Evolution of Home Hemodialysis Monitoring Systems

Abstract

Systems for monitoring hemodialysis patients at home have evolved during the past 30 years. They consist of hardware and software to record dialysis events from the home hemodialysis machine and transmit them to a server, which in turn sends the data to a remote central monitoring center. Most of the parameters monitored are related to machine function and events. At present, the only commonly monitored patient vital functions are pulse and blood pressure. The early systems used direct telephone lines and modem for telecommunication. The use of Internet links reduces the cost of the service and provides fast and safe transmission of the data. The actual value of these monitoring systems, the need for additional monitoring options, indications for specific groups of patients dialyzing at home, and acceptance by patients, physicians, and regulators will require further evaluation.

Delivering Home Hemodialysis: Is There Still a Role for Real‐Time Treatment Monitoring?

“…The conundrum of remote monitoring for HHD remains—the technology is available (the “how” and “what”), although the underlying clinical need is yet to be refined (the “why”, “who”, and “when”). These data limitations are not just cosmetic, as it is important to recognize negative elements associated with remote monitoring systems.…”

Nocturnal hemodialysis

“…The idea of computerized monitoring of dialysis treatments dates back to the 1970s. Monitoring today is designed to provide real time data, focusing mainly on machine parameters (venous and arterial pressures, blood pump, conductivity, ultrafiltration rate and goal, blood flow rate, transmembrane pressure, and air detector) including some vital parameters of the patient (blood pressure and pulse) [39]. All sensors are linked to an alarm with the goal of awakening the patient.…”

“…The iCare system prioritizes alarms and sends them to the central monitor. All events for an individual patients session are recorded and a weekly or monthly statement are sent to the physician in charge for the patient [39].…”

“…Severe emergencies, conversely, need to trigger alarms that are loud enough to wake the patient from a deep sleep, perhaps with visual stimuli (bright lights) and physical stimuli (vibrations) as well [39]. Software that can prioritize alarms would be helpful in avoiding unnecessary disturbances to the patient.…”

Home Hemodialysis and Remote Monitoring: Current Technology, Requirements and Capabilities

“…The monitoring of the dialysis treatment can be staged into different levels: (1) monitoring of the machine and the parameters controlled by the machine; (2) monitoring of the treatment and patient parameters, and (3) remote monitoring of patient, treatment and machine [8] . All dialysis machines are designed with safety systems monitoring the proper functionality of the equipment.…”