Home hemodialysis and remote monitoring: current technology, requirements and capabilities.

The changing patterns of utilization of home hemodialysis (HHD) are reviewed with special reference to the factors responsible for its decline and recent revival. Equipment and monitoring systems dedicated to HHD have been recently introduced in response to the demand for more frequent therapies at home. The advantages and disadvantages of novel technology versus time-tested, reliable and versatile platforms are discussed. Despite the significant technological progress achieved, much remains to be done in our quest to make HHD a simple, cost-effective and very safe renal replacement therapy.

The Fresenius Medical Care home hemodialysis system.

The Fresenius Medical Care home dialysis system consists of a newly designed machine, a central monitoring system, a state-of-the-art reverse osmosis module, ultrapure water, and all the services associated with a successful implementation. The 2008K@home hemodialysis machine has the flexibility to accommodate the changing needs of the home hemodialysis patient and is well suited to deliver short daily or prolonged nocturnal dialysis using a broad range of dialysate flows and concentrates. The intuitive design, large graphic illustrations, and step-by-step tutorial make this equipment very user friendly. Patient safety is assured by the use of hydraulic systems with a long history of reliability, smart alarm algorithms, and advanced electronic monitoring. To further patient comfort with their safety at home, the 2008K@home is enabled to communicate with the newly designed iCare remote monitoring system. The Aquaboss Smart reverse osmosis (RO) system is compact, quiet, highly efficient, and offers an improved hygienic design. The RO module reduces water consumption by monitoring the water flow of the dialysis system and adjusting water production accordingly. The Diasafe Plus filter provides ultrapure water, known for its long-term benefits. This comprehensive approach includes planning, installation, technical and clinical support, and customer service.

Equipment and water treatment considerations for the provision of quotidian home hemodialysis.

BACKGROUND: Whereas clinical benefits of more frequent hemodialysis (HD) treatment are well documented, little information is available about technical aspects involved in setting up a patient's home for home HD. Technical considerations include the home infrastructure, as well as required plumbing modifications and electrical hook-ups. METHODS: Twenty home HD installations were supported for the London Daily/Nocturnal Hemodialysis Study. The Fresenius 2008H (Fresenius Medical Care, North America, Lexington, MA) HD machine was used for all home HD installations in conjunction with a Service Deionization Tank (SDI) water treatment system composed of pretreatment, purification, and posttreatment components. To ensure that SDI systems provided high-quality water and dialysate, standard bacteriological testing was performed throughout the study, and patient serum C-reactive protein (CRP) levels were tracked as an indicator of nonspecific inflammation. RESULTS: The annual number of hours of work required for each home HD installation and service/maintenance was approximately 75 and 58 hours, respectively. Water quality proved high because there were only 4 occurrences of failed endotoxin and bacterial tests; all were subsequently retested and provided satisfactory results. Serum CRP levels showed no significant difference comparing home HD patients with conventional in-center HD control patients. CONCLUSION: Although support of 20 home HD installations was economically feasible within the constraints of the London Health Sciences Centre Department of Biomedical Engineering, resources were strained by the final year of the study. This suggests that any sustained growth beyond the current study design may require a review of staffing, resources, and model of service delivery needs.

Evolution of home hemodialysis monitoring systems.

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.

Information technology and acute dialysis.

The careful application of information technology to the field of acute dialysis may result in both a better understanding of the disease as well as an improvement in patient outcomes. Often these applications increase costs and complexity with little change in understanding or quality of care. To avoid this common trap, a targeted assessment of needs and possible solutions is mandatory. Our group was assembled to provide balanced perspectives and recommendations that address how information technology should be assessed and applied to acute dialysis therapy, with the intent to increase the understanding of the current practice and to improve patient care. To achieve these goals, five areas of focus were identified: patient safety, current practice pattern assessment, practice variation, patient assessment, and dialysis machine technology. To facilitate the assessment, we formulated five specific questions and developed answers based on the available literature and group consensus.