Patient monitoring in the London Daily/Nocturnal Hemodialysis Study

Background: Patient monitoring involves real-time surveillance of patients while they dialyze at home by a staff member ("monitor") at a centralized location. Monitoring is designed to ensure patient safety, patient compliance with treatment, and automatic collection of treatment data. Methods: In the London Daily/Nocturnal Hemodialysis Study, 14 nocturnal hemodialysis (HD) patients were monitored from 13 to 602 sessions for a total of 4,096 patient-nights. Alarm data were collected and analyzed. Results: The number of alarms per night ranged from 0 to 54, with an average of 1.31 +/- 2.81, resulting in a total of 5,351 registered alarms. Three hundred twenty-two calls because of nonresponse or slow response to alarms were made to patients' homes, but no calls to designated contact persons or emergency medical services were required. Arterial and venous pressure alarms were the most common type of alarm and were caused primarily by the patient obstructing blood tubing. The average number of alarms per night decreased significantly over time as patients gained experience with nocturnal HD, from a maximum of 1.98 +/- 3.31 alarms/night during the first month at home to a low of 0.74 +/- 1.63 alarms/night by the final month of follow-up. Each progressive decrease from month 3 through month 18 was statistically significantly lower than the value at month 1. Conclusion: Monitoring is essential for the initial 3 months of nocturnal HD therapy until the HD team is convinced the patient is stable and compliant. Thereafter, monitoring is necessary only if medically indicated.