Patent Description:
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.

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's blood to remove waste, toxins and excess water from the patient. The patient is connected to a hemodialysis machine and the patient's blood is pumped through the machine. Catheters are inserted into the patient'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 <NUM> 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.

Peritoneal dialysis uses a dialysis solution, also called dialysate, which is infused into a patient'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'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.

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.

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'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.

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.

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.

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's peritoneal membrane. It is also important to control the concentration of metabolic substances in the patient's bloodstream, such as urea concentration, β<NUM>-microglobulin, creatinine concentration, and so forth. Each of these, along with many other variables, constitutes a peritoneal dialysis outcome.

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.

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.

In optimizing the therapy for both APD and CAPD, the dwell period becomes important. If spent dialysate is permitted to dwell in the patient's peritoneal cavity too long, solutes and water that have been removed from the patient into the dialysate can reenter the patient's body. It is accordingly desirable to provide an apparatus and method that prevents such a situation from occurring.

<CIT> discloses a dialysis machine with a device for preparing dialysis solutions. The device has a detector device, at least two connections and at least two interchangeable storage containers to hold the solution ingredients to be metered, each being connected to at least one connector, and with the connectors being connectable to the connections, and with the connectors or the areas of a connecting tube near the connectors having identification means which can be detected by the detector device. Also disclosed is a connector for connecting a storage container with solution ingredients to a medical apparatus, where the connector or areas of a connecting tube near the connector has identification means. A method of detecting a connection of a solution ingredient storage container is also disclosed. The connector is provided with identification means and is attached to a matching component, and a reader unit determines the type and position of the connector.

<CIT> discloses a peritoneal dialysis system comprising a smart transfer set and a docking unit, wherein the docking unit has a reader for obtaining solution data, and memory storing patient data. An optimal dwell time is determined by the docking unit and sent wirelessly to the smart transfer set. The smart transfer set has a display that shows the dwell time counted backwards after the patient presses an input device on the smart transfer set to indicate that the patient fill has been completed.

The present invention provides a handheld personal communication apparatus according to claim <NUM> and a method performed by a processor of a handheld apparatus according to claim <NUM>.

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'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.

The present disclosure sets forth systems, methods and apparatuses for selecting a dwell time for peritoneal dialysis based on an individual patient'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'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.

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's prescription and (ii) the patient's compliance can be identified and monitored, and (iii) the patient's therapy prescription can be modified if needed. In this manner, the system and method of the present disclosure optimizes the patient's treatment on a local (therapy) level and on integrated (e.g., monthly visits to doctor or clinician) level.

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's belt or be carried in the patient'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'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's pre-therapy blood pressure from a blood pressure cuff or bioimpedance measurement form a bioimpedance device.

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.

The processing and memory also store data for each day'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's or clinician's office every month or periodically. At the office the data from the portable reader is downloaded to the clinician's/doctor'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'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).

In a second primary embodiment, the portable reader records the dialysis solution bag and sends data wirelessly to the patient'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's/clinician'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's/clinician's computer can be via satellite, e.g., via text message.

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's/clinician's computer periodically, e.g., daily. Communication between the base station and the doctor's/clinician'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.

In a fourth primary embodiment, the patient'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's/clinician's computer and/or a supply ordering service, e.g., via satellite communication, e.g., daily.

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.

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 <NUM> 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'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.

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'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.

It is accordingly an advantage of the present disclosure to optimize peritoneal dialysis ("PD") dwell times.

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.

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.

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.

It is still a further embodiment of the present disclosure to be able to readily monitor the patient's compliance with prescribed therapy.

Additional features and advantages are described herein, and will be apparent from the following Detailed Description and the figures.

Referring now to the drawings and in particular to <FIG>, one embodiment of the therapy optimization system and method is illustrated by system 10a. System 10a involves the interaction between a patient <NUM> and a doctor, nurse or clinician <NUM> (referred to herein collectively as medical professional <NUM>). 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.

Regardless of whether APD or CAPD is used, the PD treatment typically involves one or more bags or containers <NUM> 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.

Dialysate container <NUM> can also vary in volume, such as being provided in one, <NUM>, two, and <NUM> liter bags. Dialysate container <NUM> 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 <NUM> 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's peritoneum longer.

Dialysate container or bag <NUM> can be provided accordingly with a marker or barcode <NUM>, which designates at least one of dialysate composition, dextrose level and container solution volume. System 10a also includes a patient scale <NUM>, which the patient uses to weigh himself or herself. The tracking of the patient's weight assists the physician in monitoring the patient's weight trends, which may result in a prescription change, for example if the patient appears to be gaining weight from the therapy. Scale <NUM> is included with electronics in and particular a wireless emitter <NUM> for emitting a signal indicative of the weight of patient <NUM>. One suitable scale having a wireless output and system for addressing and accessing same is disclosed in <CIT>, assigned it to the assignee of the present disclosure. Wireless emitter <NUM> may use a known wireless communication technology, such as Bluetooth™, ZigBee™, or other protocol, e.g., one based on IEEE <NUM>.

System 10a further includes a portable reader 30a, which can be formed as a key ring <NUM> or worn on a necklace <NUM>. Portable reader 30a includes a housing <NUM>, which can be formed via plastic injection molding. Housing <NUM> houses an optical scanner <NUM>, such as a laser scanner, which reads marking or barcode <NUM> placed on solution bag or container <NUM>. In one embodiment, when patient <NUM> holds portable reader 30a close enough to marking <NUM>, patient <NUM> presses an input device <NUM>, which causes scanner <NUM> to read marking <NUM>. Alternatively, scanner <NUM> reads marking <NUM> automatically when marking <NUM> is within range of portable reader 30a.

Portable reader 30a also includes a wireless receiver <NUM>, which accepts a wireless weight signal from wireless emitter <NUM> of weight scale <NUM>. One suitable protocol and addressing system for enabling wireless receiver <NUM> to accept a weight signal from wireless emitter <NUM> is discussed above in the '<NUM> Application.

Housing <NUM> of portable reader 30a is further fitted with processing <NUM> and memory <NUM>, which receive and store the marking information from scanner <NUM>. Processing <NUM> and memory <NUM> 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 <NUM>. Processing <NUM> and memory <NUM> are further configured to accept the weight data received at wireless receiver <NUM> and store such data in memory <NUM>.

Processing <NUM> and memory <NUM> store an algorithm that uses the solution data and the patient specific data to determine an optimal dwell time for patient <NUM> using fresh dialysate from container <NUM>. One suitable algorithm for determining the optimal dwell time is to generate a patient specific 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' 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 <NUM> 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 are disclosed in copending <CIT>, assigned to the assignee of the present disclosure.

Housing <NUM> of portable reader 30a is further outfitted with an output device <NUM>, 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 <NUM> communicates the optimal dwell time determined by processing <NUM> and memory <NUM> to the patient <NUM>. 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 <NUM> can gage how long the current dwell is from completion. It is contemplated for device <NUM> (for this and any of the embodiments discussed herein) to communicate information visually, audibly, tactilely and any combination thereof.

In one embodiment, processing <NUM> and memory <NUM> 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 <NUM> of portable reader 30a includes a start dwell input device <NUM>, which communicates electrically with processing <NUM>, and which patient <NUM> presses as soon as filling from dialysate container <NUM> to the patient's peritoneum has been completed. Pressing input device <NUM> signals to processing <NUM> and memory <NUM> that the dwell has begun. A timer or counter then begins to run, and output device <NUM> 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's peritoneal cavity.

The PD therapy, and in particular a CAPD therapy, may involve the patient connecting to and disconnecting from multiple containers <NUM> of fresh dialysate manually. It is contemplated in one embodiment to have patient <NUM> read the appropriate marking <NUM> of each container <NUM> of dialysate just before that container is to be used. In this way, the optimal dwell time is determined and known for each container <NUM> 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 <NUM> to scan each container <NUM> at the beginning of therapy, such that the patient does not have to scan a container <NUM> between each fill. It is quite likely than that the optimal dwell time will be the same for each container <NUM>, such that patient <NUM> does not have to keep track of which container <NUM> has been scanned first, second, third, and so on. If containers <NUM> contain different types or volumes or fresh dialysate, portable reader 30a can determine same and inform the patient that a particular container <NUM> needs to be used in the order in which it has been scanned.

In one embodiment, patient <NUM> weights himself or herself on scale <NUM> 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 <NUM> and of memory <NUM> begins with a most current patient weight in determining the optimal dwell just prior to each patient fill.

In an alternative embodiment in which patient <NUM> is not able to scan multiple containers <NUM> at the beginning of therapy, the patient'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.

Instead of a separate algorithm, processing <NUM> and memory <NUM> can further alternatively estimate or empirically determine the weight loss of the patient given the patient's beginning weight, total target weight loss, solution type and volume used over the previously optimized dwell time.

Referring now to <FIG>, one embodiment for downloading logged information from portable reader 30a of system 10a to a medical professional <NUM> for long term therapy optimization is illustrated. In one implementation, wireless receiver <NUM> is a wireless transceiver, e.g., using Bluetooth™, ZigBee™, or other wireless protocol, e.g., based on IEEE <NUM>, which not only receives wireless information but also transmits wireless information. In the illustrated embodiment, patient <NUM> brings portable reader 30a to the office of the medical professional <NUM>. As soon as portable reader 30a is placed within wireless communication range of the medical professional's computer <NUM>, portable reader 30a automatically downloads the information read from weight scale <NUM>, solution container <NUM> and information determined at portable reader 30a for each container used over a period of time, such as a month or whatever the period exists between visits to medical professional <NUM>.

In a further implementation, portable reader 30a 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's computer <NUM>. The above described information is then downloaded to the computer. Once on the computer, medical professional <NUM> can review the results and change the patient's therapy prescription if needed. <FIG> for system 10a accordingly illustrate that system 10a 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 10a takes place wirelessly over a local wireless network, both in the environment of patient <NUM> and medical professional <NUM> (which can alternatively be local wired communication).

Referring now to <FIG>, an alternative system 10b is illustrated. System 10b includes many of the features of system 10a, which are numbered the same accordingly, such as scale <NUM> having wireless emitter <NUM>, solution container <NUM> having marking or barcode <NUM> and medical professional computer <NUM>. An alternative portable reader 30b is provided, which can again be provided on a key ring <NUM>, as a key fob and/or worn on a necklace <NUM> on patient <NUM>.

Portable reader 30b includes scanner <NUM> that reads marking <NUM> either automatically or upon an activation of input <NUM>, as described above. In one implementation, portable reader 30b includes processing <NUM> and memory <NUM>, which again are housed in housing <NUM>. In one implementation, local wireless receiver or transceiver <NUM> is replaced with a local wireless emitter <NUM>, which can be the same or similar to emitter <NUM> located within scale <NUM>. Emitter <NUM> sends a wireless weight signal to the patient's cellular phone or portable email device (referred to herein and collectively as a personal communication device ("PCD")) <NUM>. Likewise, wireless emitter <NUM> of portable reader 30b emits a wireless signal representing solution data, as described above, to PCD <NUM>. PCD <NUM> can be configured to calculate the optimal dwell time using the above described algorithm or via an empirical method. PCD <NUM> includes a display device <NUM>, multiple input devices <NUM> and a speaker <NUM>. One or both of video screens <NUM> and speaker <NUM> can be used as an output device, which communicates the optimal dwell time to patient <NUM>. For example, display <NUM> can show a countdown of the optimal dwell time to patient <NUM>, so that the patient knows how much longer the optimized dwell will continue. Alternatively or additionally, PCD <NUM> calls patient <NUM> via speaker <NUM> 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 <NUM> is a wireless transceiver, which can receive a wireless signal from PCD <NUM>, telling portable reader 30b to provide an audible and/or visual output to patient <NUM>.

In yet another alternative embodiment, portable reader 30a (shown and described in connection with <FIG>) is used with system 10b instead of portable reader 30b. All of the optimal dwell time computations are then performed on portable reader 30a, which then sends the optimal dwell time and any other desired information to PCD <NUM> for communication with the medical professional's computer <NUM>.

System 10b, like system 10a also provides a long term therapy optimization feature, which involves communication between PCD <NUM> and medical professional's computer <NUM>. In an embodiment, on a periodic basis, such as daily or otherwise according to an application stored on PCD <NUM>, PCD <NUM> sends a text or satellite message to the medical professional's computer <NUM>, downloading any of the pertinent data described above in connection with system 10a. The information allows medical professional <NUM> to evaluate the patient's therapy performance over time and make PD prescription changes if necessary. It is therefore contemplated that the portable reader 30b communicates with PCD <NUM> on a first periodic basis, e.g., after each reading taken by reader 30b, and that PCD <NUM> communicates with the medical professional's computer <NUM> on a second periodic basis, e.g., daily.

Referring now to <FIG>, an alternative system 10c is illustrated. System 10c includes many of the features of systems 10a and 10b, which are numbered the same accordingly, such as scale <NUM> having wireless emitter <NUM>, solution container <NUM> having marking or barcode <NUM> and medical professional computer <NUM>. Portable reader 30a is provided, which can again be provided on a key ring <NUM>, as a key fob and/or worn on a necklace <NUM> on patient <NUM>. As before, portable reader 30a includes scanner <NUM> that reads marking <NUM> either automatically or upon an activation of input <NUM>, as described above. Portable reader 30a is shown here including processing <NUM> and memory <NUM>, which again are housed in housing <NUM>, however, processing <NUM> and memory <NUM> may not be needed because the dwell calculations are done at base station <NUM> discussed below. Portable reader 30a includes local wireless transceiver <NUM>, to receive optimal dwell information from base station <NUM> for communication to patient via output device <NUM>.

Base station <NUM> includes a wireless transceiver <NUM>, which receives a wireless weight signal from transmitter <NUM> of weight scale <NUM> and any of the above-described solution data from transceiver <NUM> of portable reader 30a. Wireless transceiver <NUM> communicates dwell data to wireless transceiver <NUM> of portable reader 30a to provide an audible and/or visual output to patient <NUM>.

Base station <NUM> includes processing <NUM> and memory <NUM> configured to calculate the optimal dwell time using the above described algorithm or via an empirical method. Base station <NUM> can include a display device <NUM>, multiple input devices <NUM>, and a speaker <NUM> if needed. One or both of video screens <NUM> and speaker <NUM> can be used, in addition to out device <NUM> of portable reader 30a, as an output device to communicate the optimal dwell time to patient <NUM>. For example, device <NUM> and display <NUM> can show a countdown of the optimal dwell time to patient <NUM>, so that the patient knows how much longer the optimized dwell will continue. Alternatively or additionally, speaker <NUM> and/or device <NUM> alerts patient <NUM> when it is time for the patient to drain the spent dialysate at the end of the optimized dwell period.

Base station <NUM> also includes a docking area <NUM> for holding portable reader 30a, charging portable reader 30a, and possibly downloading information from and importing information to portable reader 30a, such that transceiver <NUM> of portable reader 30a may be replaced with a USB or other type of connector that is received by a data communication port at docking area <NUM> of base station <NUM>.

System 10c, like systems 10a and 10b also provides a long term therapy optimization feature, which involves communication between base station <NUM> and medical professional's computer <NUM>. In an embodiment, on a periodic basis, such as daily or otherwise according to an application stored on base station <NUM>, base station <NUM> sends a communication, e.g., via an internet connection, to the medical professional's computer <NUM>, downloading any of the pertinent data described above in connection with system 10a. The information allows medical professional <NUM> to evaluate the patient's therapy performance over time and make PD prescription changes if necessary. It is therefore contemplated that the portable reader 30a communicates with base station <NUM> on a first periodic basis, e.g., after each reading taken by reader 30a, and that base station <NUM> communicates with the medical professional's computer <NUM> on a second periodic basis, e.g., daily.

Referring now to <FIG>, an alternative system 10d is illustrated. System 10d includes many of the features of systems 10a, 10b and 10c, which are numbered the same accordingly, such as scale <NUM> having wireless emitter <NUM>, solution container <NUM> having marking or barcode <NUM> and medical professional computer <NUM>. personal communication device ("PCD") <NUM> is provided, which can be worn on a necklace <NUM> on patient <NUM> but is most likely carried by the patient. Here, PCD <NUM> includes a camera <NUM> that takes a picture of marking <NUM> either automatically or upon an activation of an input <NUM>. PCD <NUM> 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 <NUM> to received a wireless weight signal from transmitter <NUM> of weight scale <NUM>. PCD <NUM> includes processing <NUM> and memory <NUM> that are configured to run software that converts the barcode picture into digital data.

One suitable software is QuickMark, provided by SimpleAct, Inc. , No. <NUM>, Cingchen St. , Songshan District, Taipei City, <NUM> Taiwan (R. ), Telephone No. <NUM>-<NUM>-<NUM>. 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 <NUM> and memory <NUM> 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.

PCD <NUM> includes a display device <NUM>, multiple input devices <NUM>, and a speaker <NUM> if needed. One or both of video screen <NUM> and speaker <NUM> can be used as an output device to communicate the optimal dwell time to patient <NUM>. For example, display <NUM> can show a countdown of the optimal dwell time to patient <NUM>, so that the patient knows how much longer the optimized dwell will continue. Alternatively or additionally, speaker <NUM> alerts patient <NUM> when it is time for the patient to drain the spent dialysate at the end of the optimized dwell period.

System 10d, like systems 10a to 10c also provides a long term therapy optimization feature, which involves communication between PCD <NUM> and medical professional's computer <NUM>. In an embodiment, on a periodic basis, such as daily or otherwise according to an application stored on PCD <NUM>, PCD <NUM> sends a communication, e.g., via a satellite text protocol, to the medical professional's computer <NUM> and/or supply reordering system, downloading any of the pertinent data described above in connection with system 10a. The information allows medical professional <NUM> to evaluate the patient's therapy performance over time and make PD prescription changes if necessary. System 10d is desirable in one respect because a separate portable reader is not needed. PCD <NUM>, which patient <NUM> uses for other purposes, such as personal email, phone usage, media storage, is also used for the optimization of the patient's dialysis therapy.

Referring now to <FIG>, system 110a illustrates one suitable therapy prescription downloading and supply ordering system using PCD <NUM>, PCD <NUM> or portable reader 30a, 30b or 30c discussed above. In the illustrated embodiment PCD <NUM> is shown, which includes all of the features and alternatives discussed above for PCD <NUM>. In a first step of the method or facet of system 110a, medical professional <NUM> communicates with central server <NUM>, e.g., via a web browser and computer. Server <NUM> can be a server maintained by the company that provides solution bags <NUM> or by a company contracted by the solution bag company. Medical professional <NUM> enters patient specific information, such as gender, height, weight, transport type, and fill volume, into the doctor's web browser located at computer <NUM>, which can run a therapy prediction software, such as one described in <CIT>, assigned to the assignee of the present disclosure. The prediction software presents medical professional <NUM> with one or more recommendations for a therapy prescription. The software allows the medical professional <NUM> to accept or modify the prescription. Medical professional <NUM> issues a "program" command via the browser, which causes server <NUM> to automatically and remotely program PCD <NUM> with the desired therapy prescription. The communication from PCD <NUM> to server <NUM> can be a one time communication or communication that occurs periodically after medical professional <NUM> reevaluates patient <NUM>.

In a second step of the method or facet of system 110a, server <NUM> communicates the medical professional's <NUM> prescription to a warehouse computer <NUM> located at a warehouse of the manufacturer of the solution and solution bags <NUM>. The communication from server <NUM> to warehouse computer <NUM> can be transparent or done automatically whenever medical professional <NUM> changes the therapy prescription for patient <NUM>. Warehouse computer <NUM> generates a supply order, e.g., a bill of lading.

In a third step of the method or facet of system 110a, warehouse computer <NUM> sends or prepares the bill of lading to/for delivery person <NUM>, which is done on a periodic basis, such as once a month. In a fourth step of the method or facet of system 110a, delivery person <NUM> obtains the necessary supplies, e.g., solution bags <NUM>, connectors, etc., and delivers the supplies to patient <NUM>, 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 <NUM> to track the amount of supplies delivered from warehouse <NUM>.

In a fifth step of the method or facet of system 110a, patient <NUM> uses PCD <NUM> to scan barcodes off of solution bags <NUM>. PCD <NUM> receives patient data for patient <NUM>, 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 <NUM> communicates the bag scan (or other supply usage data) and patient data to a central server <NUM>. The communication from PCD <NUM> to server <NUM> is in one embodiment automatic and transparent to patient <NUM>. It should be appreciated that step five allows server <NUM> to know how much of the supplies or solution bags <NUM> delivered to patient <NUM> have actually been used by the patient. Knowing how many supplies have been delivered from the warehouse housing computer <NUM> and how many supplies have been used by patient <NUM>, system 110a at server <NUM> can determine when to deliver and how many supplies or solution bags <NUM> to deliver to patient <NUM>. And as discussed, server <NUM> orders supplies or patient <NUM> based on the therapy prescription sent from medical professional <NUM>.

Knowing how many supplies have been used by patient <NUM> also enables medical professional <NUM> to track the patient's compliance with the prescribed therapy. If patient <NUM> is supposed to use twenty solution bags <NUM> of dialysate per week, but PCD <NUM> consistently reports back that the patient is using less than twenty bags, medical professional <NUM> upon viewing this compliance data, e.g., at computer <NUM>, can contact patient <NUM> to inquire as to why the patient's prescription is not being followed. Or, the compliance data can be discussed the next time patient <NUM> visits medical professional <NUM>. To this end, it is contemplated for medical professional <NUM> to be able to access patient therapy compliance data from server <NUM> and/or for server <NUM> to periodically send patient therapy compliance data reports to computer <NUM> of medical professional <NUM>. The report in one embodiment is copied to PCD <NUM> and patient <NUM>, so that patient <NUM> knows that medical professional <NUM> is seeing the patient's compliance reports, good or bad.

Referring now to <FIG>, system 110b illustrates another suitable therapy prescription downloading and supply ordering system using PCD <NUM>, PCD <NUM> or portable reader 30a, 30b or 30c discussed above. System 110b includes all of the steps and alternatives discussed above for system 110a of <FIG>. In an additional step or facet of system 110b, delivery person <NUM> is provided with a handheld device, such as PCD <NUM> or PCD <NUM>, which enables delivery person <NUM> to report back to server <NUM> how many supplies, such as supply bags <NUM>, have actually been delivered to patient <NUM>. System 110b closes the loop between server <NUM>, warehouse computer <NUM> and driver <NUM>. Unlike system 110a, which assumes all supplies listed on the bill of lading are delivered to patient <NUM>, system 110b allows server <NUM> to receive the amount of supplies actually delivered from delivery person <NUM> to patient <NUM>. This information in combination with the amount of supplies used sent from patient PCD <NUM> enables server <NUM> to know when and how many supplies, such as solution bags <NUM> to order for the patient <NUM>.

Claim 1:
A handheld personal communication apparatus (30a, 30b, 30c, <NUM>, <NUM>) for a continuous ambulatory peritoneal dialysis ("CAPD") treatment comprising:
an optical or wireless reader (<NUM>, <NUM>, <NUM>, <NUM>) configured to obtain one or more peritoneal dialysis input parameters by reading a marking (<NUM>) displayed on a dialysis fluid container (<NUM>) to acquire data concerning at least one of a dialysis fluid type or a dialysis fluid volume from the marking;
a receiver (<NUM>) configured to receive information indicative of a patient's response to dialysis including at least a patient weight signal from a weight scale (<NUM>);
a processor (<NUM>, <NUM>) configured to
use the one or more peritoneal dialysis input parameters and the information indicative of the patient's response to dialysis to determine a dialysis dwell time for a dialysis dwell of a single CAPD cycle of a dialysis therapy for the patient, the dialysis dwell time corresponding to a time to achieve at least one of (a) a maximum ultrafiltrate level for the CAPD cycle, (b) a urea removal level for the CAPD cycle, or (c) a creatinine removal level for the CAPD cycle,
begin a timer for the dialysis dwell after receiving a patient input from a start dwell input device (<NUM>, <NUM>) that is pressed after completing a filling of the patient's peritoneum with dialysis fluid from the dialysis fluid container (<NUM>), and
after the timer has reached the dialysis dwell time, transmit an output signal; and
an output interface (<NUM>, <NUM>, <NUM>) configured to, in response to the output signal, provide an indication to the patient of a completion of the dialysis dwell time,
wherein the indication includes at least one of (i) a display of a visual notification on a screen of the output interface, (ii) an audio notification via a speaker of the output interface, or (iii) a tactile actuation via an actuator of the output interface.