Hemodynamic monitoring during hemodialysis

Intradialytic monitoring of hemodynamic parameters is an active area of res earch; future developments in this field will decrease intradialytic morbid ity and the mortality of end-stage renal disease patients treated by hemodi alysis. Recent investigations have been assisted by the development of devi ces that can continuously and noninvasively measure hematocrit and plasma p rotein concentration during the treatment. Intradialytic morbidity, fluid o verload, and hypertension in chronic hemodialysis patients have been shown to be associated with either large or small intradialytic decreases in bloo d or plasma volume that can be routinely measured by these devices. The use of intradialytic changes in blood volume as a feedback control parameter t o vary the ultrafiltration rate and dialysate sodium concentration, so call ed profiling, is now possible, but further research in this area is necessa ry to show how to optimize the control algorithms. Other, more preliminary studies suggest that monitoring of central blood volume, extracellular volu me, and cardiac output during hemodialysis may permit improved hemodynamic stability during treatment and better control of blood pressure. Although o ptimal application of these techniques and devices remains to be shown, the ir routine use during maintenance hemodialysis therapy will likely be the s tandard of care in the near future. (C) 1999 by the National Kidney Foundat ion, Inc.