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. 2022 May;41(3):363-371.
doi: 10.23876/j.krcp.21.157. Epub 2022 May 23.

System of integrating biosignals during hemodialysis: the CONTINUAL (Continuous mOnitoriNg viTal sIgN dUring hemodiALysis) registry

Seonmi Kim  1 , Donghwan Yun  2 , Soonil Kwon  3 , So-Ryoung Lee  3 , Kwangsoo Kim  4 , Yong Chul Kim  1 , Dong Ki Kim  1 , Kook-Hwan Oh  1 , Kwon Wook Joo  1 , Hyung-Chul Lee  5 , Chul-Woo Jung  5 , Yon Su Kim  1   2 , Seung Seok Han  1
Affiliations

System of integrating biosignals during hemodialysis: the CONTINUAL (Continuous mOnitoriNg viTal sIgN dUring hemodiALysis) registry

Seonmi Kim et al. Kidney Res Clin Pract. 2022 May.

Abstract

Background: Appropriate monitoring of intradialytic biosignals is essential to minimize adverse outcomes because intradialytic hypotension and arrhythmia are associated with cardiovascular risk in hemodialysis patients. However, a continuous monitoring system for intradialytic biosignals has not yet been developed.

Methods: This study investigated a cloud system that hosted a prospective, open-source registry to monitor and collect intradialytic biosignals, which was named the CONTINUAL (Continuous mOnitoriNg viTal sIgN dUring hemodiALysis) registry. This registry was based on real-time multimodal data acquisition, such as blood pressure, heart rate, electrocardiogram, and photoplethysmogram results.

Results: We analyzed session information from this system for the initial 8 months, including data for some cases with hemodynamic complications such as intradialytic hypotension and arrhythmia.

Conclusion: This biosignal registry provides valuable data that can be applied to conduct epidemiological surveys on hemodynamic complications during hemodialysis and develop artificial intelligence models that predict biosignal changes which can improve patient outcomes.

Keywords: Biosignal; Cardiac arrhythmias; Hypertension; Hypotension; Renal dialysis.

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Conflict of interest statement

Conflicts of interest

All authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.. System and registry.
(A) Schematic representation of the system platform from monitoring to storage. (B) Representative image of the bedside equipment. AC, anticoagulants; BFR, blood flow rate; CONTINUAL, Continuous mOnitoriNg viTal sIgN dUring hemodiALysis; ECG, electrocardiogram; HD, hemodialysis; HIS, hospital information system; HR, heart rate; SpO2, peripheral oxygen saturation; Temp, temperature; UF, ultrafiltration.
Figure 2.
Figure 2.. Case with subclinical intradialytic hypotension (IDH).
(A) Biosignal changes with time of dialysis as monitored through the system. Sweep rate = 25 mm/sec. Voltage (vertical axis) against time (horizontal axis) = –1.5 to 2.5 mV. (B) Blood pressure (BP) and heart rate (HR) during hemodialysis. DBP, diastolic BP; SBP, systolic BP.
Figure 3.
Figure 3.. Case with intradialytic hypertension.
(A) Biosignal changes with time of dialysis as monitored through the system. Sweep rate = 25 mm/sec. Voltage (vertical axis) against time (horizontal axis) = –2.5 to 2.5 mV. (B) Blood pressure (BP) and heart rate (HR) during hemodialysis. An R/S ratio equal to or greater than 1 suggests the presence of potential pathology in heart. DBP, diastolic BP; SBP, systolic BP.
Figure 4.
Figure 4.. Case with paroxysmal atrial fibrillation (Af), followed by intradialytic hypotension (IDH).
(A) Biosignal changes with time of dialysis as monitored through the system. Sweep rate = 25 mm/sec. Voltage (vertical axis) against time (horizontal axis) = –0.5 to 1.5 mV. (B) Blood pressure (BP) and heart rate (HR) during hemodialysis. DBP, diastolic BP; SBP, systolic BP.
Figure 5.
Figure 5.. Case with intradialytic nonsustained ventricular tachycardia (NSVT).
(A) Biosignal changes with time of dialysis as monitored through the system. Sweep rate = 25 mm/sec. Voltage (vertical axis) against time (horizontal axis) = –2.0 to 1.5 mV. (B) Blood pressure (BP) and heart rate (HR) during hemodialysis. SBP, systolic BP; DBP, diastolic BP.
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