Prediction of Dialysis-induced Hypotension

Abstract

Intradialytic hypotension is the most common acute complication during conventional hemodialysis treatment. Clinical methods for prediction of acute hypotension during treatment is of great importance in the daily routine as it may prevent such events. This paper presents a method for predicting acute intradialytic hypotension using information from a pulse oximeter which reflects vasoconstriction and cardiac output. The method is based on monitoring changes in the DC level of a measure denoted relative magnitude of the capillary pulse (RMCP), here modeled as a DC level in Laplacian noise. Hypothesis testing is performed in order to obtain an optimal detector for monitoring these changes. The prediction performance was evaluated on 28 treatments from 11 hypotension prone patients who underwent hemodialysis treatment. Continuous blood pressure, photoplethysmography (PPG) signal, and oxygen saturation were acquired during the 28 treatments. A total of 7 acute symptomatic hypotension occurred during the treatments. The proposed method was able to predict all cases with acute intradialytic hypotension without producing any false alarms; hypotension was predicted with an average of 38 min in advance.