Noninvasive continuous intradialytic blood pressure monitoring: the key to improving haemodynamic stability

Intradialytic hypotension (IDH) occurs in 20% of haemodialysis treatments, leading to end-organ ischaemia, increased morbidity and mortality; and contributing to poor quality of life for patients. Treatment of IDH is reactive since brachial blood pressure (BP) is recorded only intermittently during haemodialysis, making early detection and prediction of hypotension impossible. Noninvasive continuous BP monitoring would allow earlier detection of IDH and thus support the development of methods for its prediction and consequently prevention. Noninvasive continuous BP monitoring is not yet part of routine practice in renal dialysis units, with a small number of devices (e.g. finger cuffs) having occasionally been used in research settings. In use, patients frequently report pain or discomfort at measurement sites. Additionally, these devices can be unreliable in patients with reduced blood flow to the digits, often manifest in dialysis patients. All existing methods are sensitive to patient movement. A new method for continuously estimating BP has been developed by monitoring arterial pressure near the arteriovenous fistula which can be achieved without any extraneous monitoring equipment attached to the patient. Additionally, artificial intelligence-based methods for real-time prediction of IDH are currently emerging.Key monitoring technologies and computational methods are emerging to support the development of real-time IDH prediction.