ABSTRACT
Home hemodialysis (HD) for the treatment of patients with end-stage renal disease (ESRD) was first put into practice about 30 years ago. In this paper we describe the application of telematics monitoring services (TMS) for supporting patients who need home or satellite HD (SHD). For the clinical trials two modified HD machines were located in the renal unit and a central control station (UNIX workstation with multimedia PC-terminal) was located in another room of the hospital. Bi-directional communication between modified HD machines and central control station was managed via ISDN (Integrated Services Digital Network) links. Using these HD-machines 150 HD sessions were performed in nine patients over a period of five months. This system enabled on-line remote supervision of the HD machine-related functions (air in the blood, leak of blood, low conductivity etc.) and the clinical condition of patients through measurement of blood pressure (BP), pulse rate, PO2 (pulse oxymetry) and electrocardiogram (ECG) from the central control station (CCS). The user checked the type of alarm/warning, its appearance on HD machines and multimedia terminal units (MTU), the action of the protective system and the appearance of consultative messages from CCS on the remote terminal unit RTU. According to the data collected, the disturbances of HD machine function were visible and audible in the CCS and the user messages were always observed on the RTU. No unusual dialysis-associated complications were observed, all data and alarms/warnings were transmitted correctly and patients had adequate HD treatment.
Subject(s)
Hemodialysis, Home/methods , Kidney Failure, Chronic/therapy , Telemedicine/methods , Female , Greece , Hemodialysis, Home/instrumentation , Humans , Local Area Networks , Male , Monitoring, Physiologic/methods , Risk Assessment , Telemedicine/instrumentation , Treatment OutcomeABSTRACT
Because there have been reports suggesting that patients who receive lithium are at risk for renal damage, the authors carried out extensive noninvasive testing of renal function in 43 patients who had been taking lithium for from 1 to 120 months. Their only abnormal finding was that the urine concentrating ability of these patients was moderately but asymptomatically impaired. They suggest that although patients receiving lithium should be carefully evaluated and tested, there is not enough evidence to justify not initiating or continuing lithium use in patients who might benefit from it.
