Noninvasive Continuous Monitoring of Digital Pulse Waves during Hemodialysis

Intermittent hemodynamic instability during hemodialysis treatment is a frequent complication in patients with end-stage renal failure. A noninvasive method for continuous hemodynamic monitoring is needed. We used noninvasive digital photoplethysmography and an algorithm for continuous, investigator-independent, automatic analysis of digital volume pulse in 10 healthy subjects and in 20 patients with end-stage renal failure during the hemodialysis session. The reflective index was defined representing the diastolic component of the digital pulse wave. The properties of the reflective index were studied in healthy control subjects (n=10). An increased reflective index was due to increased peripheral pulse wave reflection (e.g., vasoconstriction). During a hemodialysis session, the reflective index increased significantly from 36+/-3 arbitrary units to 41+/-3 arbitrary units (n=20; p<0.05) measured using digital photoplethysmography. This increase appeared in 15 of the 20 patients with end-stage renal failure. Our data establish digital photoplethysmography as a noninvasive, reliable, and sensitive method for continuous monitoring during the hemodialysis session.