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The present invention relates generally to the field of blood dialyzer. More specifically, the present invention provides a hemodialyzer for clinical hemodialysis for patients in renal failure.
Hemodialysis has been successfully implemented to remove metabolic toxins from a patient whose kidney function no longer supports adequate clearance of the metabolic toxins from the patient's body. A critical component of the hemodialysis comprises hemodialyzer which removes the metabolic toxins mostly through diffusion of small molecule solutes and convection of middle molecules across a membrane of the hemodialyzer.
Efficiency of the hemodialyzer is known to depend on diffusive clearance of the small molecule solutes (KoA: mass transfer coefficient Ko×mass transfer area A), convective clearance of the middle molecules (Kuf: volume of fluid transferred across the membrane in mmHg of pressure gradient) and hydrostatic pressure gradient across the membrane of the hemodialyzer (TMP—TransMembrane Pressure). Of these, the diffusive clearance (diffusive mass transfer) appears to be limited by a dialysate phase in a way that the KoA increases proportionally to an increase in a dialysate flow rate but not to an increase in a blood flow rate. In a hemodialyzer system having a constant dialysate flow rate, and a fixed surface area and thickness of dialyzer membrane, the KoA is dependent on a concentration gradient between blood and dialysate, and on distribution of the blood in a blood compartment coaxially flowing in a countercurrent direction to the dialysate in a dialysate compartment. It is well known that the efficiency of the hemodialyzer decreases when there is a mismatch between blood and dialysate flow distributions.
The majority of hemodialyzers in a cylindrical configuration available for clinical use have been found to have non-uniform blood distribution profiles between a central region and a peripheral region of a packed bundle of hollow fibers for a blood phase. Uniformity of blood distribution is inversely affected by concentration of red blood cells in the blood, wherein a higher concentration of the red blood cells in the blood phase is associated with a higher blood flow rate across and a higher wall shear stress on the hollow fibers located centrally than on those located peripherally in the packed bundle of the hollow fibers. For the dialysate phase, dialysate flow distribution and flow rate are affected by presence of irregularities in inter-fiber channels and gaps in a packing structure of the packed bundle of the hollow fibers. The packed bundle of the hollow fibers is more concentrated and more tightly packed in the central region than in the peripheral region of said packed bundle, resulting in a preferential distribution of dialysate flow and a greater dialysate flow rate in the peripheral region than in the central region which may harbor stagnant areas.
Decrease in the efficiency of a cylindrical hemodialyzer due to the non-uniform dialysate flow distribution and the non-uniform dialysate flow rate seen in a configuration of the coaxial countercurrent flow between the blood and the dialysate can be minimized by a specific configuration of the packing structure of the hollow fibers such as Moire structure. It can also be ameliorated by a change in configuration of the dialysate flow from the coaxial countercurrent flow to a centrifugal flow moving radially across the packed bundle of the hollow fibers from the central region to the peripheral region of the packed bundle. In the centrifugal flow configuration of the dialysate flow, the central region having the more densely packed bundle of the hollow fibers receives the dialysate at its highest flow rate which centrifugally decreases across a radius of the packed bundle toward the peripheral region. The central region of the packed bundle which has the highest concentration of the red blood cells in the blood phase receives the dialysate at its highest flow rate centrifugally moving away from an axis of the packed bundle, which exposes the blood phase in the central region to an increase in the dialysate flow rate. As indicated above, a regional KoA of the central region increases by the increase in the flow rate of the centrifugal dialysate flow, thus minimizing effects of the non-uniform blood distribution on the efficiency of the hemodialyzer.
To improve on the diffusive clearance of the small molecule solutes in a cylindrical hemodialyzer, the present invention of a centrifugal-dialysate-flow hemodialyzer comprises a blood compartment having a packed bundle of hollow fibers in a doughnut configuration on a radial cross-section, and a dialysate compartment having an axial spiral flow converter slidably inserted in a center of the packed bundle of the hollow fibers and an outer circumferential space encircling an outer circumferential layer of the packed bundle of the hollow fibers housed in a cylindrical tube. The axial spiral flow converter comprises a head portion having a rotary propeller coaxially adjoining a stem portion having a longitudinal spiral blade. The rotary propeller is coaxially housed in a proximal dialysate subcompartment which is connected to a dialysate intake tube in a way that the rotary propeller is passively rotatable by an incoming dialysate into the proximal dialysate subcompartment from the dialysate intake tube. The longitudinal spiral blade is slidably inserted in the center of the packed bundle of the hollow fibers in the doughnut configuration for a full length of the packed bundle.
In one embodiment, the cylindrical hemodialyzer comprises a proximal dialyzer compartment, a mid tubular dialyzer compartment, and a distal dialyzer compartment. The proximal dialyzer compartment comprises the proximal dialysate subcompartment distally adjoining a distal blood subcompartment. The distal dialyzer compartment comprises a distal dialysate subcompartment distally adjoining a proximal blood subcompartment. A proximal portion of the mid tubular dialyzer compartment adjoins a distal portion of the distal blood subcompartment proximally. A distal portion of the mid tubular dialyzer compartment adjoins a proximal portion of the distal dialysate subcompartment. Blood flows from the proximal blood subcompartment of the distal dialyzer compartment to the distal blood subcompartment of the proximal dialyzer compartment. Dialysate flows from the proximal dialysate subcompartment of the proximal dialyzer compartment to the distal dialysate subcompartment of the distal dialyzer compartment, which establishes a countercurrent flow configuration between dialysate flow and blood flow.
In one embodiment, the proximal dialysate subcompartment and the distal blood subcompartment are compartmentalized without communication by a radial wall disposed between said proximal dialysate subcompartment and said distal blood subcompartment. The proximal dialysate subcompartment comprises a first cylindrical space and is provided in a cylindrical tubular configuration having an upper radial wall, a tubular side wall and the radial wall disposed distally. The dialysate intake tube adjoins the proximal dialysate subcompartment and opens to the first cylindrical space of the proximal dialysate subcompartment. Around a center of the radial wall disposed distally, a tubular opening coaxially adjoins the radial wall. The tubular opening is provided in a tubular configuration having a flush proximal end with the radial wall and a tubular cylinder of a length that goes through the distal blood subcompartment and opens to the proximal portion of the mid tubular dialyzer compartment. The rotary propeller of the axial spiral flow converter is disposed inside the first cylindrical space in a way that the rotary propeller is rotatable about a longitudinal axis of the cylindrical hemodialyzer and that the rotary propeller is rotatably propelled by the incoming dialysate from the dialysate intake tube. A distal portion of the tubular cylinder is configured to be leakproofly inserted in a proximal portion of an open central tubular column of the packed bundle of the hollow fibers in the doughnut configuration housed in the mid tubular dialyzer compartment.
In one embodiment, the distal blood subcompartment of the proximal dialyzer compartment comprises a second cylindrical space, provided in a cylindrical tubular configuration, having the radial wall of the proximal dialysate subcompartment, a tubular side wall, and a lower radial wall. The radial wall of the proximal dialysate subcompartment serves as an upper wall for the distal blood subcompartment, and is configured with a hole to accommodate a blood output tube. The blood output tube is provided in a tubular configuration, and fixedly connected to the hole of the radial wall of the proximal dialysate subcompartment. The lower radial wall of the proximal dialyzer compartment comprises a tubular opening coaxially disposed in said lower radial wall. The tubular opening is provided in a tubular configuration having a flush proximal end with the lower radial wall and a tubular cylinder of a length that protrudes into and opens to the proximal portion of the mid tubular dialyzer compartment. A distal portion of the tubular cylinder is configured to leakproofly encase a proximal portion of a circumferential perimeter of the packed bundle of the hollow fibers housed in the mid tubular dialyzer compartment. The tubular opening of the lower radial wall of the proximal dialyzer compartment is much larger in size than the tubular cylinder proximally adjoining the tubular opening of the distally disposed radial wall of the first cylindrical space of the proximal dialysate subcompartment. Size difference in width between the tubular opening of the lower radial wall and the tubular cylinder proximally adjoining the tubular opening of the distally disposed radial wall is configured to be equivalent to a width from an edge of the open central tubular column to the outer circumferential layer of the packed bundle of the hollow fibers. An exposed proximal end of the packed bundle of the hollow fibers leakproofly encased by the distal portion of the tubular cylinder of the distal blood subcompartment is open to the second cylindrical space of the distal blood subcompartment, having a flush configuration with an inner surface of with the lower radial wall of the distal blood subcompartment. The second cylindrical space of the distal blood subcompartment collects the blood from a proximal end of the packed bundle of the hollow fibers, and transmits out the blood through the blood output tube.
In one embodiment, the mid tubular dialyzer compartment comprises a cylindrical tube having the proximal portion, the distal portion and a mid portion connecting the proximal portion to the distal portion. The proximal portion of the mid tubular dialyzer compartment fixedly and leakproofly adjoins the distal portion of the distal blood subcompartment under the lower radial wall of the proximal dialyzer compartment. The distal portion of the mid tubular dialyzer compartment fixedly and leakproofly adjoins and opens without an intervening wall to the proximal portion of the distal dialysate subcompartment of the distal dialyzer compartment. The mid tubular dialyzer compartment coaxially encloses the packed bundle of the hollow fibers in a way that there is provided the outer circumferential space bordered by the outer circumferential layer of the packed bundle of the hollow fibers and the inner surface of said mid tubular dialyzer compartment. The outer circumferential layer of the packed bundle of the hollow fibers is separated by >1 mm from the inner surface of said mid tubular dialyzer compartment. The dialysate radially flows from the open central tubular column of the packed bundle of the hollow fibers to the outer circumferential space in a centrifugal direction.
In one embodiment, the distal dialysate subcompartment and the proximal blood subcompartment of the distal dialyzer compartment are compartmentalized without communication by an upper radial wall disposed between said distal dialysate subcompartment and said proximal blood subcompartment. The distal dialysate subcompartment comprises a third cylindrical space, provided in a cylindrical tubular configuration, having a tubular side wall and the upper radial wall, but does not have a wall between the third cylindrical space and the mid tubular dialyzer compartment. A dialysate output tube is fixedly attached to a hole made on the tubular side wall and opens to the third cylindrical space. The upper radial wall of the distal dialysate subcompartment comprises a tubular opening coaxially adjoining the upper radial wall. The tubular opening is provided in a tubular configuration having a flush distal end with the upper radial wall, and adjoins a tubular cylinder of a length that protrudes into and opens to the distal portion of the mid tubular dialyzer compartment. A proximal portion of the tubular cylinder is configured to leakproofly encase the distal portion of the circumferential perimeter of the packed bundle of the hollow fibers housed in the mid tubular dialyzer compartment. The distal portion of the packed bundle of the hollow fibers coaxially goes through the distal dialysate subcompartment, which produces a doughnut configuration of the third cylindrical space.
In one embodiment, the proximal blood subcompartment of the distal dialyzer compartment comprises a fourth cylindrical space, provided in a cylindrical tubular configuration, having the upper radial wall of the distal dialysate subcompartment, a tubular side wall, and a lower radial wall. A tubular cylinder coaxially and fixedly adjoins an upper surface of the lower radial wall around a center of said upper surface of the lower radial wall. The tubular cylinder runs for a length that goes through the distal dialysate subcompartment and opens to the distal portion of the mid tubular dialyzer compartment. A proximal portion of the tubular cylinder is configured to be leakproofly inserted in a distal portion of the open central tubular column of the packed bundle of the hollow fibers in the doughnut configuration housed in the mid tubular dialyzer compartment. Disposed inside the tubular cylinder of the proximal blood subcompartment, an anchoring flange, provided in a configuration of tubular cylinder, coaxially and fixedly adjoins the upper surface of the lower radial wall around the center of said upper surface of the lower radial wall. A distal tip of the longitudinal spiral blade of the axial spiral flow converter is rotatably housed in a tubular cylinder of the anchoring flange. The lower radial wall of the proximal blood subcompartment is configured with a hole to accommodate a blood intake tube. The blood intake tube is provided in a tubular configuration, and fixedly connected to the hole of the lower radial wall of the proximal blood subcompartment. An exposed distal end of the packed bundle of the hollow fibers leakproofly encased by the proximal portion of the tubular cylinder of the distal dialysate subcompartment is open to the fourth cylindrical space of the proximal blood subcompartment, having a flush configuration with an inner surface of the upper radial wall of the distal dialysate subcompartment. The blood is pushed into the fourth cylindrical space through the blood intake tube, following which the blood goes through individual hollow fibers of the packed bundle of the hollow fibers from the distal portion to the proximal portion of the said packed bundle of the hollow fibers into the distal blood subcompartment of the proximal dialyzer compartment. It then goes out through the blood output tube.
In one embodiment, the axial spiral flow converter comprises the head portion having the rotary propeller fixedly adjoining the stem portion of the longitudinal spiral blade along a longitudinal axis of the axial spiral flow converter. The rotary propeller comprises a set of rotary blades fixedly attached to a rotary shaft at an angle ranging from 0° to 180° degree. The rotary propeller is rotatably housed in the first cylindrical space of the proximal dialysate subcompartment in a way that the rotary propeller is rotatable about the longitudinal axis of the cylindrical hemodialyzer and that the rotary propeller is rotatably propelled by the incoming dialysate from the dialysate intake tube into the first cylindrical space. The longitudinal spiral blade comprises a longitudinal shaft to which a single helical blade fixedly encircles said longitudinal shaft from a bottom of the rotary propeller to the distal tip portion of the longitudinal spiral blade. The longitudinal spiral blade is slidably and coaxially placed in the tubular cylinder of the proximal dialysate subcompartment, in the open central tubular column of the packed bundle of the hollow fibers for its entire length, and in the tubular cylinder of the proximal blood subcompartment. The distal tip of the longitudinal spiral blade is rotatably housed in the tubular cylinder of the anchoring flange of proximal blood subcompartment. The longitudinal spiral blade in a rotating configuration pulls the dialysate in the open central tubular column and centrifugally spreads the dialysate in the open central tubular column across the packed bundle of the hollow fibers to the outer circumferential space bordered by the outer circumferential layer of the packed bundle of the hollow fibers.
In one embodiment, the packed bundle of the hollow fibers contains about 10,000 hollow fibers, with an inner diameter of each wet fiber measuring about 200 micrometer, a membrane thickness measuring about 20-45 micrometer, and a length measuring 80-240 mm. The hollow fibers are made of any of following polymers: Cuprophan, Cellulose diacetate, Cuproammonium rayon, Hemophan, Polysulfone, Polycarbonate, Cellulose triacetate, Polyamide, Polyethersulfone, Polyacrilonitrile, or Polymethylmethacrylate. An individual hollow fiber is configured to be elastomerically stretchable upon a dialysate flow tangentially contacting the individual hollow fiber, so as to impart longitudinal flexibility.
In one embodiment, the packed bundle of the hollow fibers is provided in the doughnut configuration on a radial cross-section having an empty column of the open central tubular column circumferentially surrounded by a plurality of the hollow fibers packed in a cylindrical configuration. A first set of resiliently stiff string harness in a tubular configuration is insertably placed inside the open central tubular column so as to provide said open central tubular column with a structural strength. A second set of elastomeric string harness in a tubular configuration is provided on an outer part of the outer circumferential layer of the packed bundle of the hollow fibers to tie up said packed bundle of the hollow fibers. The elastomeric string harness is made of an elastomeric polymer, and is configured to be reversibly and circumferentially stretchable so as to let individual hollow fibers radially pushed apart from other adjacent individual hollow fibers by an outward pressure of the centrifugal dialysate flow radially moving from the open central tubular column to the peripheral layer of the packed bundle of the hollow fibers. The elastomeric string harness in a stretched configuration allows the individual hollow fibers of the packed bundle of the hollow fibers to be radially dispersed in a way that there is an increase in an interfibrillar space between two adjacent individual hollow fibers by the outward pressure of the centrifugal dialysate flow from the open central tubular column to the peripheral layer of the packed bundle of the hollow fibers. The space permits the dialysate to flow through the interfibrillar space in a centrifugal direction. The packed bundle of the hollow fibers is coaxially placed inside the mid tubular dialyzer compartment, wherein the proximal portion of the circumferential perimeter of the packed bundle of the hollow fibers housed in the mid tubular dialyzer compartment is leakproofly encased by the distal portion of the tubular cylinder of the distal blood subcompartment, and wherein the distal portion of the circumferential perimeter of said packed bundle of the hollow fibers is leakproofly encased by the proximal portion of the tubular cylinder of the distal dialysate subcompartment.
In one embodiment, the dialysate flows into the first cylindrical space of the proximal dialysate subcompartment through the dialysate intake tube, and rotates the rotary propeller of the axial spiral flow converter. The rotary propeller coaxially rotates the longitudinal spiral blade which then centrifugally converts an axial flow of the dialysate coming into the open central tubular column of the packed bundle of the hollow fibers to a radial flow toward the outer circumferential space bordered by the outer circumferential layer of the packed bundle of the hollow fibers and an inner surface of the mid tubular dialyzer compartment. The dialysate collected in the outer circumferential space then flows to the third cylindrical space of the distal dialysate subcompartment of the distal dialyzer compartment. The dialysate collected in the third cylindrical space of the distal dialysate subcompartment from the outer circumferential space of the mid tubular dialyzer compartment then flows out through the dialysate output tube.
As described below, the present invention provides a centrifugal-dialysate-flow hemodialyzer comprising a blood compartment having a packed bundle of hollow fibers in a doughnut configuration on a radial cross-section, and a dialysate compartment having an axial spiral flow converter slidably inserted in a center of the packed bundle of the hollow fibers and an outer circumferential space encircling an outer circumferential layer of the packed bundle of the hollow fibers housed in a cylindrical tube. It is to be understood that the descriptions are solely for the purposes of illustrating the present invention, and should not be understood in any way as restrictive or limited. Embodiments of the present invention are preferably depicted with reference to
It is to be understood that the aforementioned description of the apparatus is simple illustrative embodiments of the principles of the present invention. Various modifications and variations of the description of the present invention are expected to occur to those skilled in the art without departing from the spirit and scope of the present invention. Therefore the present invention is to be defined not by the aforementioned description but instead by the spirit and scope of the following claims.