Pilot Study Using a Pulse Oximeter Derived Photo-plethysmographic Waveform to Guide Hemodialysis Ultrafiltration

Inclusion Criteria

• •1. Age \>18 years
• •2. On dialysis \> 6 months with a stable dialysis program
• •3. Consistent achievement of a spKt/V ≥ 1.2
• •4. HGB ≥ 10 gm% ± ESA support
• •5. Consistent failure to achieve a post weight ≤ dry weight + 0.5Kg
• •6. Able to give informed consent directly
• •7. Frequent hypotensive reactions (≥ 1 / treatment in 4 of last 8 treatments)
• •* Symptoms of hypotension
• •* Intervention administered because of IDH (saline, "turn downs, early termination, trendelenberg position)
• •* Drop in BP irrespective of symptoms. SBP \< 90 mmHG intra or post HD if pre SBP was \> 110 mmHG; SBP \< 85 mmHG or 15 mmHG drop from start if starting BP ≤ 110 mmHG.
• •* Or judged by the nursing staff to be difficult to achieve dry weight.