Remote Patient Monitoring Program in Automated Peritoneal Dialysis: Impact on Hospitalizations

Abstract

Background Automated peritoneal dialysis (APD) is a growing PD modality but as with other home dialysis methods, the lack of monitoring of patients’ adherence to prescriptions is a limitation with potential negative impact on clinical outcome parameters. Remote patient monitoring (RPM) allowing the clinical team to have access to dialysis data and adjust the treatment may overcome this limitation. The present study sought to determine clinical outcomes associated with RPM use in incident patients on APD therapy. Methods A retrospective cohort study included 360 patients with a mean age of 57 years (diabetes 42.5%) initiating APD between 1 October 2016 and 30 June 2017 in 28 Baxter Renal Care Services (BRCS) units in Colombia. An RPM program was used in 65 (18%) of the patients (APD-RPM cohort), and 295 (82%) were treated with APD without RPM. Hospitalizations and hospital days were recorded over 1 year. Propensity score matching 1:1, yielding 63 individuals in each group, was used to evaluate the association of RPM exposure with numbers of hospitalizations and hospital days. Results After propensity score matching, APD therapy with RPM ( n = 63) compared with APD-without RPM ( n = 63) was associated with significant reductions in hospitalization rate (0.36 fewer hospitalizations per patient-year; incidence rate ratio [IRR] of 0.61 [95% confidence interval (CI) 0.39 – 0.95]; p = 0.029) and hospitalization days (6.57 fewer days per patient-year; IRR 0.46 [95% CI 0.23 – 0.92]; p = 0.028). Conclusions The use of RPM in APD patients is associated with lower hospitalization rates and fewer hospitalization days; RPM could constitute a tool for improvement of APD therapy.

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

“…Consistent trends were seen with respect to moderate users of the RTM versus nonusers, albeit outcomes did not significantly differ with the exception of sustained PD technique failure rates in the subgroup of survivors at the 3-and 6-month follow-up periods. These results further substantiate prior findings suggesting that use of other RTM systems in patients on PD may reduce hospital rates (14,15), and reveal frequent RTM use may also have the potential to increase sustained use of PD as a modality.…”

“…In our analysis we included 17% of patients from the overall active PD population based on inclusionary restrictions to have created an online account, age $18 years, and body mass index ,65 kg/m 2 . Prior reports suggest similar adoption with 18% of patients on PD in Columbia using a different remote monitoring system incorporated via connected health sensors in the cycler (14). Given patients on PD are typically younger, it would be expected that there might be a larger proportion of patients on PD with access to the internet.…”

“…The associations between RTM use in patients on PD and hard outcomes have been reported in a limited number of small cross-sectional analyses. A study of 63 patients who had an RTM system incorporated in their PD cycler found that the incidence of hospital admissions was 39% (incidence rate ratio, 0.61; 95% CI, 0.39 to 0.95) lower and hospital days was 54% (incidence rate ratio, 0.46; 95% CI, 0.23 to 0.92) lower compared with 63 matched patients who did not have an RTM system in their cycler (14). Another study of 269 patients on PD who received an intervention of daily RTM of BP and weight coupled with video conferencing telehealth care showed that the adjusted risk of hospital admission was 46% (odds ratio, 0.54; 95% CI, 0.33 to 0.89) lower and hospital days was 54% (odds ratio, 0.46; 95% CI, 0.26 to 0.81) lower compared with before the intervention (15).…”

The reliability and success of peritoneal dialysis during the COVID-19 pandemic

“…This platform enables patient treatment data, including peritoneal volume, alerts during treatment, drainage problems, interruption of therapy, loss of dwell time, loss of therapy time to receive, and transmission through to the PD center 7,9 . It has provided many opportunities, such as instant monitoring of treatment adherence, early detection of problems, and resolving most of the problems remotely without admitting to the hospital 9,26 . On the other hand, our clinical assessment was only about whether patients skipped the PD session, and other possible, which were mentioned above, PD treatment incompatibilities did not indicate.…”

Telenephrology with Remote Peritoneal Dialysis Monitoring during Coronavirus Disease 19

“…Education and a wellstructured plan were crucial for successful implementation. It has been demonstrated that the use of standardized remote patient monitoring program for the management of automated PD patients was associated with lower hospitalization rates and decreased hospital length of stay [5]. Having a well-established home dialysis program where 40% of the RTS dialysis population utilizing PD as their dialysis modality has allowed RTS Colombia dialysis facilities to adapt quickly during the pandemic.…”