PERSONAL DIALYSIS USING A WEB-BASED, PORTABLE

SYSTEM

C-PAK (Carry-on Pulse Artificial Kidney)

Jung Chan Lee, Wook Eun Kim, Ki Moo Lim, Jeong Chul Kim

Interdisciplinary Program in Medical and Biological Engineering Major, Seoul National University, Seoul, Korea

Byoung Goo Min

Department of Biomedical Engineering, Seoul National University, Seoul, Korea

Keywords: Hemodialysis, Hemofiltaration, Artificial Kidney, Web-based Remote Monitoring.

Abstract: While the number of patients suffering from acute and chronic renal failure has been steadily increasing

every year, the mortality rate is not improving. For the purpose of improvement on the quality of life and

mortality of renal disease patients, we employ the hemofiltration principle to treat the end-stage renal

disease patients. Hemofiltration equipment can be installed without additional plumbing and electrical

power construction; operated only with several pre-packaged fluid bags without a huge water treatment

facility. This paper describes the development of portable renal treatment equipment based on

hemofiltration treatment, Carry-on Pulse Artificial Kidney (C-PAK), and reports the results of animal test

using the equipment. The web-based remote monitor/control system for C-PAK is introduced also. We

expect that our portable hemofiltration device for chronic renal failure patient would be an alternative for

conventional hemodialysis machine and a solution to home renal treatment.

1 INTRODUCTION

While the number of patients suffering from acute

and chronic renal failure has been steadily increasing

every year, the mortality rate is not improving.

According to the USRDS (United States Renal Data

System), 20% of the inpatients to intensive care unit

of hospitals suffer from acute renal failure. The

mortality of renal disease patients with other

complications has reached 50-80%. Because the

number of patients increases over 6% by annually,

we expect the population of renal failure to nearly

double in 10 years. However, the number of nurses

and physicians who treat the increasing number

patients is already insufficient. (Rayner, 2000)

The dramatically increasing number of renal

disease patients will be a financial burden to the

medical insurance. Nowadays, a patient who is

treated with in-center renal treatments costs

US$68,400 per year in the United States.

(McFarlane, 2002, Mohr, 2001)

Athough renal replacement treatment have been

developed for a long time after Kolff introduced the

hemodialysis in 1943, patients with end-staged renal

disease have an average life expectancy of only 5

years and their quality of life is extremely poor.

(Jaber, 2004)

For the purpose of improvement on the quality of

life and mortality of renal disease patients, we

employ the hemofiltration principle to treat the end-

stage renal disease patients. Several researchers have

already reported their clinical results of this

convective treatment. However, simple replacement

of conventional hemodialysis or peritoneal dialysis

is meaningless. We expect that the patients suffering

from end-stage renal failure will be able to choose

the flexible treatment method and schedule. Also the

patient should be treated with the renal treatment

wherever and whenever upon patient’s request. A

drastic switch from in-center conventional dialysis

policy to home renal treatment is necessary. Instead

of standardized renal treatment with fixed dose, a

treatment with adequate dose for each patient must

166

Chan Lee J., Eun Kim W., Moo Lim K., Chul Kim J. and Goo Min B. (2008).

PERSONAL DIALYSIS USING A WEB-BASED, PORTABLE SYSTEM - C-PAK (Carry-on Pulse Artiﬁcial Kidney).

In Proceedings of the First International Conference on Biomedical Electronics and Devices, pages 166-169

DOI: 10.5220/0001050701660169

 SciTePress

be employed with personalized renal treatment

equipments.

Hemofiltration, the filtration of the native

kidney, has improved the clearance of intermediate-

sized molecules that are insufficiently removed by

hemodialysis. In particular, beta2-microglobulin,

which causes hemodialysis-related amyloidosis

within several years of hemodialysis treatment, can

be removed effectively by hemofiltration treatment.

In addition, hemofiltration treatment is strongly

associated with better cardiovascular stability.

Moreover, comparison studies supported the claims

of reduced mortality of end-staged renal disease

patients given hemofilration treatment. (Jaber and

Zimmerman, 2004)

Hemofiltration equipment can be installed

without additional plumbing and electrical power

construction; operated only with several pre-

packaged fluid bags without a huge water treatment

facility.

In this paper, we describe the development of

portable renal treatment equipment based on

hemofiltration treatment, Carry-on Pulse Artificial

Kidney (C-PAK), and report the results of animal

test using the equipment. We also introduce the web-

based remote monitor/control system for C-PAK.

2 METHODS

2.1 Design of Portable Hemofiltration

System

C-PAK is designed for hemofiltration treatment. C-

PAK consists of the control panel, the driving panel,

the disposable set and the electrical power/control

unit. (Figure 1-2)

The control panel includes several function keys

and a colour touch screen. All operation is available

using pop-up menu on the touch screen. The

function keys are used in unexpected case, i.e. when

the touch screen is not working correctly. During the

treatment, the blood flow rates, the replacement flow

rates, the effluent flow rates, the replacement fluid

remains, the effluent volume, the total treatment

time, and the remaining treatment time are displayed

on touch screen.

The driving panel consists of four pumps, several

sensors, and a safety gadget. Pump unit includes the

dual pulsatile blood pump, the replacement fluid

pump, the effluent fluid pump, and the anti-

coagulation pump. The sensor unit includes the

blood detector, the air-bubble detector, the access

pressure sensor, the pre-filter pressure sensor, the

return pressure sensor, the effluent pressure sensor,

the blood leak detector, the replacement fluid weight,

and the effluent fluid weight. The safety gadget is

the tube clamp.

The electrical power/control unit consists of the

power supply, the several motor drivers, and the

main controller including the microprocessor.

During the treatment, the main controller manages

several motor drivers, calculates the remained

treatment time according to the received data from

each sensor and then sends the data and graphs to

display on the touch screen. Especially, maintaining

the body water balance between the replacement

fluid and the effluent is the most important role of

the main controller.

Figure 1: Design of C-PAK.

Figure 2: Structure of C-PAK.

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2.2 Animal Tests of Portable

Hemofiltration System

Animal tests (N=13) were prepared to estimate the

treatment efficacy of C-PAK. The ligations of renal

artery of mongrel dogs weighing 31.77±2.53 kg

were performed to induce the renal failure. After

ligation surgery, blood urea nitrogen (BUN)

concentrations were measured at 12-hr interval.

When BUN exceeds 60 mg/dl, the animal was

treated with hemofiltration treatment. The

venovenous catheters were inserted into the jugular

vein for vascular access. The dual pulsaltile blood

pump could maintain the blood flow rates at 100-

150 ml/min during hemofiltration treatment and the

blood flow rates were monitored by ultrasonic flow

meter.

The bloods were sampled at 1-hr interval. When

the exchange volume was achieved, last blood

sample was collected and the test was terminated.

BUN, creatinine, electrolytes, packed cell volume

(PCV), fibrinogen (FIB), total protein (TP), red

blood cell (RBC), white blood cell (WBC), glucose,

activated partial thromboplastin time (aPTT), and

prothrombin time (PT) were measured from blood

sampling.

All measured parameters were expressed as

means ± standard deviation. The adequate efficacy

line was defined as Kt/V>0.40 for daily renal

treatment.

2.3 Web-based Remote

Monitor/Control System for

Portable Hemofiltration System

Web-base remote monitor/control system forms a

network to connect the patient, his or her medical

personnel, and C-PAK.. Embedded system with

ARM processor is developed as micro sever, and a

communication protocol organizes the network

between the micro severs and the main server.

Without any restriction of time and place, the

medical personnel can access to the main server to

monitor the treatment status of the patient and the

device in order to send prescriptions with adequate

dose for the patient via micro sever. Also, patients

can connect to the main servers to check the

treatment efficacy and the prescriptions transferred

from their medical personnel. (Figure 3-5)

Main server is working with Redhat Linux 9.0

(Red Hat, Inc.) as operating system with

Apache/Tomcat server for web service and with

MySQL server for database service. Micro server

which is directly connected to C-PAK sends the

status of both patient and device to the main server

through network.

Micro sever is designed with Net+50 system

(NetSilicon, Inc.) based on ARM7 processor and

Ethernet controller. ThreadX (Express Logic, Inc.) is

employed as an embedded real-time operating

system (RTOS) of micro server. RS-232 port of C-

PAK was employed for a connection of C-PAK with

micro server.

Figure 3: Network structure of web-based monitor-control

system for portable hemofiltration system.

Figure 4: Data transfer protocol between micro server and

main server.

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3 RESULTS

The prototypes of C-PAK were manufactured and in

total of 13 animal test cases were performed using

C-PAK. Treatment time was 221 ± 41 min, and

achieved exchange volume was 8.98 ± 2.79 l. Kt/V

was 0.40 ± 0.14.

The web-based remote monitor/control system

was built with a main server and micro servers. C-

PAK was connected to a micro server via RS-232

connection. Although web-based remote

monitor/control system could not be tested during

animal tests, the monitored data transferring test and

the remote control test were successfully performed

with virtual treatment environment.

System One (NxStage Medical, Inc.) is the only

commercialized hemofiltration device for home use.

However, our device can meet lighter weights (less

than 15kg) than System One (about 35kg).

Figure 5: Data transfer scheme of micro server.

4 CONCLUSIONS

C-PAK achieved the sufficient treatment efficacy for

daily renal treatment in animal tests. The web-based

remote monitor/control system will be integrated

into the home/portable hemofiltration system.

We expect that our portable hemofiltration

device for chronic renal failure patient would be an

alternative for conventional hemodialysis machine

and a solution to home renal treatment.

REFERENCES

Rayner, H., Pisoni, R., Bommer, J., Canaud, B., Hecking,

E., Locatelli, F., Piera, L., Bragg-Gresham, J.,

Feldman, H., Goodkin, D., Gollespie, B., Wolfe, R.,

Held, P., Port, F., 2000. Mortality and hospitalization

in haemodialysis patients in five European

countries:results from the Dialysis Outcomes and

Practice Patterns Study(DOPPS). Nephrol Dial

Trasnplant.

McFarlane, P., Pieraatos, A., Redelmeier, D., 2002. Cost

savings of home nocturnal versus conventional in-

center hemodilysis. Kidney Int.

Mohr, P., Neumann, P., Franco, S., Marainen, J.,

Lockridge, R., Ting, G., 2001. The case for daily

dialysis: Its impact on costs and quality of life. Am J

Kidney Dis.

Jaber, B., Zimmerman, D., 2004. Rationale and experience

with short daily hemofiltration. Semin Dial.

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