Physiological monitoring and control in hemodialysis: state of the art and outlook

Abstract

Medical devices for monitoring and feedback control of physiological parameters of the dialysis patient were introduced inthe early 1990s. They have a wide range of applications, aiming at increasing the safety and ensuring the efficiency of the treatment, and at an improved restoration of physiological conditions, leading to an overall reduction in morbidity and mortality. Such devices include sensors for the measurement of temperature, optical parameters and sound speed in blood, and electrical characteristics of the human body, and other parameters. Essential for the development of these devices is a detailed understanding of the pathophysiological background of a therapeutical problem. There is still a large potential to introduce new devices for further therapy improvement and automation. Also, the size of the hemodialysis market appears attractive; however, a new product has to meet several specific requirements in order to also become commercially successful. This review describes the therapeutic and technical principles of several available devices, reports on concepts for possible future devices, and presents a short overview on the market environment.

Keywords::

• automation
• bioimpedance
• dialysis
• expert systems
• feedback control
• fluid status
• hypotension
• monitoring
• optical sensors
• ultrasound sensors
• uremic toxins