii) providing decision support to a prescribing physician regarding drugs to apply and target doses, which follow commonly accepted literature guidance and consider patient characteristics, disease type, and state, (iv) calculating actual dosing to reach desired dosing, and making adjustments as necessary to maintain the desired dose over time, (v) causing the flowrate or adjustment information to be communicated to the operator for approval or transmit the information to the connected infusion and extracoporeal devices to automatically make the adjustments for administering the drug and/or treatment fluid to the patient, and (vi) optionally synchronizing with associated hospital IT systems such as an electronic medical record database, medical monitoring, telemedicine, or operational platforms, to report the treatment data and other data, such as treatment results, types and doses of drugs delivered, caregiver notes, e.g., patient subjective feelings, presence of septic or infectious conditions, and the like. Decision support for target doses, for example, may includes an indication of risk and a probability of future state of the patient, e.g., regarding blood pressure changes, fluid overload, and/or cardiac issues. In this manner, the synchronized operation may bring value over and above coordination between renal failure and infusion pump operation. 
     The intravenous (“IV”) drugs delivered during the CRRT or IHD treatment may include any type of antibiotic, such as vancomycin, gentamicin, cefepime, piperacillin, tazobactim, ceftazidime, avibactam, cefazolin, aztreozam, nafcillin, oxacillin. Other drugs include meropenem, cefepime, and fluconazole. Other drugs in which dosing is challenged by renal failure treatment and thus benefit from being synchronized with renal failure flowrates according to the present disclosure include any type of fluid resuscitation drug, systemic anticoagulation drug, e.g., heparin or citrate, vasopressors, electrolytes, trace elements, nutritional supplements, anticonvulsants, antifungals, antineoplastic, neuromuscular blocking, analgesic, and/or immunosupressent. Any drug that may be administered in combination with a CRRT or IHD treatment is contemplated for the present system and method. 
     It is desirable for a coordinating logic implementor of the present disclosure to be able to operate with existing CRRT machines, IHD machines and infusion pumps (including but not limited to large volume infusion pumps (“LVP”), syringe pumps, bladder pumps, drip pumps and any other type of IV drug pump), so that in one embodiment, the coordinating logic implementor is located externally to each of the machines, e.g., resting on, connected to or located adjacent to the CRRT or DID machine. In one preferred embodiment, the coordinating logic implementor is in electronic and/or data communication with the CRRT or DID machine, e.g., via a wired or wireless connection. In an alternative embodiment, the coordinating logic implementor may be provided as a portion of the overall control unit of the CRRT or IHD machine and thus be located within same. 
     In various embodiments, the coordinating logic implementor may or may not be in electronic and/or data communication with the one or more infusion pump, for example, depending on the communication capability of the pump. It may be that the coordinating logic implementor is able to communicate wired or wirlessly with all of the infusion pumps, some of the infusion pumps or none of the infusion pumps. If the infusion pumps are connected to the coordinating logic implementor, then they may be controlled automatically or upon confirmation and setting by the operator. If the infusion pumps are not connected to the coordinating logic implementor, then they may be controlled manually upon confirmation and setting by the operator who may view the recommendation either at a display screen of the coordinating logic implementor or of the CRRT or IHD machine. 
     The coordinating logic implementor coordinates the operation of the CRRT or IHD machine and the infusion pumps in multiple ways. One way is for the system to take into account the flowrates of the IV drugs in the prescribed fluid removal or ultrafiltration calculation. A goal of a CRRT or IHD treatment may be to remove fluid from the patient so that the patient who is experiencing AKI does not gain fluid over time. An IV drug may contribute in a significant way to the overall amount of fluid delivered to the patient. The IV delivery amount is taken into consideration in determining an instantaneous effluent flowrate removed by the CRRT or IHD machine. The coordinating logic implementor also knows when the IV drug is being delivered, such that it may command a higher effluent flowrate during drug delivery and a lower effluent flowrate when drug delivery is halted. The coordinating logic implementor repeats this analysis for each IV drug being delivered during the CRRT or IHD treatment and combines the results when two or more drug deliveries overlap. 
     Another way in which coordinating logic implementor coordinates the operation of the CRRT or IHD machine and the infusion pumps is to adjust one or more infusion pump administration rate to compensate for a portion of the drug intended for the patient instead being removed from the extracapoeral circuit as effluient via the CRRT or IHD treatment. In an embodiment, an estimation is made as to the percentage of the drug within the effluent removed. The estimation may be made using one or more assumption, such as, the effluent being fully hemogoneous and the estimation of the patient&#39;s blood volume, which may be esitmated based on the patient&#39;s weight. In an alternative embodiment, the patient&#39;s blood volume may be determined prior to treatment and entered into coordinating logic implementor, e.g., via a user interface associated with the coordinating logic implementor or via the user interface the CRRT or IHD machine, which in turn relays the blood volume wired or wirlessly to the coordinating logic implementor. 
     If the estimated drug percentage is, for example, one percent, then the coordinating logic implementor may either increase the flowrate associated with the prescribed drug by one percent or recommend to the operator a flowrate setpoint that is one percent higher than the flowrate associated with the prescribed dosage. The increased IV drug flowrate, if automatically implemented or if accepted by the operator, may be taken into account in the effluent flowrate adjustment discussed above or ignored if it would have a negligable inpact. Raising the IV drug flowrate in this manner compensates for the amount of IV drug removed via effluent removal of the CRRT or IHD machine. 
     In determining whether to adjust the flowrate for an IV drug, the coordinating logic implementor may take into account whether the CRRT or IHD machine is actually running. For example, if the IV drug is delivered before or after CRRT or IHD treatment, the coordinating logic implementor does not adjust the IV drug flowrate from the flowrate associated with the prescribed dosage. If the CRRT or IHD machine is stopped for watever reason during treatment, e.g., due to an alarm, alert, supply bag change, etc., the coordinating logic implementor is informed of the stoppage and may react in a plurality of alternative ways, for example, (i) automatically reduce or suggest to reduce the IV drug flowrate to the flowrate associated with the prescribed dosage while the stoppage persists, (ii) maintain the IV drug flowrate at the elevated flowrate during the stoppage but count the additional flowrate as being part of the administered dosage, so that overall drug delivery time may be reduced to meet the prescribed dosage, or (iii) shut down the IV drug flowrate completely, e.g., if the drug is meant to accompany the CRRT or IHD treatment, e.g., if the drug is an anticoagulant, phosphorous supplement, and the like. 
     Alternatively or in addition to adjusting IV pump flowrate(s) so that an actual IV dose received by a patient meets a prescribed dose for the patient despite IV drug lost due to efflent removal from a renal failure therapy, it is also contemplated that the present system and method adjust IV drug concentration. For example, the acutal concentration of one or more IV drug may be increased from a prescribed concentration so that the actual amount of the drug absorbed by the patient meets an expected prescribed amount of drug absorbed by the patient taking into account an amount of drug lost via effluent removal. 
     It is contemplated for the present system and method to compensate (e.g., decrease) the increase in IV drug flowrate or concentration due to a clotting of the blood filter over time, which may lessen the amount of IV drug removal for a set effleunt removal flowrate. The amount of clotting may be estimated by a pressure increase, e.g., effluent line pressure increase, which is correlated in a lookup table, e.g., empirically, with varying amounts of IV drug removal decrease. The system of the present disclosure receives the increasing pressure signals over the course of treatment, invokes the lookup table and adjusts (e.g., decreases) the percentage increase in IV drug flowrate and/or concentration accordingly. 
     Further alternatively, IV fluid flowrate or concentration may be adjusted based on an amount of dilution due to replacement fluid flow and/or dialysis fluid flow as opposed to effluent fluid flowrate. Here, the adjustment may be based on a relationship between the flowrates of the IV fluid, replacement fluid flow and/or dialysis fluid. 
     In another aspect of the system and method of the resent disclosure, the chemical constituency of the IV fluid, replacement fluids and/or dialysis fluid are analyzed and overlapping chemicals or constituents are compared to allowable levels to see if the chemcial makeup of the IV fluid should be adjusted or if the combined chemical or constituent dose is acceptable. If it is determined that the IV drug constituency needs to be modified, the present system outputs a revised formulation for approval and subsequent compiunding at the hospital&#39;s pharmacy, for example. 
     At the end of, or at any suitable time throughout, the CRRT or IHD treatment and drug delivery, it is contemplated to send any or all relevant treatment data to an electronic medical record (“EMR”) database of the hospital, which stores a file for the patient. To do so, it is contemplated for the coordinating logic implementor to be in wired or wireless communication with a hospital server or other computer storage for the EMR database, data warehouse or data lake. 
     In a typical hospital or emergency room setting, it is likely that there will only be one CRRT or IHD machine and associated one or more infusion pump. In such a case, there will be a dedicated coordinating logic implementor for the arrangment of machines, which acts as a hub to the spoke medical machines. In a more clinical setting, e.g., using hemodialysis machines for IHD, where IV drug delivery may still take place, it is contemplated to provide a coordinating logic implementor that is dedicated to two or more CRRT or IHD machines and associated infusion pump. Here, the coordinating logic implementor may (i) again be the hub to all of the spoke medical machines, including the CRRT or IHD machines, or (ii) be a higher level hub to each of the spoke CRRT or IHD machines in its cluster, wherein the CRRT or IHD machines are in turn lower lever hubs to their associated spoke infusion pumps. The latter arrangment may be preferred when shorter range wireless communication is provided. 
     In light of the disclosure herein, and without limiting the scope of the invention in any way, in a first aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, an extracorporeal and drug delivery system including (i) a renal failure therapy machine operable with a blood filter in fluid communication with an arterial line for removing blood from a patient to the blood filter and a venous line for returning blood from the filter to the patient, the renal failure therapy machine including (a) an effluent pump positioned and arranged to pump effluent from the blood filter at an effluent flowrate, and (b) at least one of a dialysis fluid pump positioned and arranged to pump dialysis fluid to the blood filter at a dialysis fluid flowrate, a predilution pump positioned and arranged to pump replacement fluid into the arterial line at a predilution flowrate, or a postdilution pump positioned and arranged to pump replacement fluid into the venous line at a postdilution flowrate; (ii) an infusion pump operable to deliver an intravenous (“IV”) drug to the patient at an IV drug flowrate; and (iii) a coordinating logic implementor configured to determine an adjustment for the IV drug flowrate based on an amount of the IV drug removed via the effluent flowrate. 
     In a second aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the renal failure therapy machine is a continuous renal replacement machine, and which includes the effluent pump and at least two of the dialysis fluid pump, the predilution pump or the postdilution pump. 
     In a third aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the renal failure therapy machine is a hemodialysis machine, and which includes the effluent pump and the dialysis fluid pump. 
     In a fourth aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the coordinating logic implementor is provided separately from the renal failure therapy machine and the infusion pump, and wheren the coordinating logic implementor is in wired or wireless communication with at least the renal failure therapy machine. 
     In a fifth aspect of the present disclosure, which may be combined with the fourth aspect in combination with any other aspect listed herein, or portion thereof, the system is configured such that a total patient fluid input is communicated to or determined by the coordinating logic implementor for the coordinating logic implementor to determine the adjustment for the IV drug flowrate based on the amount of the IV drug removed via the effluent flowrate. 
     In a sixth aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the system is configured to at least one of (i) automatically implement the adjustment for the IV drug flowrate at the infusion pump or (ii) display the adjustment at one or more of the renal failure therapy machine, the infusion pump, or the coordinating logic implementor for implementation. 
     In a seventh aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the coordinating logic implementor is integrated into the renal failure therapy machine. 
     In an eighth aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, wherein the infusion pump is a first infusion pump, the IV drug is a first IV drug, the IV drug flowrate is a first IV drug flowrate, which includes a second infusion pump operable to deliver a second IV drug to the patient at a second IV drug flowrate, and wherein the coordinating logic implementor is configured to determine an adjustment for the second IV drug flowrate based on an amount of the second IV drug removed via the effluent flowrate. 
     In a ninth aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the system is configured such that the effluent flowrate may take into account the adjustment for IV drug flowrate and at least one of the dialysis fluid flowrate, predilution flowrate, or postdilution flowrate. 
     In a tenth aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the system is configured such that the effluent flowrate takes into account a prescribed patient fluid loss rate. 
     In an eleventh aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the amount of the IV drug removed via the effluent flowrate includes a percentage of the IV drug in the effluent flowrate. 
     In a twelfth aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the coordinating logic implementor is configured to determine the adjustment for the IV drug flowrate based on the amount of the IV drug removed via the effluent flowrate and upon an estimation of a blood volume of the patient. 
     In a thirteenth aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the coordinating logic implementor is further configured to take into account blood filter patency or clotting in determining the adjustment for the IV drug flowrate. 
     In a fourteenth aspect of the present disclosure, which may be combined with the thirteenth aspect in combination with any other aspect listed herein, or portion thereof, the system is configured such that the adjustment causes the IV drug flowrate to meet the prescribed IV drug flowrate when the amount of the IV drug is removed via the effluent flowrate. 
     In a fifteenth aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the renal failure therapy machine is a first renal failure therapy machine, the infusion pump is a first infusion pump, which includes a second renal failure therapy machine associated with a second infusion pump, and wherein the coordinating logic implementor is configured to determine an adjustment for the IV drug flowrate of the second infusion pump. 
     In a sixteenth aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the coordinating logic implementor is alternatively or additionaly configured to determine an adjustment to a concentration of the IV drug based on an amount of the IV drug removed via the effluent flowrate. 
     In a seventeenth aspect of the present disclosure, which may be combined with the sixteenth aspect in combination with any other aspect listed herein, or portion thereof, the system is configured to display the concentration adjustment at one or more of the renal failure therapy machine, the infusion pump, or the coordinating logic implementor for implementation. 
     In an eighteenth aspect of the present disclosure, which may be combined with the sixteenth aspect in combination with any other aspect listed herein, or portion thereof, the system is configured such that the concentration adjustment causes an IV drug dose received by the patient to meet a prescribed IV drug dose when the amount of the IV drug is removed via the effluent flowrate. 
     In a nineteenth aspect of the present disclosure, which may be combined with the sixteenth aspect in combination with any other aspect listed herein, or portion thereof, the infusion pump is a first infusion pump, the IV drug is a first IV drug, which includes a second infusion pump operable to deliver a second IV drug to the patient, and wherein the coordinating logic implementor is configured to determine an adjustment to a concentration of the second IV drug based on an amount of the second IV drug removed via the effluent flowrate. 
     In a twentieth aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the coordinating logic implementor is alternatively or additionaly configured to determine an adjustment to a flowrate and/or concentration of the IV drug based on an amount of dilution of the IV drug due to at least one of the dialysis fluid flowrate, the predilution flowrate or the postdilution flowrate. 
     In a twenty-first aspect of the present disclosure, which may be combined with the twentieth aspect in combination with any other aspect listed herein, or portion thereof, the amount of dilution is based on a relationship between a flowrate of the IV drug and at least one of the dialysis fluid flowrate, the predilution flowrate or the postdilution flowrate. 
     In a twenty-second aspect of the present disclosure, which may be combined with any other aspect listed herein, or portion thereof, the coordinating logic implementor is alternatively or additionaly configured to determine if a constituent of the IV drug exists in at least one of the dialysis fluid, predilution replacement fluid or postdilution replacement fluid, and if so, determine if a formulation adjustment should be made to the IV drug. 
     In a twenty-third aspect of the present disclosure, which may be combined with the twenty-second aspect in combination with any other aspect listed herein, or portion thereof, the formulation adjustment includes decreasing or eliminating the constituent in or from the IV drug. 
     In a twenty-fourth aspect of the present disclosure, any of the structure, functionality and alternatives associated with any of  FIGS. 1 to 4  may be combined with any of the structure, functionality and alternatives associated with any other of  FIGS. 1 to 4 . 
     In light of the present disclosure and the above aspects, it is therefore an advantage of the present disclosure to provide a combined extracorporeal and drug delivery system and method that reduces workload on doctors, nurses and caregivers. 
     It is another advantage of the present disclosure to provide a combined extracorporeal and drug delivery system and method that improves fluid removal accuracy. 
     It is a further advantage of the present disclosure to provide a combined extracorporeal and drug delivery system and method that improves drug dosage delivery accuracy. 
     It is still another advantage of the present disclosure to provide a combined extracorporeal and drug delivery system and method that may be implemented with existing equipment. 
     It is still a further advantage of the present disclosure to provide a combined extracorporeal and drug delivery system and method that modifies IV drug flowrate, and/or concentration. 
     It is yet another advantage of the present disclosure to provide a combined extracorporeal and drug delivery system and method that modifies IV drug flowrate or concentration based on effluent removal or dilution, e.g., due to replacement and/or dialysis fluid flowrates. 
     It is yet a further advantage of the present disclosure to provide a combined extracorporeal and drug delivery system and method that takes into account overlapping chemicals or constituents in the IV drug and replacement and/or dialysis fluids to see if the amount of the overlapping fluid in the IV drug is allowable, should be reduced or should be eliminated. 
     Additional features and advantages of the disclosed devices, systems, and methods are described in, and will be apparent from, the following Detailed Description and the Figures. The features and advantages described herein are not all-inclusive and, in particular, many additional features and advantages will be apparent to one of ordinary skill in the art in view of the figures and description. Also, any particular embodiment does not have to have all of the advantages listed herein. Moreover, it should be noted that the language used in the specification has been selected principally for readability and instructional purposes, and not to limit the scope of the inventive subject matter. 
    
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         FIG. 1  is a perspective view of one embodiment of the combined extracorporeal and drug delivery system of the present disclosure. 
         FIG. 2  is a schematic view of one embodiment of the combined extracorporeal and drug delivery system of the present disclosure. 
         FIG. 3  is a schematic flowchart illustrating example does correction adjustments that may be made according to the combined extracorporeal and drug delivery system of the present disclosure. 
         FIG. 4  is a schematic view of one embodiment of the combined extracorporeal and drug delivery system of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION OF EXAMPLE EMBODIMENTS 
     Referring now to the drawings and in particular to  FIG. 1 , an embodiment of a combined extracorporeal and drug delivery system  10  of the present disclosure is illustrated. System  10  includes a renal failure therapy machine  20 , such as a continuous renal replacement therapy (“CRRT”) machine or an intermittent hemodialysis (“IHD”) machine and intravenous (“IV”) drug infusion pump  70 ,  80  and/or  90 . Renal failure therapy machine  20  can for example perform type of renal therapy, such as arteriovenous hemofiltration, continuous arteriovenous hemodialysis, continuous arteriovenous hemodiafiltration, continuous venovenous hemofiltration, continuous venovenous hemodialysis, continuous venovenous hemodiafiltration, slow continuous ultrafiltration, hemoperfusion, therapeutic plasma exchange, cytopheresis, continuous ultrafiltration with periodic intermittent hemodialysis), treatment of fluid overloads, congestive heart failure, drug overdoses, poisonings, immune disorders, sepsis, acid imbalances and any combination thereof 
     Renal failure therapy machine  20  in the illustrated embodiment includes a housing  22  supported by a rolling frame  24 , so that renal failure therapy machine  20  may be moved or oriented to a position that is convenient for operation within a hospital room or intensive care unit (“ICU”). Renal failure therapy machine  20  in the illustrated embodiment includes scales  26   a  to . . .  26   n , which enable the weight and thus the volume and flowrate of one or more fluid, such as dialysis fluid, replacement fluid, or effluent, to be determined. For instance, scale  26   a  may be used in one implementation to monitor the fresh dialysis fluid flow, while scale  26   b  is used to monitor the flow of effluent. Renal failure therapy machine  20  in the illustrated embodiment also includes exterior apparatuses  28  supported by housing  22 , which may include for example pumps, pressure sensors, air detectors, blood leak detectors, valves such as tubing pinch valves, discussed in more detail. 
     Scales  26   a  to . . .  26   n  and all sensors of apparatuses  28  output to a control unit  30 , which controls all electrically actuated devices  28  of renal failure therapy machine  20 . Control unit  30  in the illustrated embodiment includes one or more processor  32  and one or more memory  34 , video card, sound card, wireless transceiver or wired interface  36 , and the like. Control unit  30  communicates with a coordinating logic implementor  100  wired or wirelessly. Any wired communication discussed herein may be via Ethernet or fiber optic connection, for example. Any wireless communication discussed herein may be performed via any of Bluetooth™, WiFi™, Zigbee®, Z-Wave®, wireless Universal Serial Bus (“USB”), radio frequency (“RF”), ultrasonic, photoelectric, microwave or infrared protocols, or via any other suitable wireless communication technology. 
     Renal failure therapy machine  20  in the illustrated embodiment also includes a graphical user interface (“GUI”)  40 , which enables an operator to enter data and commands into and/or receive information from control unit  30 . GUI  40  includes a video monitor, which may likewise operate with a touch screen overlay placed onto the video monitor for inputting commands into control unit  30 . GUI  40  may also include one or more electromechanical input device, such as a membrane switch or other button. Control unit  30  may also include an audio controller for playing sound files, such as alarm or alert sounds, at one or more speaker of renal failure therapy machine  20 . Although GUI  40  is illustrated as being connected to housing  22 , it is also possible that GUI  40  is separate from and communicates wirelessly with control unit  30  via any of the protocols described above. 
     Coordinating logic implementor  100  in the illustrated embodiment includes its own control unit  110 . Control unit  110  in the illustrated embodiment includes one or more processor  112  and one or more memory  114 , video card, sound card, and wireless transceiver or wired interface  116  for communicating with control unit  30  of renal failure therapy machine  20 , and if enabled, the control units of IV drug infusion pump  70 ,  80  and/or  90 . 
     Coordinating logic implementor  100  in the illustrated embodiment also includes a graphical user interface (“GUI”)  120 , which enables an operator to enter data and commands into and/or receive information from control unit  110 . GUI  120  includes a video monitor, which may likewise operate with a touch screen overlay placed onto the video monitor for inputting commands into control unit  110 . GUI  120  may also include one or more electromechanical input device, such as a membrane switch or other button. Control unit  110  may also include an audio controller for playing sound files, such as alarm or alert sounds, at one or more speaker of coordinating logic implementor  100 . 
     Although coordinating logic implementor  100  is illustrated as being located adjacent to renal failure therapy machine  20 , coordinating logic implementor  100  may alternatively be located on or connected to renal failure therapy machine  20 . In a further alternative embodiment, coordinating logic implementor  100  is integrated within renal failure therapy machine  20 , such that control unit  110  and its software and programming is integrated into control unit  30 . Providing coordinating logic implementor  100  separate from renal failure therapy machine  20 , however, allows coordinating logic implementor  100  to operate with existing renal failure therapy machines, perhaps with a software upgrade. It is contemplated to implement coordinating logic implementor  100  as a stand alone device, as part of any of the medical fluid machines, and/or as third party hardware, and/or as abstracted into software somewhere (like in an EMR, edge computing, cloud services, etc.). 
     IV drug infusion pumps  70 ,  80  and/or  90  each include a control unit  72 ,  82  and  92 , respectively. Control units  72 ,  82  and  92  may each likewise include one or more processor, one or more memory, a video card, a sound card, and a wireless transceiver or wired interface for communicating with control unit  110  of coordinating logic implementor  100 . IV drug infusion pumps  70 ,  80  and/or  90  each also include one or more pump actuator  74 ,  84  and  94  under control of control unit  72 ,  82 ,  92 , respectively, such as a peristaltic, platen or other type of tubing or syringe pump actuator. IV drug infusion pumps  70 ,  80  and/or  90  each also include one or more graphical user interface (“GUI”)  76 ,  86  and  96 , respectively. Each GUI  76 ,  86  and  96  may include a video monitor, which may likewise operate with a touch screen overlay placed onto the video monitor for inputting commands into control unit  72 ,  82  and  92 , respectively. Each GUI  76 ,  86  and  96  may also include one or more electromechanical input device, such as a membrane switch or other button. 
     Renal failure therapy machine  20  and external infusion pumps  70 ,  80  and  90  each, in one embodiment, include an address that distinguishes the machine and pumps from one another in the eyes of coordinating logic implementor  100 . The addresses designate the pumps of renal failure therapy machine  20  and infusion pumps  70 ,  80  and  90  to be associated with a specific patient undergoing an AKI or other renal failure treatment. The addresses prevent miscommunication between multiple renal failure therapy machines  20  and associated infusion pumps  70 ,  80  and  90  if multiple treatments are taking place simultaneously and in close proximity to one another, e.g., for example, in adjacent ICU&#39;s or in a treatment center. The potential for miscommunication exists to a greater degree with wireless communication. 
     The addresses described above enable information to be transferred back and forth between coordinating logic implementor  100 , renal failure therapy machine  20  and infusion pumps  70 ,  80  and  90 . For example, current treatment data may be sent from either one or both of renal failure therapy machine  20  and infusion pumps  70 ,  80  and  90  to coordinating logic implementor  100 . Coordinating logic implementor  100  may send one or more determined operating parameter to renal failure therapy machine  20  and to one or more of infusion pumps  70 ,  80  or  90  for (i) automatic entry and actuation by a respective control unit  30 ,  72 ,  82  or  92  and/or (ii) display at a respective GUI  40 ,  76 ,  86  or  96  for approval or acceptance. In a further alternative embodiment, coordinating logic implementor  100  may display one or more determined operating at its GUI  120  alternatively or in addition to the display at GUI  40 ,  76 ,  86  or  96 . 
     The following scenarios are contemplated for system  10  and associated methodology: (i) there is communication between coordinating logic implementor  100  and renal failure therapy machine  20 , and system  10  has been authorized to allow automatic inputting and actuation of one or more operating parameter sent from coordinating logic implementor  100  to renal failure therapy machine  20 ; (ii) there is communication between coordinating logic implementor  100  and infusion pump  70 ,  80  or  90 , and system  10  has been authorized to allow automatic inputting and actuation of one or more operating parameter sent from coordinating logic implementor  100  to infusion pump  70 ,  80  or  90 ; (iii) there is communication between coordinating logic implementor  100  and renal failure therapy machine  20 , but system  10  has not been authorized to allow automatic inputting and actuation of one or more operating parameter sent from coordinating logic implementor  100  to renal failure therapy machine  20 , so that the one or more parameter is displayed at one or more of GUI  40  or  120  as a suggested parameter to the operator; (iv) there is communication between coordinating logic implementor  100  and infusion pump  70 ,  80  or  90 , but system  10  has not been authorized to allow automatic inputting and actuation of one or more operating parameter sent from coordinating logic implementor  100  to infusion pump  70 ,  80  or  90 , so that the one or more parameter is displayed at one or more GUI  120 ,  76 ,  86  or  96  as a suggested parameter to the operator; and (v) there is no communication between coordinating logic implementor  100  and infusion pump  70 ,  80  or  90 , so that one or more parameter determined by coordinating logic implementor  100  is displayed at one or more GUI  120  or  40  (of machine  20 ) as a suggested IV drug parameter to the operator. In the latter scenario (v), the prescribed dose or flowrate corresponding to a prescribed drug dose is initially entered manually into coordinating logic implementor  100  via GUI  120  or renal failure therapy machine  20  via GUI  40 . 
       FIG. 1  further illustrates that system  10  contemplates that coordinating logic implementor  100  be configured to communicate with the hospital&#39;s electronic medical record (“EMR”) database  150 , e.g., wired or wirlessly. In an embodiment, at the end of a CRRT or IHD treatment and associated drug delivery, any or all relevant treatment data is sent from coordinating logic implementor  100  to EMR database  150 , which stores a file for the patient. Other treatment information, such as the drugs delivered, alarms, alerts, caregiver or operator notes entered during treatment, may also be sent, e.g., date- and time-stampped, from coordinating logic implementor  100  to EMR database  150 . 
     Referring now to  FIG. 2 , system  10  is illustrated schematically to show one embodiment of the different types of fluid inputs that may affect the overall effluent flowrate determination. System  10  in  FIG. 2  includes renal failure therapy machine  20 , coordinating logic implementor  100  and infusion pumps  70 ,  80  and  90  as described in connection with  FIG. 1 .  FIG. 2  also illustrates fresh dialysis fluid scale  26   a  and effluent scale  26   b  described in connection with  FIG. 1  along with additional scales, namely, upstream predilution scale  26   c , downstream predilution scale  26   d  and postdilution scale  26   e . Coordinating logic implementor  100  is in communication with EMR database  150  as illustrated in  FIG. 2 . 
     Scales  26   a  to  26   e  respectively weigh fluid residing within dialysis fluid container  52   a , effluent container  52   b , upstream predilution container  52   c , downstream predilution container  52   d  and postdilution container  52   e . Containers  52   a  to  52   c  form a portion of a disposable set  50 , which attaches to housing  22  (of  FIG. 1 ) of renal failure therapy machine  20  for treatment. Disposable set  50  in the illustrated embodiment also includes an arterial line  54  for removing blood from a patient P, a venous line  56  for returning blood to patient P, and a drip chamber  58  placed in venous line  56  for removing any air from the blood before returning to patient P. A blood filter or dialyzer  60  seperates arterial line  54  from venous line  56 . Blood filter or dialyzer  60  includes a blood compartment  60   a , a dialysis fluid compartment  60   b , which are separated by a semipermeable membrane  62 . Arterial line  54  leads to blood compartment  60   a , while venous line  56  extends from blood compartment  60   a . Similarly, a fresh dialysis fluid line  64  extends from dialysis fluid container  52   a  to dialysis fluid compartment  60   b , while effluent line  66  extends from dialysis fluid compartment  60   b  to effluent container  52   b.    
     Disposable set  50  in the embodiment of  FIG. 2  also includes an upstream predilution line  68   c  extending from upstream predilution container  52   c  to arterial line  54 , a downstream predilution line  68   d  extending from downstream predilution container  52   d  to arterial line  54 , and a postdilution line  68   e  extending from postdilution container  52   e  to venous line  56 . 
       FIG. 1  generalizes pumps, sensors and valves, etc., associated with housing  22  of renal failure therapy machine  20  as exterior apparatuses  28 . Those exterior apparatuses are illustrated in more detail in  FIG. 2  as including a fresh dialysis fluid pump  42   b  operating with fresh dialysis fluid line  64 , an effluent pump  42   b  operating with effluent line  66 , an upstream predilution pump  42   c  operating with upstream predilution line  68   c , a downstream predilution pump  42   d  operating with downstream predilution line  68   d , and a postdilution pump  42   e  operating with postdilution line  68   e . Additonally, a blood pump  44  is provided, which pumps blood from patient P along arterial line  54 , through blood filter  60  and back to patient P via venous line  56 . Plural valves are provided, such as venous valve  46 . A level detector  48  is also provided to detect a liquid level in drip chamber  58 . 
     All pumps, valves, detectors, scales, sensors and the like are under control of, or send output signals to, control unit  30  as illustrated by the dashed lines in  FIG. 2 .  FIG. 2  illustrates a CRRT embodiment for renal failure therapy machine  20 . An IHD or hemodialysis embodiment for renal failure therapy machine  20  would look much the same, but may instead (i) have online dialysis fluid generation and a house drain as opposed to containers  26   a  and  26   b , (ii) use different types of pumping and valving (e.g., peristaltic and pinch used for CRRT as illustrated, or pneumatic and/or electromechanical for IHD), (iii) use volumetric or flowrate determination versus CRRT&#39;s weight detection for fluid control and balancing, and (iv) not deliver treatment fluid to blood lines  54  or  56 . CRRT accordingly presents a most-case scenario for the number of different types of fluids that may be inputted into the effluent equation shown below, thereby providing support for IHD embodiments as well. It should be appreciated however that CRRT of system  10  does not have to use replacement fluid or can have one or both predilution and/or postdilution replacement fluids. Additionally, CRRT may or may not have dialysis fluid flow. CRRT of system  10  may have any combination of such fluid flows. 
     The flowrates associated with the different pumping sources in  FIG. 2  are illustrated and include Q BLOOD  for blood flow, Q DIAL  for fresh dialysis fluid flow, Q EFF  for effluent flow, Q PBP  for pre-blood pump flow (e.g., heparin anticoagulant), Q REP1  for predilution replacement fluid flow, Q REP2  for postdilution replacement fluid flow, Q D70  for infusion pump  70 &#39;s drug flow, Q D80  for infusion pump  80 &#39;s drug flow and Q D90  for infusion pump  90 &#39;s drug flow. Except for Q BLOOD  for blood flow, system  10  takes into account each of Q DIAL , Q PBP , Q REP1 , Q REP2 , Q 70 , Q 80 , and Q 90  in determining effluent flow Q EFF . Q DIAL , Q PBP , Q REP1 , and Q REP2  in an embodiment are prescribed by a doctor along with a prescribed patient fluid loss or ultrafiltration removal flow rate Q UF . The drug for Q 70 , Q 80 , and Q 90  may be a flowrate that corresponds to a dose prescribed by a doctor or may be adjusted from the prescribed flowrate as discussed in detail below. 
     An overall fluid balance equation for system  10  in  FIG. 2  is as follows: 
         Q   UF   =Q   EFF   [Q   DIAL   +Q   PBP   +Q   REP1   +Q   REP2   +Q   D70   +Q   D80   +Q   D90 ] 
     In one example, Q UF =200 ml/hr, Q DIAL =1000 ml/hr, Q PBP =600 ml/hr, Q REP1 =800 ml/hr, and Q REP2 =800 ml/hr. The drug flowrates are determined initially from the dosage prescribed by the doctor. The dosages may be provided in a form such as mg/(kg of patient weight) over a number of hours, which knowing the patient&#39;s weight gives g/hr, and knowing the density of the drug yields ml/hr. Assuming for the present example that Q D70  is 60 ml/hr, Q D80  is 100 ml/hr and Q 90  is 80 ml/hr, the above equation is populated as follows: 
       200= Q   EFF −[1000+600+800+800+60+100+80]200= Q   EFF −[3440 (total patient fluid input)] Q   EFF =3640 ml/hr
 
     Notably, the 240 ml/hr total drug component (60+100+80) in the above calculation represents seven percent of the total patient fluid input of 3440 ml/hr, which is relatively significant, yielding a like percentage increase in effluent accuracy. In an embodiment, the above calculation is performed at coordinating logic implementor  100 , which is able to obtain all input information from all doctor prescribed information either (i) electroncially from renal failure therapy machine  20  and/or infusion pumps  70 ,  80  and  90 , (ii) entered manually at GUI  120 , or (iii) some combination thereof. 
     Knowing the effluent, Q EFF =3640 ml/hr, based on the prescribed dosages for the three drugs of infusion pumps  70 ,  80  and  90 , system  10  now compensates for drug fractions that are removed via effluent flow Q EFF . Coordinating logic implementor  100  receives the weight of patient P at the beginning of treatment and uses a conversion algorithm to compute the patient&#39;s corresponding blood volume. Assuming patient P to weigh 80 kg, one estimator (https://reference.medscape.com/calculator/estimated-blood-volume) estimates the blood volume of patient P to be 6000 ml. Knowing that 3440 ml will be added over the next hour, the cumulative volume totals 9440 ml. The percentage of each drug in the volume over the hour is then (i) 60/9440 or 0.63% for the drug of infusion pump  70 , (ii) 100/9440 or 1.1% for the drug of infusion pump  80 , and 80/9440 or 0.84% for the drug of infusion pump  90 . 
     Coordinating logic implementor  100  then increases the actual flowrates for each infusion pump  70 ,  80  and  90 , so that over the hour the drug received by the patient achieves the prescribed dosage. In the example, the flowrate for pump  70  would increase from 60 ml/hr to 60.38 ml/hr (0.63% increase). The flowrate for pump  80  would increase from 100 ml/hr to 101 ml/hr (1.1% increase). The flowrate for pump  90  would increase from 80 ml/hr to 80.67 ml/hr (0.84% increase). Assuming the flowrate adjustment to be relatively small, as here, the calculation for effleunt flowrate Q EFF  does not need to be performed again. It is contemplated for larger drug flowrate adjustments, however, that system  10  takes adjustments into account in determining Q EFF  in the manner above. The drug flowrate adjustments from a drug standpoint are important however because the patient is now receiving the prescribed amount of the drugs. 
     In determining whether to adjust the flowrate for an IV drug, coordinating logic implementor  100  may take into account whether CRRT or IHD machine  20  is actually running. For example, if the IV drug is delivered before or after CRRT or IHD treatment, coordinating logic implementor  100  does not adjust, or suggest to adjust, the IV drug flowrate from the flowrate associated with the prescribed dosage. If CRRT or IHD machine  20  is stopped for whatever reason during treatment, e.g., due to an alarm, alert, supply bag change, etc., machine  20  communicates same (e.g., wired or wirelessly) to coordinating logic implementor  100 , which may be programmed to react in any of a plurality of alternative ways, for example, (i) cause at least one infusion pump  70 ,  80 ,  90  to automatically reduce, or suggest for reduction at the at least one infusion pump  70 ,  80 ,  90 , its IV drug flowrate as described herein while the stoppage persists, (ii) maintain the at least one IV drug flowrate at the elevated flowrate during the stoppage but count the additional flowrate as being part of the administered dosage, and communicate same to at least one infusion pump  70 ,  80 ,  90  or to an oprator of same, so that overall drug delivery time may be reduced to meet the prescribed dosage, or (iii) shut down one or more infusion pump  70 ,  80 ,  90  completely, e.g., if its drug is meant to accompany the CRRT or IHD treatment, e.g., if the drug is an anticoagulant, phosphorous supplement, and the like. 
     In an embodiment, all enabled communication is two-way, so that coordinating logic implementor  100  will know when, during operation of renal failure therapy machine  20 , one or more infusion pump  70 ,  80 ,  90  is operating. In an embodiment, logic implementor  100  periodically polls (e.g., every second, multiple seconds, or fraction of a second) control unit  72 ,  82 ,  92  of infusion pump  70 ,  80 ,  90 , respectively, whether it is currently in a pumping mode or not. Control unit  72 ,  82 ,  92  responds appropriately back to control unit  110  of coordinating logic implementor  100 , which reacts accordingly. In the example above for determining Q EFF , logic implementor  100  during operation of renal failure therapy machine  20  and knowing Q D70  is 60 ml/hr, Q D80  is 100 ml/hr and Q 90  is 80 ml/hr, will (i) automatically increase/reduce, or suggest to increase/reduce, Q EFF  by 60 ml/hr when infusion pump  70  commences/stops pumping, (ii) automatically increase/reduce, or suggest to increase/reduce, Q EFF  by 100 ml/hr when infusion pump  80  commences/stops pumping, and (iii) automatically increase/reduce, or suggest to increase/reduce, Q EFF  by 80 ml/hr when infusion pump  90  commences/stops pumping. 
     To the extent that any one of infusion pump  70 ,  80 ,  90  commensing or stopping pumping appreciably affects total patient fluid input (3440 ml/hr in the example above), coordinating logic implementor  100  is configured to adjust up or down, or to suggest same, the flowrate of any other infusion pump  70 ,  80 ,  90  currently running. In this manner, system  10  is configured to adjust the operation of any infusion pump  70 ,  80 ,  90  based on the current state (e.g., pumping versus not pumping) of any other infusion pump  70 ,  80 ,  90 . 
     The above examples involve the adjustment of IV drug flowrate to compensate for a portion of a prescribed drug being removed from the patient as effluent fluid of a renal failure therapy instead of being absorbed by and therfore treating the patient. Another way to compensate for the effluent removal according to the present disclosure is to adjust the concentration of the IV drug so that the amount of drug actually absorbed by the patient matches that which is prescribed. In the example above, (i) the amount or percentage of the IV drug of infusion pump  70  lost over an hour is 0.63%, (ii) the amount of the IV drug of infusion pump  80  lost over the hour is 1.1%, while (iii) the amount of the IV drug of infusion pump  90  lost over the hour is 0.84%. It is accordingly contemplated that coordinating logic implementor  100  make a suggestion to the physician, technician, machine operator, etc., to increase the concentration of the IV drug by the percentage lost, so that the patient receives the prescribed amount of each IV drug despite losing some of the drug to effluent removal of the renal failure therapy. In an example, if the concentration of (i) the IV drug of infusion pump  70  is 20% by volume, then its concentration is increased by 0.63% to 20.13% by volume, (ii) the IV drug of infusion pump  80  is 10% by volume, then its concentration is increased by 1.1% to 10.11% by volume, and (iii) the IV drug of infusion pump  90  is 12% by volume, then its concentration is increased by 0.84% to 12.1% by volume. 
     The above example assumes that the prescribed flowrate is not adjusted, namely, that Q D70  remains at 60 ml/hr, Q D80  remains at 100 hr and Q 90  remains at 80 hr using the adjusted concentrations. It is contemplated for coordinating logic implementor  100  of system  10  in another alternative embodiment to provide a combination of an adjusted flowrate and an adjusted concentration so that the prescribed dose is met even though some of the IV drug is removed via the effluent flow. 
     Many hospitals have sophisticated compounding systems or units that are able to achieve highly accurate concentrations, such as those specified above. Adjusting concentration versus flowrate may be advantageous when, for example, the prescribed flowrate is at a maximum allowable flowrate for the drug and/or for the infusion pump  70 ,  80 ,  90 . The adjustment of concentration may require coordinating logic implementor  100  to suggest to the physician or caregiver, etc., that the concentration change be made, as opposed to automatic concentration adjustment, so that the physician or caregiver, etc., may order the IV drug having the adjusted concentration from the hospital&#39;s pharmacy. As with any suggestion from coordinating logic implementor  100  discussed herein, the suggestion may be provided audibly, visually or audiovisually at any one or more of GUI  40  of renal failure therapy machine  20 , GUI  120  of coordinating logic implementor  100 , and/or GUI&#39;s  76 ,  86  and  96  of associated infusion pumps  70 ,  80 ,  90 . 
     Method  210  of  FIG. 3  summarizes the above-described adjustments (automatic or suggested) determined by coordinating logic implementor  100  of system  10 . In an embodiment, method is implemented at control unit  110  of coordinating logic implementor  100 . At oval  212 , method  210  begins. At block  214 , control unit  110  adds the IV drug pump flowrates (e.g., Q 70 , Q D80  and Q D90 ) to the overall equation for effluent flowrate (Q EFF ) and effluent flowrate (Q EFF ) is calculated as illustrated above. 
     At block  216 , control unit  110  determines (i) a perecentage adjustment for each IV drug flowrate (Q 70 , Q 80 , Q D90 ) using the calculated effluent flowrate and the patient&#39;s blood volume in a manner described above and/or (ii) determines a concentration adjustment for the IV drugs of infusion pumps  70 ,  80 ,  90  in a manner described above. The adjustments may be implemented automatically or be suggested to the caregiver as discussed herein. 
     At diamond  218 , control unit  110  determines whether the perecentage adjustments, if made, for the IV drug flowrates (Q 70 , Q 80 , Q D90 ) when taken collectively significantly affect the calculation for effluent flowrate (Q EFF ) performed at block  214 . “Significantly” may be determined by comparing the collective adjustment of IV drug flowrates (Q 70 , Q 80 , Q D90 ) as a percentage of a currently calculated effluent flowrate (Q EFF ) to a threshold percentage (e.g., 0.5%). If the percentage adjustment meets or exceeds the threshold percentage, then the affect is considered “significant” according to diamond  218 . In the example above, Q EFF  is determined to be 3640 ml/hr, while the flowrate for (i) pump  70  is adjusted from 60 ml/hr to 60.38 ml/hr, (ii) pump  80  is adjusted from from 100 ml/hr to 101 ml/hr, and pump  90  is adjusted from 80 ml/hr to 80.67 ml/hr. The total or collective adjustment of the IV pumps is 2.05 ml/hr (0.38 ml/hr+1.00 ml/hr+0.67 ml/hr), which as a percentage of the currently calculated Q EFF  of 3640 ml/hr is 0.06%, and which is well below an example threshold percentage (e.g., 0.5%). 
     If the perecentage adjustments for the IV drug flowrates significantly affect the calculation for effluent flowrate (Q EFF ) as determined at diamond  218 , then method  210  returns to block  214  and updates effluent flowrate (Q EFF ) and to block  216  to update the flowrate adjustments for the IV pumps. The loop between diamond  218  and blocks  214  and  216  continues until the perecentage adjustments for the IV drug flowrates do not significantly affect the calculation for effluent flowrate (Q EFF ) as determined at diamond  218 , at which point method  210  proceeds to block  220 . At block  220 , control unit  110  causes the adjustments determined at block  216  to be implemented automatically or suggests the adjustments to the caregiver in any of the manners described herein. At diamond  222 , method  210  ends. 
     Dashed block  217  illustrates and option for method  210  in which blood filter  60  (e.g., dialyzer or hemofilter) patency or lifespan is taken into consideration. In both CRRT and IHD, the dialyzer or hemofilter  60  is known to clot slowly over time, which may decrease the rate of drug removal despite the flow rates being set as constants at renal failure therapy machine  20 . The amount of clotting may be estimated by sensing pressure in one or more of effluent line  66 , arterial line  54  and/or venous line  56 . For example, if the pressure in effluent line  66  builds over the course of treatment, it may be assumed to be from the clotting of blood filter  60 . The pressure build may be correlated, e.g., empirically, with a percentage decrease in drug removal. The correlation is in one embodiment stored as a lookup table in control unit  110  of coordinating logic implementor  100 . Here, as coordinating logic implementor  100  receives increasing pressure signals from a pressure sensor operating with effluent line  66  over the course of a treatment, coordinating logic implementor  100  finds the corresponding percentage decrease of drug removal from the lookup table and reduces the percentage adjustment for IV drug flowrate and/or IV drug concentration determined in block  216  accordingly. 
     Method  210  adjusts IV drug flowrates based on the fact that a patient undergoing a renal failure therapy treatment may be undergoing fluid removal in the form of ultrafiltration as effluent fluid. Such fluid removal is presumed to also remove a portion of one or more IV drug, which is otherwise intended to treat the patient. Method  210  highlights two ways to adjust for the IV drug removal due to effluent removal. It should be appreciated however that the present disclosure contemplates other ways to compensate for IV drug removal or dilution that do not involve effluent flowrate (Q EFF ). 
     In one alternative way, IV drug flowrates Q 70 , Q 80 , and Q 90  (and/or concentrations) are adjusted (or suggested to be adjusted by coordinating logic implementer  100 ) instead based on an amount that the drugs are diluted by the Q REP1  for predilution replacement fluid flow and Q REP2  for postdilution replacement fluid flow. Here, the IV drug flowrates Q 70 , Q 80 , and Q 90  may increase, for example, by a percentage equal to the drug flowrate divided by the total replacement fluid flowrate plus the drug flowrate. For example, using the same example flowrate data from above, where Q REP1  is 800 ml/hr, Q REP2  is 800 ml/hr, Q D7  is 60 ml/hr, Q D80  is 100 ml/hr and Q 90  is 80 ml/hr, then (i) Q D70  is increased by 60 ml/hr/(800 ml/hr+800 ml/hr+60 ml/hr) or 3.6%, (ii) Q D80  is increased by 100 ml/hr/(800 ml/hr+800 ml/hr+100 ml/hr) or 5.9%, while (iii) Q 90  is increased by 80 ml/hr/(800 ml/hr+800 ml/hr+80 ml/hr) or 4.8%. So to make up for the fact that the three IV drugs are diluted during treatment by the predilution and postdilution replacement fluid flows, the flowrate of Q D70  is increased from 60 ml/hr to 62.2 ml/hr (by 3.6%). The flowrate of Q D80  is increased from 100 ml/hr to 106 ml/hr (by 5.9%). The flowrate of Q 90  is increased from 80 ml/hr to 83.8 ml/hr (by 4.8%). It should be appreciated that those of skill may determine other ways to compensate for IV drug dilution due to replacement fluid flow other than the example compensation just described, and that IV drug concentration may be adjusted alternatively or additionally due to IV drug dilution as just described. 
     As is known, predilution replacement fluid and postdilution replacement fluid are used in hemofiltation (“HF”) and hemodialfiltration (“HDF”) treatments, either for CRRT or IHD. In HF, there is no dialysis fluid flow, Q DIAL . HD and HDF do employ dialysis fluid flow, Q DIAL . In theory, dialysis fluid flow does not add to the patient&#39;s overall blood volume due to the fact that dialysis fluid flow is passed along the outsides of the dialyzer membranes whose tiny hollow fiber pores block the dialysis fluid from entering the blood sides of the membranes. In such a case, dialysis fluid flowrate Q DIAL  does not dilute the IV drug flowrates. With high flux dialyzers, however, it is likely, if not expected, that some percentage of the dialysis fluid will migrate into the extracorporeal circuit and thus into the patient&#39;s blood volume. If the amount of the migration becomes significant enough, for example, in the case of chronic HD in which dialysis fluid flowrates are specified in ml/min as opposed to the example Q DIAL  of 1000 ml/hr discussed above, then IV drug flow dilution due to dialysis fluid flow may present itself. In such a situation, IV drug flow dilution due to dialysis fluid flow may be compensated for in the same manners (flowrate and/or concentration) described above for predilution replacement fluid and postdilution replacement fluid. 
     In compensating for IV drug flow dilution due to dialysis fluid flow, coordinating logic implementor  100  estimates the amount or flowrate of dialysis fluid migrating from the dialysis fluid compartment of the dialyzer into the blood compartment of the dialyzer. The estimation (Q EST ) may take into account, and therefore vary due to, any one or more of: the amount of flux or openness of the dialyzer membranes, the blood flowrate, the dialysis fluid flowrate, a relationship between the blood flowrate and the dialysis fluid flowrate, the pressure of blood flow through the dialyzer, the pressure of dialysis fluid flow through the dialyzer, and/or a relationship between the pressure of blood flow and dialysis fluid flow through the dialyzer (e.g., transmembrane pressure). Once coordinating logic implementor  100  establishes Q EST , then the IV drug flowrates Q 70 , Q 80 , and Q 90  may be increased (or suggested to be increased via the coordinating logic implementer), for example, by a percentage equal to the drug flowrate divided by Q EST  plus the drug flowrate. As with any suggestion from coordinating logic implementor  100  discussed herein, the IV drug flowrate suggestions here may be provided audibly, visually or audiovisually at any one or more of GUI  40  of renal failure therapy machine  20 , GUI  120  of coordinating logic implementor  100 , and/or GUI&#39;s  76 ,  86  and  96  of associated infusion pumps  70 ,  80 ,  90 . 
     In a further alternative aspect of the present disclosure, the chemical formulation of an IV drug is modified due to, for example, chemical overlap with the formulation of the predilution replacement fluid, postdilution replacement fluid, and/or dialysis fluid. As discussed above, many hospitals have sophisticated compounding systems or units that are able to achieve highly accurate concentrations. It is therefore possible to adjust the chemical makeup of an IV drug to avoid duplication of a particular chemical substance with that of renal therapy replacement fluid or dialysis fluid. For example, renal therapy replacement fluids and IV drug fluids may both contain phosphate. System  10  here is configured to look at both phosphate doses to see if they can coexist or if a modification to the IV drug phosphate constituency needs to be made. 
     If providing both renal therapy replacement and IV drug fluids treatment fluids to the patient during a same hospital treatment (either directly simultaneously or close together enough that phosphate or other overlapped constituent from the two sources is present in the patient simultaneously), then it is desirable and contemplated that coordinating logic implementor  100  of system  10  be configured to (i) know the chemical compositions of both the renal therapy replacement fluid(s) and the IV drug, (ii) identify and combine the doses or flowrates of the overlapping constituents or chemicals of the renal therapy replacement fluid(s) and the IV drug, (iii) determine if the combined dose or flowrate exceeds a maximum dose or flowrate for each overlapping constituent or chemical, or determine if the dose or flowrate of the constituent or chemical should not exceed that of the IV drug prescription at all, and (iv) if the amount of the constituent or chemical in the renal therapy replacement fluid should be reduced or eliminated, notify the clinician, doctor or other user of system  10  and/or the hospital pharmacy, so that the IV drug is so modified. As with any suggestion from coordinating logic implementor  100  discussed herein, the IV drug constituent suggestions here may be provided audibly, visually or audiovisually at any one or more of GUI  40  of renal failure therapy machine  20 , GUI  120  of coordinating logic implementor  100 , and/or GUI&#39;s  76 ,  86  and  96  of associated infusion pumps  70 ,  80 ,  90 . 
     In an example, suppose that the prescribed dose of phosphate for patient P is X mg/(kg (patient weight) * hr), that the dose of phosphate received from the renal replacement fluid (Q REP1  plus Q REP2 ) is X/3, and that the dose of phosphate that patient P actually receives should not exceed the prescribed dose. Here, control unit  110  of coordinating logic implementor  100  is programmed to (i) accept and know the prescribed dose of phosphate for patient P (X mg/kg (patient weight) * hr, (ii) accept and know that the actual dose of phosphate is not to exceed the prescribed dose, (iii) accept and know the patient&#39;s weight (e.g., taken prior to treatment and delivered directly, wired or wirelessly to coordinating logic implementor  100 ) and thus be able to determine X, (iv) accept and know the chemical constituency of replacement fluid  1  and/or replacement fluid  2  (whichever one or both are used), (v) accept and know the prescribed flowrate of replacement fluid  1  and/or replacement fluid  2 , (vi) calculate the dose of replacement fluid  1  and/or replacement fluid  2  knowing the replacement fluid chemical constituency and the weight of patient P, (vii) offset (or eliminate) the amount of phosphate in the IV drug knowing the replacement fluid dose to achieve the prescribed dose, and (viii) communicate the updated chemical formula for the IV drug having the offset amount of constituency of phosphate in any manner discussed herein. In the example above, the constituency of the IV drug is changed from having X mg/(kg (patient weight) * hr) dose of phosphate to 2×/3 mg/(kg (patient weight) * hr) dose of phosphate, so that when delivered in combination with replacement fluid  1  and/or replacement fluid  2  having X/3 mg/(kg (patient weight) * hr) dose of phosphate, the resulting dose of phosphate delivered is the prescribed dose X mg/(kg (patient weight) * hr). 
     Control unit  110  of coordinating logic implementor  100  may alternatively be programmed to allow patient P to receive the additional X/3 mg/(kg (patient weight) * hr) dose of phosphate from replacement fluid  1  and/or replacement fluid  2 . Or, control unit  110  of coordinating logic implementor  100  may determine that the dose of phosphate from replacement fluid  1  and/or replacement fluid  2  exceeds that of the prescribed dose of the IV drug in which case, control unit  110  of coordinating logic implementor  100  generates an alarm or alert in any of the manners and to any of the destinations discussed herein. The above teachings using replacement fluid apply equally to dialysis fluid assuming a certain and quantifiable amount of dialysis fluid migrates into the extracorporeal circuit as discussed above. It should be appreciated that the constituency of replacement fluid  1  and/or replacement fluid  2  may be modified instead or additionally to the modification of the constituency of the IV drug, for example, if the replacement fluid is made online at or near renal failure therapy machines  20 . It is often the case however that the replacement fluids are premade, bagged and sterilized. The previous paragraphs apply to any overlapping chemical or constituent and are in no way limited to phosphate. 
     Referring now to  FIG. 4 , an embodiment of system  10  shows a single coordinating logic implementor  100  opertaing in the manner described above with multiple clusters of renal failure therapy machines  20  and their associated infusion pumps  70 ,  80 ,  90 . In one embodiment, logic implementor  100  is the hub for all spoke renal failure therapy machines  20  and all spoke infusion pumps  70 ,  80 ,  90 , which is the case with  FIGS. 1 and 2 .  FIG. 4  illustrates an alternative embodiment. Here, coordinating logic implementor  100  is illustrated as being a higher level hub to each of the spoke CRRT or IHD machines  20  in its cluster, wherein CRRT or IHD machines  20  are in turn lower lever hubs to their associated spoke infusion pumps  70 ,  80 ,  90 . Coordinating logic implementor  100  is in communication with EMR database  150  as illustrated in  FIG. 4 . The arrangment of  FIG. 4  may be preferred when shorter range wireless communication is provided. Here, for example, (i) treatment parameters or states are communicted from infusion pumps  70 ,  80 ,  90  to coordinating logic implementor  100  via the corresponding renal failure therapy machine  20 , and (ii) operating parameters (automatic or suggested) are determined at and communicted from coordinating logic implementor  100  to infusion pumps  70 ,  80 ,  90  via the renal failure therapy machine  20 . 
     As used in this specification, including the claims, the term “and/or” is a conjunction that is either inclusive or exclusive. Accordingly, the term “and/or” either signifies the presence of two or more things in a group or signifies that one selection may be made from a group of alternatives. 
     The many features and advantages of the present disclosure are apparent from the written description, and thus, the appended claims are intended to cover all such features and advantages of the disclosure. Further, since numerous modifications and changes will readily occur to those skilled in the art, the present disclosure is not limited to the exact construction and operation as illustrated and described. Therefore, the described embodiments should be taken as illustrative and not restrictive, and the disclosure should not be limited to the details given herein but should be defined by the following claims and their full scope of equivalents, whether foreseeable or unforeseeable now or in the future.