Relative risk of home hemodialysis attrition in patients using a telehealth platform

Abstract

Introduction: Home hemodialysis (HHD) facilitates increased treatment frequency, which may improve patient outcomes. However, attrition due to technique failure limits the clinical effectiveness of the modality. Nx2me Connected Health is a telehealth platform that enables ongoing assessment of HHD patients using NxStage equipment, and that may reduce patient burden. We aimed to assess whether use of Nx2me was associated with risk of HHD attrition. Methods:We compared risks of all-cause attrition, dialysis cessation (i.e., death or transplant), and technique failure in Nx2me users and matched control patients, using a retrospective cohort study. We also compared the likelihood of HHD training graduation in patients who initiated use of Nx2me during training with the likelihood in matched control patients. Matching factors included date of HHD initiation, NxStage treatment duration at initiation of follow-up, and prescribed treatment frequency. We used stratified Fine-Gray and Cox regression to compare risks, with adjustment for demographic factors and vascular access modality, and stratification by matched cluster. Findings:We identified 606 Nx2me users; 49.5% initiated use of Nx2me in <3 months after initiation of HHD with NxStage equipment. Adjusted hazard ratios (AHRs) of all-cause attrition, dialysis cessation, and technique failure were 0.80 (95% confidence interval, 0.68-0.95), 1.10 (0.86-1.41), and 0.71 (0.57-0.87), respectively, for Nx2me users vs. matched controls. AHRs were similar in patients who initiated use of Nx2me in <3 months after initiation of HHD. The AHR of HHD training graduation was 1.61 (1.10-2.36) in patients who initiated use of Nx2me within 2 weeks of training initiation vs. matched controls.Discussion: Use of Nx2me was associated with lower risk of all-cause attrition, lower risk of technique failure, and higher likelihood of HHD training graduation. Further studies are needed to identify the mechanisms by which use of a telehealth platform may improve clinical outcomes and reduce patient burden.

Remote Treatment Monitoring on Hospitalization and Technique Failure Rates in Peritoneal Dialysis Patients

“…It has been estimated that adoption of RTM systems to monitor PD treatments may also yield some economic benefits to healthcare systems in various countries (13,15). The influence of RTM on technique failure rates has not been reported previously in PD, yet the improvements we found are consistent with observations from RTM in the home HD population (16). Notably, technique failure rates in all groups of our analysis were lower than many reports in the literature (17,18), which could be in part due to our definition of a sustained technique failure event that required .6 consecutive weeks of HD and appropriately did not count technique failures as composite outcomes including death.…”

Technology, Telehealth, and Nephrology: The Time Is Now

“…In addition, innovative technologies allow medical information to be obtained directly from the peritoneal dialysis (PD) or home hemodialysis machine, as well as parameters self-monitored by the patient (2). The "Nx2me connect" app allows direct transmission of treatment parameters such as access blood flows, vital signs, and prescription details to the dialysis unit via a simple web-based application; such advances may help reduce treatment burden, and potentially lead to reduced attrition, improved compliance, and better sense of being "connected" with the treating physician (12). Remote monitoring in high-risk dialysis patients has been linked to decreased hospitalizations, improve quality of life, and cost savings in hemodialysis patients (13), and decreased emergency room visits, reduced disease burden, and improve compliance in PD patients (14).…”

Telehealth and Home Dialysis

“…Poorly designed telehealth systems or systems with delays or dropped connections may ultimately frustrate patients and providers alike and lead to lower-quality encounters. A well designed and functioning telehealth system, however, could lead to better retention of patients on the telehealth platform (10).…”