Remote monitoring in peritoneal dialysis: benefits on clinical outcomes and on quality of life

Abstract

Background Automated peritoneal dialysis (APD) has been proved benefit from remote monitoring (RM), but evidences are limited. In this study, we compared clinical outcomes and quality of life (QoL) in two group of patients undergoing APD, with and without exposure of RM. Methods This is a retrospective cohort study, comparing outcomes in two groups of APD patients monitored during 6 months with RM (group A: n = 35) or standard care (group B: n = 38 patients). In our clinical practice, we assign the RM system to patients who live more distant from the PD center or difficulty in moving. We evaluated emergency visits, hospitalizations, peritonitis, overhydration, and dropout. QoL was assessed with the Kidney Disease Quality of life-Short Form (KDQOL-SF). We included four additional questions focused on patient's perception of monitoring, safety and timely problems solution (Do you think that home-therapy monitoring could interfere with your privacy? Do you think that your dialysis sessions are monitored frequently enough? Do you think that dialysis-related issues are solved timely? Do you feel comfortable carrying out your home-based therapy?). Results The case group presented a higher comorbidity score, according to Charlson Comorbidity Index (group A: 5.0; IQR 4.0-8.0 versus group B: 4.0; IQR 3.0-6.0) (p = 0.042). The results in group A showed a reduction in the urgent visits due to acute overhydration (group A: 0.17 ± 0.45 versus group B: 0.66 ± 1.36) (p: 0.042) and in the number of disease-specific hospitalization (group A n = 2.0; 18.2% versus group B n = 7.0; 77.8%) (p = 0.022). We did not find any difference between the two groups in terms of hospitalization because of all-cause, peritonitis, overhydration, and dropout. The analysis of KDQOL-SF subscales was similar in the two groups; on the contrary, the answers of our pointed questions have showed a significant difference between the two groups (group A: 100 IQR 87.5-100.0 versus group B 87.5; IQR 75.0-100.0) (p: 0.018). Conclusion RM improved clinical outcomes in PD patients, reducing the emergency visits and the hospitalizations, related to nephrological problems, especially in patients with higher comorbidity score. The acceptance and satisfaction of care were better in patients monitored with RM than with standard APD.

The utility of remote patient management in peritoneal dialysis

“…Secondly, the KDQOL-SF scale is an instrument developed for patients with chronic kidney disease, but no specific questions assess the effect of home dialysis monitoring daily activities and patient satisfaction. In 2020, Manani et al [ 15 ] detected similar results in patients with RPM with APD in accordance with a previous systematic review. Unlike other studies, they designed an internal questionnaire to evaluate the effect of RPM on HRQoL to a greater extent, and found that RPM–APD indicated an excellent acceptance and satisfaction when monitored closely and frequently.…”

“…One of the main advantages of integrating RPM to APD is increased treatment adherence, and it is known that non-adherence to treatment is associated with more frequent peritonitis episodes [ 7 , 27 , 30 ]. However, current data in the literature contain conflicting results regarding the effect of RPM programs with APD on the frequency of peritonitis episodes, but, in general, RPM had no significant effect on the development of peritonitis [ 6 , 10 , 11 , 15 ]. While Sanabria et al [ 6 ] reported fewer peritonitis episodes in patients with RPM than those without RPM, Manani et al [ 15 ] and Corzo et al [ 11 ] reported higher but not significant peritonitis episodes in the RPM group.…”

“…However, current data in the literature contain conflicting results regarding the effect of RPM programs with APD on the frequency of peritonitis episodes, but, in general, RPM had no significant effect on the development of peritonitis [ 6 , 10 , 11 , 15 ]. While Sanabria et al [ 6 ] reported fewer peritonitis episodes in patients with RPM than those without RPM, Manani et al [ 15 ] and Corzo et al [ 11 ] reported higher but not significant peritonitis episodes in the RPM group. However, the frequency of peritonitis was not the primary endpoint of these studies and there is no study focusing directly on peritonitis.…”

“…In 2019, Sanabria et al [ 6 ] conducted a study which was the first clinical observation that evaluated the effect of RPM on hospitalization, with 126 patients with APD (63 patients with RPM and 63 patients without RPM), and they showed that RPM programs led to a decrease in both hospitalization rate (decrease in 0.36 episodes per patient-year) and the length of hospital stay (decrease in 6.57 hospital days per patient-year). Later, in a retrospective study consisting of 35 patients with RPM–APD and 35 patients without RPM–APD, the RPM group had lower hospitalization rate and shorter length of hospital stay [ 15 ]. However, the difference was not statistically significant.…”

Automated Peritoneal Dialysis: Patient Perspectives and Outcomes

“…It has been found to improve patient's adherence to prescribed therapy, to enhance timely recognition of complications and proactive intervention, to reduce patient's unscheduled access to the hospital and to promote dialysis adequacy. 10,11 These instruments have been well accepted by patients and their family. 12 APD effectiveness has been recently reported also in particular clinical settings such as urgent PD start 13 and treatment of acute kidney injury (AKI).…”