U.S. patent application number 15/482252 was filed with the patent office on 2017-07-27 for esterified polysaccharide osmotics.
The applicant listed for this patent is Fresenius Medical Care Deutschland GmbH. Invention is credited to Ingo Bichlmaier, Dominik Fenn, Thomas Fichert, Thomas Schweitzer.
Application Number | 20170209480 15/482252 |
Document ID | / |
Family ID | 43898848 |
Filed Date | 2017-07-27 |
United States Patent
Application |
20170209480 |
Kind Code |
A1 |
Fenn; Dominik ; et
al. |
July 27, 2017 |
Esterified Polysaccharide Osmotics
Abstract
Esterified polysaccharide osmotics are provided as are the use
of same, a process for synthesis of same, and compositions
containing same.
Inventors: |
Fenn; Dominik;
(Kaiserslautern, DE) ; Fichert; Thomas;
(Warendorf, DE) ; Schweitzer; Thomas;
(Wemmetsweiler, DE) ; Bichlmaier; Ingo; (Munich,
DE) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Fresenius Medical Care Deutschland GmbH |
Bad Homburg |
|
DE |
|
|
Family ID: |
43898848 |
Appl. No.: |
15/482252 |
Filed: |
April 7, 2017 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
13053128 |
Mar 21, 2011 |
9649325 |
|
|
15482252 |
|
|
|
|
61330479 |
May 3, 2010 |
|
|
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61P 7/00 20180101; A61P
43/00 20180101; A61M 1/1654 20130101; A61P 13/02 20180101; A61P
7/08 20180101; A61K 31/715 20130101; A61P 13/12 20180101; A61M
1/287 20130101; A61M 1/1666 20140204; A61K 31/718 20130101 |
International
Class: |
A61K 31/718 20060101
A61K031/718; A61M 1/28 20060101 A61M001/28; A61M 1/16 20060101
A61M001/16 |
Foreign Application Data
Date |
Code |
Application Number |
Mar 19, 2010 |
DE |
102010012183.5-41 |
Claims
1. A polysaccharide osmotic comprising monosaccharide monomers,
which are esterified at least partially with maleic acid, wherein
the monosaccharide monomers include glucose and/or fructose, and
wherein the average molecular weight of the polysaccharide is
between 15,000 and 25,000 g/mol.
2. The polysaccharide osmotic according to claim 1, wherein the
polysaccharide has a degree of polymerization between 10 and
170.
3. The polysaccharide osmotic according to claim 1, wherein a 7.5
weight percent aqueous solution of the polysaccharide has an
osmolarity greater than 11.9 mosm/L.
4. The polysaccharide osmotic according to claim 1, wherein the
polysaccharide has a degree of substitution between 0.01 and 3.
5. A method for carrying out a dialysis treatment comprising
dialyzing blood or a patient with a dialysis solution comprising
the polysaccharide osmotic of claim 1.
6. The method of claim 5, wherein the dialysis treatment comprises
a hemodialysis treatment.
7. The method of claim 5, wherein the dialysis treatment comprises
a peritoneal dialysis treatment.
8. A method for preparation of a polysaccharide osmotic, comprising
the steps of: a. mixing a polysaccharide with a first organic
solvent to form a dispersion or solution, and b. mixing the
dispersion or solution obtained in step a. with a maleic acid
anhydride to form the esterified polysaccharide osmotic of claim
1.
9. The method according to claim 8, comprising the additional step
of: c. precipitating the esterified polysaccharide osmotic obtained
in step b. by adding a second organic solvent, wherein the
esterified polysaccharide osmotic has a greater solubility in the
first organic solvent than in the second organic solvent or in a
mixture of the first and second organic solvents.
10. A dialysis solution comprising at least one polysaccharide
osmotic according to claim 1, and water.
11. A kit configured for the preparation of the dialysis solution
according to claim 10, comprising: a first component, a second
component, and optionally one or more additional components,
wherein the dialysis solution is obtained by mixing the first
component with the second component and optionally with the
additional component(s).
12. A solid composition suitable for preparation of the dialysis
solution according to claim 10, wherein the dialysis solution is
obtainable by dissolving the solid composition in a solvent.
13. A method of preparing a dialysis solution, comprising mixing at
least one polysaccharide osmotic according to claim 1, with
water.
14. A method of preparing a dialysis solution, comprising mixing
together the first component, the second component, and the one or
more additional components, of the kit of claim 11, wherein the kit
includes the one or more additional components.
15. A method of preparing a dialysis solution, comprising
dissolving the solid composition of claim 12 in a solvent, to form
a solution, and mixing the solution with water.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 13/053,128, filed Mar. 21, 2011, now allowed,
which claims the benefit of U.S. Provisional Patent Application No.
61/330,479, filed on May 3, 2010, and claims priority to German
Patent Application No. 102010012183.5-41, filed on Mar. 19, 2010,
all of which are incorporated herein in their entireties by
reference.
FIELD OF THE INVENTION
[0002] The present invention relates to esterified polysaccharide
osmotics, their use, processes for synthesis of same and
compositions containing same.
BACKGROUND OF THE INVENTION
[0003] Osmotically active compounds (osmotics, osmotic agents) are
widely used in the pharmaceutical and medical fields. For example,
osmotics are used to adjust the tonicity of pharmaceutical drugs,
in particular parenteral medications, where the osmotic pressure of
a drug is adjusted to be hypotonic, hypertonic or isotonic,
depending on how they are administered. For example, the osmotic
pressure of a parenteral drug solution can be adjusted to the
osmotic pressure of human blood by adding an osmotic agent
(iso-osmotic solutions).
[0004] Furthermore, osmotics are used in dialysis treatments, in
particular in peritoneal dialysis, to withdraw excess water from
the dialysis patient.
[0005] The peritoneal dialysis process is based on the fact that a
solution containing osmotically active compounds is introduced
through a catheter into the peritoneal cavity of the dialysis
patient. This solution left in the patient's abdominal cavity for a
certain period of time (usually a few hours) and develops its
osmotic effect there, i.e., endogenous water is withdrawn from the
patient's abdominal cavity. After a certain dwell time, the
peritoneal dialysis solution which is now dilute is drained out
through a catheter.
[0006] This principle is used in various peritoneal dialysis
treatment methods. For example, the methods of intermittent (IPD),
nocturnal intermittent (NIPD), continuous cyclic (CCPD) or
continuous ambulant peritoneal dialysis (CAPD) may be used as
needed. Instruments used in IPD, NIPD and CCPD support the patient
in performing the peritoneal dialysis method. CAPD is a manual
method.
[0007] The addition of osmotically active compounds in particular
should ensure that the osmotic pressure of the peritoneal dialysis
solution is high enough during the entire dwell time in the
abdominal cavity to withdraw water from the patient, i.e., water is
transferred from the patient's circulation into his abdominal
cavity (ultrafiltration).
[0008] However, because of the transfer of water into the abdominal
cavity, the peritoneal dialysis solution introduced there is
necessarily diluted. This dilution results in a decline in the
concentration of the osmotically active compound and thus also the
osmotic pressure of this solution.
[0009] If the osmotic pressure of the peritoneal dialysis solution
declines because of this dilution, this in turn results in a
decline in the transfer of water into the abdominal cavity per
occurring per unit of time or it may stop entirely. In these cases,
effective removal of water is no longer occurring with a
progressively longer dwell time of the peritoneal dialysis solution
in the patient's abdominal cavity.
[0010] The direction of transfer of water may even be reversed by
absorption of osmotically active compounds into the patient's
bloodstream, i.e., water is transferred out of the patient's
abdominal cavity and into his bloodstream (negative
ultrafiltration). This is the case when the dilute peritoneal
dialysis solution in the abdominal cavity has a lower osmotic
pressure than the endogenous water (e.g., the blood) of the
patient.
[0011] By adding suitable osmotically active compounds to the
peritoneal dialysis solution, the osmotic pressure can be
maintained for a treatment time that is suitable for peritoneal
dialysis, so there is not an excessive decline in ultrafiltration
within the dwell time of the solution in the abdominal cavity.
Negative ultrafiltration is thus also largely prevented.
[0012] The solutions used in the peritoneal dialysis treatment
usually contain sugar monomers or polymers, such as glucose or
polyglucose (e.g., starch derivatives), as osmotically active
compounds.
[0013] EP-B1-0602585 proposes the use of hydroxyethyl starch as an
osmotic.
[0014] EP-B1-0083360, EP-B2-0115911, EP-B1-0153164 and
EP-B1-0207676 relate to solutions for peritoneal dialysis,
containing starch hydrolysate-glucose polymers as osmotically
active compounds.
BRIEF DESCRIPTION OF THE DRAWINGS
[0015] FIG. 1 is a graph showing a CNMR spectrum.
[0016] FIG. 2 is a graph showing an HNMR spectrum.
[0017] FIG. 3 is a diagram showing the results of a comparative
experiment involving an osmotic agent in various matrix
solutions.
DETAILED DESCRIPTION OF EMBODIMENTS
[0018] The object of the present invention is in particular to make
available osmotics which have a higher osmotic activity than
traditional osmotically active compounds and are therefore suitable
in particular for use in peritoneal dialysis treatment.
[0019] This object is achieved through the subject of the patent
claims.
[0020] The inventive osmotics are characterized in that, in
comparison with traditional osmotics, they have a higher osmotic
activity at the same concentration.
[0021] This increased osmotic activity leads in particular to
removal of water (ultrafiltration) during the dialysis treatment
being increased and/or maintained for a long period of time. Thus,
there is more effective removal of water in the dialysis treatment
when using the inventive osmotics in particular. This may
contribute toward shortening of the dialysis treatment time, for
example. Alternatively, the concentration of the inventive osmotic
may be reduced to achieve the same osmotic activity of a
traditional osmotic.
[0022] The shortening of the dialysis treatment time and/or the
reduction in the reduction in the concentration may in turn lead to
a lower incidence of adverse effects in the dialysis patient.
[0023] A first subject of this invention concerns polysaccharides
containing monosaccharide monomers, which are esterified at least
partially with a dicarboxylic acid and/or tricarboxylic acid
esterified, for use as an osmotic.
[0024] Through esterification of the polysaccharide with a
dicarboxylic acid and/or tricarboxylic acid, deprotonatable side
chains, which are thus also anionically charged, are introduced
into the polysaccharide.
[0025] It has been found that by introducing these deprotonatable
and/or anionic side chains, the efficiency of the peritoneal
dialysis treatment is improved by increased ultrafiltration.
[0026] For the purpose of this description, the term
"polysaccharide" comprises compounds containing at least ten
monosaccharide monomers (Pure & Applied Chemistry, 1995, 67,
1360).
[0027] In the sense of this description, the terms "esterified" and
"ester" comprise compounds which have the structural unit the
structural unit --C(.dbd.O)--O-- (Pure & Applied Chemistry,
1995, 67, 1334).
[0028] In a preferred embodiment, the dicarboxylic acid is a
physiological dicarboxylic acid and the tricarboxylic acid is a
physiological tricarboxylic acid.
[0029] In the sense of this description, the term "physiological
dicarboxylic acid" and/or "physiological tricarboxylic acid"
comprise(s) dicarboxylic acids and/or tricarboxylic acids, which
occur in the human metabolism. Examples that can be mentioned here
include the physiological dicarboxylic and tricarboxylic acids of
the Krebs cycle.
[0030] In the sense of this description, the term "dicarboxylic
acid" stands for an organic compound having two acid groups
(carboxyl groups, --COOH), and the term "tricarboxylic acid" stands
for an organic compound having three acid groups. The acid groups
may be uncharged, i.e., present as --COOH (carboxyl) or anionic,
i.e., deprotonated as --COO.sup.- (carboxylate).
[0031] In the case when the acid group is present as an anionic
carboxylate, it may form a salt with a cationic counterion (e.g.,
sodium, potassium, calcium, magnesium cation).
[0032] The dicarboxylic acid is preferably selected from the group
including oxalic acid, oxalacetic acid, ketoglutaric acid, glutamic
acid, aspartic acid, fumaric acid, maleic acid, malic acid, malonic
acid, succinic acid, glutaric acid, adipic acid, pimelic acid,
suberic acid, azelaic acid, sebacic acid. In another preferred
embodiment, the dicarboxylic acid is oxalic acid, glutamic acid,
aspartic acid, maleic acid or succinic acid. Maleic acid and
succinic acid are preferred in particular.
[0033] The tricarboxylic acid is preferably citric acid or
isocitric acid, in particular citric acid.
[0034] The inventive polysaccharide may be composed of the same or
different monosaccharide monomers. The inventive polysaccharide is
preferably composed of the same monosaccharide monomers. Glucose is
preferred in particular.
[0035] However, the polysaccharide may be composed of
monosaccharide monomers other than glucose and/or fructose. Those
skilled in the art are familiar with typical monosaccharide
monomers.
[0036] The monosaccharide monomers in the inventive polysaccharide
are preferably linked by glycosidic bonds.
[0037] The inventive polysaccharide may be crosslinked. Typical
crosslinking agents are well-known to those skilled in the art.
Epichlorohydrin and diisocyanate compounds may be mentioned here as
examples. It is preferred in particular for the inventive
polysaccharide not to be crosslinked.
[0038] The average molecular weight of the inventive polysaccharide
is preferably 2000 to 30,000 g/mol, more preferably 2500 to 26,000
g/mol, even more preferably 3000 to 22,000 g/mol, even more
preferably 3500 to 20,000 g/mol, most preferably 4000 to 18,000
g/mol and in particular 5000 to 15,000 g/mol.
[0039] In another preferred embodiment, the average molecular
weight of the inventive polysaccharide is 15,000 to 25,000 g/mol,
in particular 18,000 to 22,000 g/mol.
[0040] The inventive polysaccharide preferably has an average
degree of polymerization of 10 to 170, more preferably 11 to 130,
even more preferably 12 to 100, most preferably 13 to 80 and in
particular 14 to 50.
[0041] In another preferred embodiment, the average degree of
polymerization of the inventive polysaccharide is 80 to 140,
preferably 85 to 135, more preferably 90 to 130, most preferably 95
to 125 and in particular 100 to 120.
[0042] A 7.5 weight percent aqueous solution of the inventive
polysaccharide preferably has a theoretical osmolarity of
.gtoreq.11.9 mosm/L, more preferably greater than .gtoreq.12.5
mosm/L, even more preferably greater than .gtoreq.13.0 mosm/L, most
preferably greater than .gtoreq.13.5 mosm/L and in particular
greater than .gtoreq.14.0 mosm/L.
[0043] For the purpose of this description, the term "theoretical
osmolarity" stands for theoretically calculated osmolarity. Methods
of calculating this value are familiar to those skilled in the
art.
[0044] In a preferred embodiment, the colloid osmotic pressure of a
7.5 weight percent solution of the inventive polysaccharide is
.gtoreq.50 mosm/L or .gtoreq.60 mosm/L, more preferably .gtoreq.70
mosm/L or .gtoreq.80 mosm/L, even more preferably .gtoreq.90 mosm/L
or .gtoreq.100 mosm/L, most preferably .gtoreq.110 mosm/L or
.gtoreq.120 mosm/L and in particular .gtoreq.130 mosm/L or
.gtoreq.140 mosm/L.
[0045] In another preferred embodiment, the colloid osmotic
pressure of a 7.5 weight percent solution of the inventive
polysaccharide is .gtoreq.150 mosm/L or .gtoreq.160 mosm/L, more
preferably .gtoreq.170 mosm/L or .gtoreq.180 mosm/L, even more
preferably .gtoreq.190 mosm/L or .gtoreq.200 mosm/L, most
preferably .gtoreq.210 mosm/L or .gtoreq.220 mosm/L and in
particular .gtoreq.230 mosm/L or .gtoreq.240 mosm/L.
[0046] In another preferred embodiment, the colloid osmotic
pressure of a 7.5 weight percent solution of the inventive
polysaccharide is 50 to 500 mosm/L, more preferably 75 mosm/L to
400 mosm/L, even more preferably 100 to 300 mosm/L, most preferably
110 mosm/L to 275 mosm/L and in particular 120 mosm/L to 250
mosm/L.
[0047] In another preferred embodiment, the colloid osmotic
pressure of a 7.5 weight percent solution of the inventive
polysaccharide is 100 to 500 mosm/L, more preferably 100 mosm/L to
400 mosm/L, even more preferably 100 to 350 mosm/L, most preferably
100 mosm/L to 325 mosm/L and in particular 100 mosm/L to 290
mosm/L.
[0048] For the purpose of this description, the term "colloid
osmotic pressure" stands for the experimentally measured osmotic
pressure of the solution, which is comprised of the osmotic and
oncotic pressure. Those skilled in the art are familiar with
suitable methods of experimental determination of this value.
[0049] The osmolality of a 7.5 weight percent aqueous solution of
the inventive polysaccharide is preferably .gtoreq.16 mosm/kg, more
preferably .gtoreq.18 mosm/kg, even more preferably .gtoreq.20
mosm/kg, most preferably .gtoreq.22 mosm/kg and in particular
.gtoreq.25 mosm/kg.
[0050] For the purpose of this description, the term "osmolality"
stands for the osmolality of the solution, which is determined
experimentally based on the reduction in freezing point. Those
skilled in the art are familiar with methods of determining the
reduction in freezing point.
[0051] The osmolarity of a 7.5 weight percent aqueous solution of
the inventive polysaccharide determined experimentally based on the
reduction in freezing point preferably amounts to .gtoreq.15
mosm/L, more preferably .gtoreq.17 mosm/L, even more preferably
.gtoreq.19 mosm/L, most preferably .gtoreq.21 mosm/L and in
particular .gtoreq.23 mosm/L.
[0052] The inventive polysaccharide is esterified with the
dicarboxylic acids and/or tricarboxylic acids described above. The
inventive polysaccharide has a degree of substitution of 0.01 to 3,
preferably 0.05 to 2.5, more preferably 0.1 to 2, most preferably
0.25 to 1.5 and in particular 0.5 to 1.
[0053] In another preferred embodiment, the inventive
polysaccharide has a degree of substitution of 0.02.+-.0.01 or
0.05.+-.0.025, more preferably 0.1.+-.0.05, even more preferably
0.5.+-.0.25, most preferably 1.+-.0.5 and in particular
1.5.+-.0.75.
[0054] In an especially preferred embodiment, the inventive
polysaccharide has a degree of substitution of 0.02.+-.0.005 or
0.05.+-.0.0125, more preferably 0.1.+-.0.025, even more preferably
0.5.+-.0.125, most preferably 1.+-.0.25 and in particular
1.5.+-.0.375.
[0055] The inventive polysaccharide is preferably suitable as an
osmotic agent for adjusting the tonicity of pharmaceutical drugs,
in particular drug solutions for parenteral administration.
[0056] In a preferred embodiment, the inventive polysaccharide is
used in a dialysis treatment, preferably in hemodialysis and/or
peritoneal dialysis treatment.
[0057] The inventive polysaccharide is suitable in particular for
use in peritoneal dialysis treatment.
[0058] Another subject of this invention relates to a method for
synthesis of the inventive polysaccharide, comprising the steps
[0059] a. Mixing a polysaccharide with a first organic solvent,
[0060] b. Mixing the dispersion or solution obtained in step a.
with a dicarboxylic acid anhydride and/or a tricarboxylic acid
anhydride.
[0061] The polysaccharide used in step a. is preferably degraded
starch.
[0062] In a preferred embodiment, a catalyst which accelerates the
esterification reaction is added to the solution or dispersion
obtained in step b. This catalyst is preferably a nucleophilic
catalyst, preferably 4-(dimethylamino)pyridine (DMAP). Those
skilled in the art are familiar with other catalysts having a
similar activity.
[0063] In addition, a base may also be added, preferably an amine
base, such as triethylamine. Those skilled in the art are familiar
with other amine bases.
[0064] The catalyst is preferably added in catalytic amounts, i.e.,
the substance quantity ratio of catalyst (e.g., DMAP) to acid
anhydride is preferably .ltoreq.1:10 or .ltoreq.1:25, more
preferably .ltoreq.1:50 or .ltoreq.1:75, even more preferably
.ltoreq.1:75 or .ltoreq.1:100, most preferably .ltoreq.1:250 and in
particular .ltoreq.1:500.
[0065] After step b., the reaction mixture may be stirred at an
elevated temperature. The temperature is preferably 40 to
80.degree. C., more preferably 50 to 70.degree. C., even more
preferably 55 to 65.degree. C. and in particular 60.degree. C.
[0066] In a preferred embodiment, the reaction mixture obtained in
step b. is stirred for 1 to 12 hours, more preferably for 2 to 8
hours, even more preferably for 4 to 6 hours and in particular for
5 hours.
[0067] The substance quantity ratio of acid anhydride to
polysaccharide is preferably 0.1 to 5 mol/AGU, more preferably 0.2
to 4 mol AGU, even more preferably 0.3 to 3 mol/AGU, most
preferably 0.4 to 2 mol/AGU and in particular 0.5 to 1 mol/AGU.
[0068] In another preferred embodiment, the substance quantity
ratio is 0.1 to 2.5 mol/AGU, more preferably 0.2 to 1.75 mol/AGU,
even more preferably 0.3 to 1.5 mol/AGU, most preferably 0.4 to
1.25 mol/AGU and in particular 0.5 to 0.75 mol/AGU.
[0069] In the sense of this description, the abbreviation "AGU"
stands for "anhydrous glucose unit." Those skilled in the art are
familiar with this standard term.
[0070] The inventive polysaccharide may be separated from the
solution or dispersion by precipitation, where precipitation may be
induced by adding a second organic solvent.
[0071] The precipitation is preferably performed due to the fact
that the inventive polysaccharide has a higher solubility in the
first organic solvent than in the second organic solvent or in a
mixture of the first and second organic solvents.
[0072] The first organic solvent may be any organic solvent, in
which the polysaccharide can be dissolved or dispersed. In a
preferred embodiment, the first organic solvent is dimethyl
sulfoxide or dimethylacetamide or a mixture thereof. Dimethyl
sulfoxide is preferred in particular.
[0073] The second organic solvent may be any organic solvent, in
which the inventive polysaccharide has a lower solubility than in
the first organic solvent.
[0074] The second organic solvent is preferably an alcoholic
solvent--preferably methanol, ethanol, propanol, isopropanol or
butanol--or a ketone solvent--preferably acetone or ethyl methyl
ketone. Ethanol in particular is preferred as the alcoholic
solvent. Acetone in particular is preferred as the ketone
solvent.
[0075] If dimethyl sulfoxide is used as the first organic solvent,
it is preferred in particular for ethanol to be used as the second
organic solvent for the precipitation.
[0076] If dimethylacetamide is used as the first organic solvent,
it is preferred in particular for acetone to be used as the second
organic solvent for the precipitation.
[0077] After precipitation of the inventive polysaccharide, the
separation is preferably performed by filtering the precipitated
precipitate.
[0078] The filtered precipitate is preferably dried. This drying
step is preferably performed at an elevated temperature (preferably
40.degree. C.) and at a reduced pressure (preferably in vacuo).
[0079] In an especially preferred embodiment, the method for
synthesis of the inventive polysaccharides comprises the following
steps: [0080] Mixing a polysaccharide--preferably degraded
starch--with dimethyl sulfoxide and/or dimethylacetamide, [0081]
Adding dicarboxylic acid anhydride and/or tricarboxylic acid
anhydride, a nucleophilic catalyst and optionally an amine base,
[0082] Stirring the mixture at a temperature of 20 to 80.degree. C.
for 2 to 12 hours, [0083] Adding an alcoholic solvent or a ketone
solvent, to induce precipitation of the esterified polysaccharide,
[0084] Filtering the precipitate and [0085] Drying the
precipitate.
[0086] In a particularly preferred embodiment, the method for
synthesis of the inventive polysaccharide comprises the following
steps: [0087] Mixing a polysaccharide with dimethyl sulfoxide or
dimethylacetamide, [0088] Adding dicarboxylic acid anhydride and/or
tricarboxylic acid anhydride, DMAP and optionally triethylamine,
[0089] Stirring the mixture for 3 to 7 hours at a temperature of 50
to 70.degree. C., [0090] Adding ethanol, if the solvent is dimethyl
sulfoxide or adding acetone, if the solvent is dimethylacetamide,
to induce precipitation of the inventive polysaccharide, [0091]
Filtering the precipitate and [0092] Drying the precipitate.
[0093] Another subject of this invention relates to dialysis
solutions containing at least one inventive polysaccharide.
[0094] In a preferred embodiment, the inventive dialysis solution
is a hemodialysis solution or a peritoneal dialysis solution. The
inventive dialysis solution is in particular a peritoneal dialysis
solution.
[0095] Dosage forms, which are used in dialysis treatment, are
preferably concentrates in multicomponent systems or ready-to-use
dialysis solutions.
[0096] For the purposes of this invention, the term "dialysis
solution" comprises a ready-to-use dosage form for dialysis
treatment, i.e., a liquid preparation, which is suitable for
administration as such. In particular the dialysis solution need
not be diluted and/or mixed with other preparations before
administration.
[0097] In contrast with the dialysis solutions described above,
concentrates which may be present in liquid, semisolid or solid
form are diluted with water or aqueous solutions or are dissolved
in water or aqueous solutions before being administered. Similarly,
the components of a multicomponent system must be mixed together
before being administered, to yield a ready-to-use dialysis
solution. Concentrates and multicomponent systems may thus be
regarded as a precursor to the inventive dialysis solution.
[0098] The inventive dialysis solution is preferably a hemodialysis
solution or a peritoneal dialysis solution. Hemodialysis solutions
and peritoneal dialysis solutions usually contain electrolytes in a
concentration, which corresponds essentially to the plasma
electrolyte concentration. Electrolytes usually include sodium,
potassium, calcium, magnesium and chloride ions.
[0099] Dialysis solutions usually have a physiologically tolerable
pH. This is preferably achieved by buffers (buffer systems), which
may also contribute to the total electrolyte content. The buffers
are preferably bicarbonate, lactate or pyruvate.
[0100] Furthermore, dialysis solutions usually have a
physiologically tolerable osmolarity. This is usually achieved
through the electrolytes contained in the dialysis solution and
inventive polysaccharides, which are physiologically tolerable as
osmotically active compounds (osmotics) in the desired
concentration.
[0101] The inventive dialysis solution has an osmolarity in the
range of preferably 200 to 550 mosm/L.
[0102] If the inventive dialysis solution is a hemodialysis
solution, the osmolarity is preferably 200 to 350 mosm/L or 210 to
340 mosm/L, more preferably 220 to 330 mosm/L, even more preferably
230 to 320 mosm/L, most preferably 240 to 310 mosm/L and in
particular 250 to 300 mosm/L. Those skilled in the art are familiar
with methods of measuring the osmolarity and the osmotic pressure.
For example, these pressures can be determined with the help of a
membrane--osmometer or by other suitable measurement methods.
[0103] If the inventive dialysis solution is a peritoneal dialysis
solution, the osmolarity is preferably 200 to 570 mosm/L or 210 to
560 mosm/L, more preferably 220 to 550 mosm/L, even more preferably
230 to 540 mosm/L, most preferably 240 to 530 mosm/L and in
particular 250 to 520 mosm/L. In a preferred embodiment, the
osmolarity is 250.+-.50 mosm/L or 250.+-.45 mosm/L, more preferably
250.+-.35 mosm/L, even more preferably 250.+-.25 mosm/L, most
preferably 250.+-.15 mosm/L, and in particular 250.+-.10 mosm/L. In
another preferred embodiment, the osmolarity 300.+-.50 mosm/L or
300.+-.45 mosm/L, more preferably 300.+-.35 mosm/L, even more
preferably 300.+-.25 mosm/L, most preferably 300.+-.15 mosm/L and
in particular 300.+-.10 mosm/L. In another preferred embodiment,
the osmolarity is 350.+-.50 mosm/L or 350.+-.45 mosm/L, more
preferably 350 .+-.35 mosm/L, even more preferably 350.+-.25
mosm/L, most preferably 350.+-.15 mosm/L and in particular
300.+-.10 mosm/L. In another preferred embodiment, the osmolarity
is 400.+-.50 mosm/L or 400.+-.45 mosm/L, more preferably 400.+-.35
mosm/L, even more preferably 400.+-.25 mosm/L, most preferably
400.+-.15 mosm/L and in particular 300.+-.10 mosm/L. In another
preferred embodiment, the osmolarity is 450.+-.50 mosm/L or
450.+-.45 mosm/L, more preferably 450.+-.35 mosm/L, even more
preferably 450.+-.25 mosm/L, most preferably 450.+-.15 mosm/L and
in particular 450.+-.10 mosm/L. In another preferred embodiment,
the osmolarity is 500.+-.50 mosm/L or 500.+-.45 mosm/L, more
preferably 500.+-.35 mosm/L, even more preferably 500.+-.25 mosm/L,
most preferably 500.+-.15 mosm/L and in particular 500.+-.10
mosm/L.
[0104] The inventive dialysis solution has a pH of preferably 4.0
to 8.0, more preferably 4.2 to 7.5, even more preferably 4.4 to
6.8, most preferably 4.6 to 6.0 or 4.8 to 5.5 and in particular 5.0
to 5.2 or 5.0.+-.0.1, measured at room temperature (20 to
23.degree. C.). In a preferred embodiment, pH is 4.8.+-.1.0 or
4.8.+-.0.8, more preferably 4.8.+-.0.7 or 4.8.+-.0.6, even more
preferably 4.8.+-.0.5 or 4.8.+-.0.4, most preferably 4.8.+-.0.3 or
4.8.+-.0.2 and in particular 4.8.+-.0.1. In another preferred
embodiment, the pH is 5.0.+-.1.0 or 5.0.+-.0.8, more preferably
5.0.+-.0.7 or 5.0.+-.0.6, even more preferably 5.0.+-.0.5 or
5.0.+-.0.4, most preferably 5.0.+-.0.3 or 5.0.+-.0.2 and in
particular 5.0.+-.0.1. In another preferred embodiment, the pH is
5.2.+-.1.0 or 5.2.+-.0.8, more preferably 5.2.+-.0.7 or 5.2.+-.0.6,
even more preferably 5.2.+-.0.5 or 5.2 .+-.0.4, most preferably
5.2.+-.0.3 or 5.2.+-.0.2 and in particular 5.2.+-.0.1. In another
preferred embodiment, the pH is 5.5.+-.1.0 or 5.5.+-.0.8, more
preferably 5.5.+-.0.7 or 5.5.+-.0.6, even more preferably
5.5.+-.0.5 or 5.5.+-.0.4, most preferably 5.5.+-.0.3 or 5.5.+-.0.2
and in particular 5.5.+-.0.1. In another preferred embodiment, the
pH is 6.0.+-.1.0 or 6.0.+-.0.8, more preferably 6.0.+-.0.7 or
6.0.+-.0.6, even more preferably 6.0.+-.0.5 or 6.0.+-.0.4, most
preferably 6.0.+-.0.3 or 6.0.+-.0.2 and in particular 6.0.+-.0.1.
In another preferred embodiment, the pH is 6.5.+-.1.0 or
6.5.+-.0.8, more preferably 6.5.+-.0.7 or 6.5.+-.0.6, even more
preferably 6.5.+-.0.5 or 6.5.+-.0.4, most preferably 6.5.+-.0.3 or
6.5.+-.0.2 and in particular 6.5.+-.0.1. In another preferred
embodiment, the pH is 7.0.+-.1.0 or 7.0.+-.0.8, more preferably
7.0.+-.0.7 or 7.0.+-.0.6, even more preferably 7.0.+-.0.5 or
7.0.+-.0.4, most preferably 7.0.+-.0.3 or 7.0.+-.0.2 and in
particular 7.0.+-.0.1. In another preferred embodiment, the pH is
7.4.+-.1.0 or 7.4.+-.0.8, more preferably 7.4.+-.0.7 or 7.4.+-.0.6,
even more preferably 7.4.+-.0.5 or 7.4.+-.0.4, most preferably
7.4.+-.0.3 or 7.4.+-.0.2 and in particular 7.4.+-.0.1. In another
preferred embodiment, the pH is 8.0.+-.1.0 or 8.0.+-.0.8, more
preferably 8.0.+-.0.7 or 8.0.+-.0.6, even more preferably
8.0.+-.0.5 or 8.0.+-.0.4, most preferably 8.0.+-.0.3 or 8.0.+-.0.2
and in particular 8.0.+-.0.1.
[0105] The inventive dialysis solution contains one or more (e.g.,
two, three, four, or five) inventive polysaccharides, where the
inventive polysaccharides are defined as above.
[0106] The inventive dialysis solution contains the inventive
polysaccharide in a total concentration of preferably 0.001 mM to
10 M or 0.01 to 1.0 M, more preferably 0.10 to 500 mM, even more
preferably 1.0 to 250 mM, most preferably 10 to 100 mM and in
particular 25 to 90 mM. In a preferred embodiment, the total
concentration is 25.+-.24 mM, more preferably 25.+-.20 mM, even
more preferably 25.+-.15 mM, most preferably 25.+-.10 mM and in
particular 25.+-.5 mM. In another preferred embodiment, the total
concentration is 50.+-.25 mM, more preferably 50.+-.20 mM, even
more preferably 50.+-.15 mM, most preferably 50.+-.10 mM and in
particular 50.+-.5 mM. In another preferred embodiment, the total
concentration is 75.+-.25 mM, more preferably 75.+-.20 mM, even
more preferably 75.+-.15 mM, most preferably 75.+-.10 mM and in
particular 75.+-.5 mM. In another preferred embodiment, the total
concentration is 100.+-.25 mM, more preferably 100.+-.20 mM, even
more preferably 100.+-.15 mM, most preferably 100.+-.10 mM and in
particular 100.+-.5 mM. In another preferred embodiment, the total
concentration is 200.+-.25 mM, more preferably 200.+-.20 mM, even
more preferably 200.+-.15 mM, most preferably 200.+-.10 mM and in
particular 200.+-.5 mM. The total concentration is preferably
calculated based on the average molecular weight of the inventive
polysaccharide.
[0107] The inventive dialysis solution contains the inventive
polysaccharide in a total mass concentration of preferably 0.01 g/L
to 1.0 kg/L, more preferably 0.1 to 750 g/L, even more preferably
1.0 to 500 g/L, most preferably 10 to 250 g/L, and in particular
100 to 200 g/L. In a preferred embodiment, the total mass
concentration is 25.+-.24 g/L, more preferably 25.+-.20 g/L, even
more preferably 25.+-.15 g/L, most preferably 25.+-.10 g/L and in
particular 25.+-.5 g/L. In another preferred embodiment, the total
mass concentration is 50.+-.25 g/L, more preferably 50.+-.20 g/L,
even more preferably 50.+-.15 g/L, most preferably 50.+-.10 g/L and
in particular 50.+-.5 g/L. In another preferred embodiment, the
total mass concentration is 75.+-.25 g/L, more preferably 75.+-.20
g/L, even more preferably 75.+-.15 g/L, most preferably 75.+-.10
g/L and in particular 75.+-.5 g/L. In another preferred embodiment,
the total mass concentration 100.+-.25 g/L, more preferably
100.+-.20 g/L, even more preferably 100.+-.15 g/L, most preferably
100.+-.10 g/L and in particular 100.+-.5 g/L. In another preferred
embodiment, the total mass concentration is 200.+-.25 g/L, more
preferably 200.+-.20 g/L, even more preferably 200.+-.15 g/L, most
preferably 200.+-.10 g/L and in particular 200.+-.5 g/L.
[0108] The inventive dialysis solution may also contain other
osmotically active substances such as glucose, polyglucose,
crosslinked glucose or polyglucose, mannitol or glycerol.
[0109] The inventive dialysis solution preferably contains one or
more electrolytes.
[0110] In the sense of this invention, the term "electrolyte"
stands for a substance that contains free ions and has electric
conductivity. The electrolyte preferably dissociates completely
into cations and anions without essentially altering the pH of an
aqueous composition. This property differentiates electrolytes from
buffer substances. The electrolytes are preferably in a
concentration which results in an essentially complete dissociation
in water.
[0111] Preferred electrolytes are selected from the group of alkali
metals, such as Na.sup.+ and K.sup.+ and the alkaline earth metals,
such as Ca.sup.2+ and Mg.sup.2+. A preferred anion is Cr.
[0112] The inventive dialysis solution may contain other anions,
such as bicarbonate, dihydrogen phosphate, hydrogen phosphate,
phosphate, acetate, lactate and pyruvate. However, because of their
buffer capacity, these anions (in suitable combinations with
cations) are not referred to as electrolytes in the sense of this
invention but instead as buffers.
[0113] In a preferred embodiment, the inventive dialysis solution
contains Na.sup.+ ions. The concentration of Na.sup.+ ions is
preferably 10 to 200 mM or 50 to 190 mM, more preferably 100 to 180
mM or 110 to 170 mM, even more preferably 115 to 165 mM or 120 to
160 mM, most preferably 125 to 155 mM and in particular 130 to 150
mM. In another preferred embodiment, the inventive dialysis
solution does not contain any Na.sup.+ ions.
[0114] In a preferred embodiment, the inventive dialysis solution
contains K.sup.+ ions. The concentration of K.sup.+ ions is
preferably 0.10 to 20 mM, more preferably 0.25 to 15 mM, even more
preferably 0.50 to 10 mM, most preferably 0.75 to 7.5 mM and in
particular 1.0 to 5.0 mM. In another preferred embodiment, the
concentration of K.sup.+ ions is 1.0.+-.0.75, 2.0.+-.0.75,
3.0.+-.0.75, 4.0.+-.0.75 or 5.0.+-.0.75 mM and in particular
1.0.+-.0.50, 2.0.+-.0.50, 3.0.+-.0.50, 4.0.+-.0.50 or 5.0.+-.0.50.
In another preferred embodiment, the inventive dialysis solution
does not contain any K.sup.+ ions.
[0115] In a preferred embodiment, the inventive dialysis solution
contains Ca.sup.2+ ions. The concentration of Ca.sup.2+ ions is
preferably 0.1 to 3 mM, more preferably 0.25 to 2.75 mM, even more
preferably 0.5 to 2.5 mM, most preferably 0.75 to 2.25 mM and in
particular 1 to 2 mM. In another preferred embodiment, the
concentration of Ca.sup.2+ ions is 0.25, 0.5, 0.75, 1, 1.25, 1.5,
1.75 or 2 mM. In another preferred embodiment, the inventive
dialysis solution does not contain any Ca.sup.2+ ions.
[0116] In a preferred embodiment, the inventive dialysis solution
contains Mg.sup.2+ ions. The concentration of Mg.sup.2+ ions is
preferably 0.01 to 1 mM, more preferably 0.05 to 0.75 mM, even more
preferably 0.1 to 0.5 mM, most preferably 0.15 to 0.4 mM and in
particular 0.2 to 0.3 mM. In another preferred embodiment, the
concentration of Mg.sup.2+ ions is 0.05, 0.075, 0.1, 0.2, 0.25,
0.50 or 0.75 mM. In another preferred embodiment, the inventive
dialysis solution does not contain any Mg.sup.2+ ions.
[0117] In a preferred embodiment, the inventive dialysis solution
contains Cl.sup.- ions. The concentration of Cl.sup.- ions is
preferably 10 to 300 mM, more preferably 25 to 250 mM, even more
preferably 50 to 200 mM, most preferably 75 to 150 mM and in
particular 80 to 125 mM. In another preferred embodiment, the
concentration of Cl.sup.- ions is 100.+-.50 mM, more preferably
100.+-.25 mM, most preferably 100.+-.10 mM and in particular
96.+-.4 mM. In another preferred embodiment, the inventive dialysis
solution does not contain any Cl.sup.- ions.
[0118] The inventive dialysis solution contains preferably one or
more buffers.
[0119] Those skilled in the art are familiar with suitable buffers.
Buffers usually include lactate, bicarbonate, carbonate, dihydrogen
phosphate, hydrogen phosphate, phosphate, pyruvate, citrate,
isocitrate, succinate, fumarate, acetate and lactate salts. Those
skilled in the art know that the corresponding cation of the anions
listed above is a component of the buffer used to adjust the pH
(e.g., Na.sup..sym. as a component of the buffer NaHCO.sub.3).
However, if the buffer salt dissociates in water, it also has the
effect of an electrolyte. For the purposes of this description, the
concentrations of cations or anions and the total concentration of
ion is calculated regardless of whether they are used as a
component of electrolytes, buffers or other compounds (e.g., as a
salt of the inventive polysaccharide).
[0120] In a preferred embodiment, the buffer contains bicarbonate.
Bicarbonate is a buffer system that is tolerated well and is in
equilibrium with carbonate in an alkaline medium and is in
equilibrium with H.sub.2CO.sub.3 and/or CO.sub.2 in an acidic
medium. In addition to bicarbonate, other buffer systems can also
be used, if they have a buffering effect in the pH range of pH 4 to
pH 8, more preferably in the range of pH 5 to pH 7.6 and in
particular in the range of pH 7.6, 7.4, 7.2 and/or 7.0, e.g.,
including compounds that can be metabolized to bicarbonate in the
body, such as lactate or pyruvate.
[0121] In another preferred embodiment, the buffer contains the
salt of a weak acid, preferably lactate. The acid strength
(pK.sub.s) of the weak acid is preferably .ltoreq.5. The buffer may
also be a mixture of substances having a buffer effect, e.g., a
mixture containing bicarbonate and a salt of a weak acid (e.g.,
lactate). A low bicarbonate concentration has the advantage that
the CO.sub.2 pressure in the container is low.
[0122] In a preferred embodiment, the inventive dialysis solution
is buffered by bicarbonate. The bicarbonate concentration is
preferably 1.0 to 200 mM, more preferably 2.5 to 150 mM, even more
preferably 5 to 100 mM, most preferably 5 to 75 mM or 10 to 50 mM
and in particular 20 to 30 mM. In another preferred embodiment, the
bicarbonate concentration is 25 mM. In another preferred
embodiment, the inventive dialysis solution does not contain any
bicarbonate.
[0123] In a preferred embodiment, the inventive dialysis solution
is buffered by lactate. The lactate concentration is preferably 1.0
to 200 mM, more preferably 2.5 to 150 mM, even more preferably 5 to
100 mM, most preferably 10 to 50 mM or 10 to 25 mM and in
particular 15 mM.
[0124] In another preferred embodiment, the inventive dialysis
solution does not contain any lactate.
[0125] In a preferred embodiment, the inventive dialysis solution
is buffered by acetate. The acetate concentration is preferably 1.0
to 100 mM, more preferably 1.0 to 50 mM, even more preferably 1.0
to 25 mM, most preferably 1.0 to 10 mM or 2.0 to 7.5 mM and in
particular 2.5 to 7.0 mM. In another preferred embodiment, the
inventive dialysis solution does not contain any acetate.
[0126] The total volume of dialysis solution is not limited. The
volume is usually several liters (suitable volume for
administration to a patient) up to a few hundred liters (suitable
storage volume for more than one patient).
[0127] As already explained above, the term "dialysis solution" in
the sense of this invention is understood to be a ready-to-use
dialysis solution, i.e., the dialysis solution may be used directly
for the dialysis treatment (hemodialysis or peritoneal
dialysis).
[0128] In a preferred embodiment, the inventive dialysis solution
is a peritoneal dialysis solution as described below.
[0129] The peritoneal dialysis solution is adjusted biochemically
so that it essentially corrects the metabolic acidosis associated
with renal failure. The peritoneal dialysis solution preferably
contains bicarbonate in approximately physiological concentrations.
In a preferred embodiment, the peritoneal dialysis solution
contains bicarbonate in a concentration of approximately 20 to 30
mM. In another preferred embodiment, the peritoneal dialysis
solution has a bicarbonate concentration of 25 mM.
[0130] Furthermore, the peritoneal dialysis solution preferably
contains carbon dioxide with a partial pressure (pCO.sub.2) of less
than 60 mmHg. In a preferred embodiment, the pCO.sub.2 of the
peritoneal dialysis solution is essentially the same as the
pCO.sub.2 measured in the blood vessels.
[0131] Furthermore, the peritoneal dialysis solution preferably has
a pH of approximately 7.4. Therefore, the peritoneal dialysis
solution is a physiologically tolerable solution.
[0132] The peritoneal dialysis solution preferably contains a weak
acid with a pK.sub.s of .ltoreq.5. The weak acids are preferably
compounds which occur as physiological metabolites in the glucose
metabolism. The weak acid is preferably selected from the group
consisting of lactate, pyruvate, citrate, isocitrate,
ketoglutarate, succinate, fumarate, malate and oxaloacetate. These
acids may be present in the peritoneal dialysis solution either
alone or as a mixture. The weak acids are preferably present in the
peritoneal dialysis solution in a concentration of 10 to 20 meq/L
and essentially as sodium salts. In the peritoneal dialysis
solution, the weak acid is preferably present in an amount
corresponding to the daily metabolic water production of
approximately 1 meq/kg per day.
[0133] The peritoneal dialysis solution contains at least one
inventive polysaccharide as defined above.
[0134] The inventive peritoneal dialysis solution preferably
contains a concentration of bicarbonate and has a pCO.sub.2, such
as that measured in healthy non-renally-insufficient patients. The
weak acid diffuses along the concentration gradient from the
dialysis solution into the blood of the dialysis patient and thus
corrects the metabolic acidosis of the dialysis patient.
[0135] Another subject of this invention relates to multicomponent
systems for preparation of the ready-to-use dialysis solutions
described above. The preparation is preferably performed in a
manner that is described in detail, i.e., by following the
corresponding instructions (protocol). Said preparation may be
performed manually, e.g., by mixing individual components or
diluting one component with water. However, the preparation may
also be performed automatically, e.g., by using a device that is
suitable for this process and may be available commercially. The
preparation need not necessarily lead to a dialysis solution with a
static composition (remaining the same) but instead may also lead
to a dialysis solution that undergoes continuous changes in its
composition, where this change can be monitored by a suitable
device. For example, the inventive polysaccharide may be present in
a dialysis solution, which is diluted continuously during the
dialysis treatment, so that the patient is exposed to a decreasing
polysaccharide concentration.
[0136] In a preferred embodiment, the inventive dialysis solutions
are suitable for use in the treatment of renal failure.
[0137] In another preferred embodiment, the inventive dialysis
solutions are suitable for use in a dialysis treatment.
[0138] In another preferred embodiment, the inventive dialysis
solutions are suitable for use in hemodialysis and/or peritoneal
dialysis treatment.
[0139] Another subject of this invention relates to a kit, which is
configured for preparation of the inventive dialysis solutions,
where the kit comprises [0140] a first component, [0141] a second
component and [0142] optionally one or more other components, and
[0143] the inventive dialysis solution is prepared by mixing the
first component with the second component and optionally the
additional component(s).
[0144] The kit comprises at least a first component and a second
component. The kit may also comprise additional components, e.g., a
third and a fourth component. The kit preferably consists of two
components, which are preferably different from one another.
[0145] In the sense of this invention, the term "component"
comprises liquid, semisolid or solid compositions, which may be the
same as or different from one another, where the inventive
ready-to-use dialysis solution is obtained by mixing all the
components of the kit. A single component preferably contains a
portion of the ingredients that are present in the ready-to-use
dialysis solution.
[0146] The first and second components, independently of one
another, may be solid, semisolid or liquid. If the components are
liquid, they may be solutions or dispersions (e.g., dispersions or
suspensions).
[0147] In a preferred embodiment, the first component is liquid,
preferably pure water or an aqueous solution, and the second
component is also liquid. In another preferred embodiment, the
first component is liquid, preferably pure water or an aqueous
solution, and the second component is solid, preferably a powdered
mixture.
[0148] The first component is preferably a solution, containing
osmotically active substances (e.g., the inventive polysaccharide),
calcium ions, magnesium ions, hydronium ions and chloride ions.
[0149] The inventive kit may be designed in various ways. For
example, the individual components may be present in separate
containers (e.g., individual bags). However, the inventive kit is
preferably a container such as a multi-chamber container system
(e.g., a flexible or rigid multi-chamber container system),
preferably a flexible multi-chamber bag system.
[0150] The inventive kit is preferably a multi-chamber container
system, which contains the first component, the second component
and optionally one or more additional components in chambers, which
are separated from one another by detachable and/or breakable
separation systems (e.g., breakable separating parts), where the
first component, the second component and optionally the one or
more additional components can be mixed with one another after
releasing and/or breaking the separation system in order to obtain
the inventive dialysis solution.
[0151] The multi-chamber container may be in the form of a plastic
container (e.g., multi-chamber plastic bag), which has a separate
chamber for each individual component. The plastic container
preferably contains the individual component solutions in chambers
separated from one another by partition elements.
[0152] The multi-chamber container is preferably a two-chamber bag
comprising a plastic container having a first chamber and a second
chamber, where the chambers may be separated from one another by a
detachable and/or breakable separation system, and the first
chamber contains the first component and the second chamber
contains the second component. The release and/or breaking of the
separation system results in the two components being mixed and
forms the ready-to-use dialysis solution. The first chamber and the
second chamber are preferably arranged adjacent to one another in
the container and are separated from one another by the separation
system. The separation system is preferably a separation seam
(e.g., a detachable or breakable weld). The separation seam is
preferably opened by applying a pressure to one of the chambers,
whereupon the separation seam breaks and/or separates and the
contents of the two chambers become mixed and the mixture can be
used as a ready-to-use dialysis solution in dialysis treatment.
[0153] The first component of the inventive kit is preferably a
sterile solution, which contains an acid and has a pH of
.ltoreq.6.0; the second component is preferably also a sterile
solution, which preferably contains a buffer and has a pH of
.gtoreq.7.0.
[0154] The inventive polysaccharide may be contained in the first
component or in the second component as well as in the two
components in the same or different concentrations. In a preferred
embodiment, the inventive polysaccharide is contained only in the
first (acid) component. In another preferred embodiment, the
inventive polysaccharide is contained only in the second (basic)
component. The first component and/or the second component and/or
the other optional component(s) may contain one or more
electrolytes as well as a buffer.
[0155] Those skilled in the art will recognize that mixing of the
individual components usually involves a dilution effect for the
case when the components contain the ingredients in different
concentrations. For example, if the inventive polysaccharide is
contained exclusively in one of the components, then mixing of this
component with at least one other component results in an increase
in volume with respect to the amount of the inventive
polysaccharide that is present and thus leads to a dilution, i.e.,
a decline in the polysaccharide concentration; consequently, the
component preferably contains the inventive polysaccharide in a
higher concentration than the ready-to-use dialysis solution.
[0156] The concentration of the inventive polysaccharide in the
component is preferably close to the saturation concentration at a
temperature of 5.degree. C. in order to ensure a sufficient
stability in storage at elevated temperatures.
[0157] In a preferred embodiment, the total mass concentration of
inventive polysaccharide in the component is 0.01 g/L to 1.0 kg/L,
more preferably 0.1 to 750 g/L, even more preferably 1.0 to 500
g/L, most preferably 10 to 250 g/L and in particular 100 to 200
g/L. In another preferred embodiment, the total mass concentration
of inventive polysaccharide in the component is 25.+-.24 g/L, more
preferably 25.+-.20 g/L, even more preferably 25.+-.15 g/L, most
preferably 25.+-.10 g/L and in particular 25.+-.5 g/L. In another
preferred embodiment, the total mass concentration of inventive
polysaccharide in the component is 50.+-.25 g/L, more preferably
50.+-.20 g/L, even more preferably 50.+-.15 g/L, most preferably
50.+-.10 g/L and in particular 50.+-.5 g/L. In another preferred
embodiment, the total mass concentration of inventive
polysaccharide in the component is 75.+-.25 g/L, more preferably
75.+-.20 g/L, even more preferably 75.+-.15 g/L, most preferably
75.+-.10 g/L and in particular 75.+-.5 g/L. In another preferred
embodiment, the total mass concentration of inventive
polysaccharide in the component is 100.+-.25 g/L, more preferably
100.+-.20 g/L, even more preferably 100.+-.15 g/L, most preferably
100.+-.10 g/L and in particular 100.+-.5 g/L. In another preferred
embodiment, the total mass concentration of inventive
polysaccharide in the component is 200.+-.25 g/L, more preferably
200.+-.20 g/L, even more preferably 200.+-.15 g/L, most preferably
200.+-.10 g/L and in particular 200.+-.5 g/L.
[0158] In a preferred embodiment, the second component contains the
total amount of inventive polysaccharide and a suitable buffer,
which adjusts the pH of the second component to more than 7.0, more
preferably to more than 7.5, even more preferably to more than 8.0,
most preferably to more than 8.5 and in particular to more than
9.0. This can preferably be achieved with bicarbonate, which may be
present in the form of dissociated sodium bicarbonate and/or
potassium bicarbonate. In another preferred embodiment, the second
component is solid and comprises a powdered mixture containing at
least one inventive polysaccharide and at least one buffer, e.g.,
sodium and/or potassium bicarbonate.
[0159] The multi-chamber bag is preferably suitable for the
preparation of a dialysis solution, which may be used in the
peritoneal dialysis treatment, and which contains the following
ingredients, preferably in the following concentrations:
[0160] Ca.sup.2.sym.0.5 to 5 meq/L;
[0161] Mg.sup.2.sym.0 to 3.0 meq/L;
[0162] Cl.sup..sym.90.5 to 121 meq/L;
[0163] K.sup..sym.0 to 4.0 meq/L;
[0164] HCO.sub.3.sup..THETA. 25 to 40 meq/L;
where one chamber of the multi-chamber bag system contains a first
acid concentrate and another chamber contains a second basic
concentrate; where the acid concentrate contains Ca.sup.2.sym. ions
and the basic concentrate contains HCO.sub.3.sup..THETA. ions but
no Ca.sup.2{circle around (2)} ions; and the two concentrates can
be mixed together after releasing and/or breaking the separation
system (e.g., separation seam); where the mixing of the two
concentrates leads to the preparation of the ready-to-use dialysis
solution and the pH of the ready-to-use dialysis solution is 7.0 to
7.6.
[0165] The basic concentrate preferably contains at least one
inventive polysaccharide and optionally glucose and/or polyglucose,
whereas the acid concentrate does not contain any inventive
polysaccharide or any glucose and/or polyglucose.
[0166] The basic concentrate preferably contains a quantity of
bicarbonate, which leads to a bicarbonate concentration of the
ready-to-use dialysis solution of at least 20 mM. The bicarbonate
concentration of the basic component is preferably so high that the
ready-to-use dialysis solution has a bicarbonate concentration of
25 mM.
[0167] The pH of the basic, buffered second concentrate is
preferably adjusted with hydrochloric acid.
[0168] The two concentrates are preferably mixed together in a
volume ratio of 10:1 to 1:10 or 8:1 to 1:8, more preferably 5:1 to
1:5 or 3:1 to 1:3, even more preferably 2:1 to 1:2 and in
particular 1:1.
[0169] The multi-chamber bag preferably has a gas barrier film,
which prevents gaseous CO.sub.2 from escaping from the system.
Those skilled in the art are familiar with gas barrier films.
[0170] A more preferred subject of this invention relates to a
method for preparing a dialysis solution, in which the desired
mixing ratio is adjusted automatically by a dialysis machine or a
peritoneal dialysis cycler.
[0171] In a preferred embodiment, the invention relates to a solid
composition which is suitable for preparing the inventive dialysis
solution by dissolving it in a defined volume of a solvent (e.g.,
water). The solid composition is preferably a component described
above and is thus a component of the inventive kit.
[0172] The solid composition contains the inventive polysaccharide
in any solid form, e.g., as a powder, granules, pellets, etc. The
inventive polysaccharide may be in the form of a lyophilisate or
may be spray-dried.
[0173] The inventive solid composition preferably contains a
bicarbonate salt, such as sodium or potassium bicarbonate. Das
substance quantity ratio of bicarbonate to the inventive
polysaccharide in the solid composition is preferably 1:100 to
100:1, more preferably 1:50 to 50:1, even more preferably 1:25 to
25:1, most preferably 1:10 to 10:1 and in particular 1:5 to
5:1.
[0174] The defined volume of solvent, which is required to prepare
the inventive dialysis solution by dissolving the solid composition
is preferably 1.0 to 2000 liters. The solvent is preferably
purified water, sterilized water or water for injection purposes,
which may optionally contain one or more of the electrolytes
described above, one or more osmotically active substances (e.g.,
at least one inventive polysaccharide) and/or one or more of the
buffers described above.
[0175] Another subject of this invention relates to the use of at
least one inventive polysaccharide for preparation of the inventive
dialysis solution (hemodialysis solution or peritoneal dialysis
solution).
[0176] Another subject of this invention relates to the use of an
inventive kit for preparation of the inventive dialysis solution
(hemodialysis solution or peritoneal dialysis solution).
[0177] Another subject of this invention relates to the use of an
inventive solid composition for preparation of the inventive
dialysis solution (hemodialysis solution or peritoneal dialysis
solution).
EXAMPLES
Example 1
[0178] 50 g degraded starch is dissolved in 500 mL DMSO. After
dissolving the starch, one spatula tip of DMAP and 22.7 g maleic
acid anhydride are added (0.75 mol/AGU). The mixture is stirred for
5 hours at 40.degree. C. The product is precipitated in acetone
with subsequent filtration and drying in vacuo at 40.degree. C.
HNMR and CNMR spectra were recorded (see FIG. 1 and FIG. 2): degree
of substitution less than 0.1.
Example 2
[0179] 60 g dried degraded starch (0.370 mol) is dissolved in 600
mL dried dimethyl-acetamide. After dissolving the starch, one
spatula tip of DMAP, 37.2 g triethylamine and 36.36 g maleic acid
anhydride are added. The mixture is stirred for 5 hours at
60.degree. C. The product is precipitated in acetone with
subsequent filtration and drying in vacuo at 40.degree. C. HNMR and
CNMR spectra were recorded.
Example 3
[0180] Like Example 2, but without the addition of
triethylamine.
[0181] The inventive starch maleates thereby obtained have an
increased osmolality in comparison with the unsubstituted degraded
starch at the same concentration (determined experimentally based
on the reduction in freezing point) and a greatly elevated colloid
osmotic pressure and ultrafiltration.
Example 4
[0182] In a comparative experiment a filling volumen of 10 ml of an
osmotic agent with a concentration of 5% (m/m) in a matrix solution
of 1 mmol/l Ca2+, 0,5 mmol/1 Mg2+, 138 mmol/l Na+, 106 mmol/1 Cl-
and 35 mmol/l lactate was filled into a semipermeable tube
(regenerated cellulose, MWCO: 1000, Fa. Roth) and stirred in a bath
of the same matrix solution for 24 hours at a temperature of
38.degree. C. At various points of time the filling volume of the
tube was measured reflecting the osmotic power of the agent.
[0183] As osmotic agents 2 starch maleates according to the
invention were compared to glucose and Icodextrin as established
osmotic agents. The starch maleates used had the following
structure:
##STR00001##
[0184] The two starch maleated differed in the degree of
substitution (DS) while starch maleate 1 had a DS of 0,1, starch
maleate 2 had a DS of 0,5.
[0185] The results are shown in FIG. 3 as a diagram.
[0186] The starch maleates showed an increased osmotic effect over
glucose after a time period of 4 hours. They showed a slightly
decreased osmotic effect compared to icodextrin.
* * * * *