Body-Worn Sensor for Point-of-Care Vascular Access Monitoring

慢性肾脏疾病是英国和世界各地医疗体系面临的主要挑战。据估计，NHS预算的很大一部分用于维持生命的肾脏替代疗法，包括血液透析。在血液透析过程中，动脉血通过外科手术创建的动静脉瘘和移植物形式的血管通路从外部过滤，以清除毒素。治疗的终生成本和长期的透析效果关键取决于维持血管通路的功能。通路故障是血液透析患者住院和手术的主要原因，每年与透析相关的入院费用估计为7500万GB。这种失败通常是血管狭窄的结果，这增加了凝血引起的血管闭塞的风险。因此，通路的维护是维持血液透析患者生命治疗的关键。目前对血管通路监测的建议主要集中在临床评估和透析治疗就诊期间的流量测量上，这往往只发现已经存在的问题。因此，一种更定期或持续的监测方法，能够及早识别出高风险患者，将提高长期通畅率，改善生活质量，同时降低死亡率和治疗成本。在这个项目中，我们将开发一种用于心血管监测的身体穿戴传感器，特别是解决血管通路健康监测方面的长期临床挑战。目前，血管通路监测完全是以医院就诊为基础的，由于问题经常发生在医院外，这是昂贵和不足的。我们的初步临床研究表明，甚至在第一次去医院就诊之前，就可以检测到通道失败的早期迹象。这一大胆研究的结果预计将不仅改变目前血管通路监测的临床实践，而且还将改变未来更广泛的心血管监测和家庭护理。

Chronic kidney disease is a major challenge for healthcare systems in the UK and around the world. It is estimated that a significant proportion of NHS budget is spent on life sustaining renal replacement therapy including haemodialysis. During haemodialysis, arterial blood is filtered externally to remove toxins through a surgically created vascular access in the form of arteriovenous fistulas and grafts. The lifetime cost of the treatment and the long-term dialysis efficacy critically depends on maintaining the functions of the vascular access. Access failure is the leading cause of hospitalisation and surgery for patients on haemodialysis, with dialysis related admissions costing an estimated £75m each year. This failure is often a result of vascular narrowing which increases the risk of vascular occlusion caused by clotting. Hence, access maintenance is the key in the life-sustaining treatment for patients under haemodialysis.Current recommendations for vascular access surveillance are focused on clinical assessment and flow-volume measurement during the hospital visits for dialysis treatment, which often only identify already established problems. Therefore, a more regular or continuous monitoring approach which enables the early identification of those patients at highest risk will improve long-term patency rates, improving quality of life while simultaneously reducing mortality rates and treatment costs.In this project, we will develop a body-worn sensor for cardiovascular monitoring, particularly to address a long-standing clinical challenge in vascular access health surveillance. Presently, vascular access surveillance is purely hospital-visit based, which is expensive and inadequate as problems often occur outside hospitals. Our preliminary clinical studies suggest that early signs of access failure can be detected even before the first hospital visit. The outcome of this adventurous research is expected to transform not only the current clinical practice in vascular-access surveillance but also the future broader cardiovascular monitoring and homecare.