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

Abstract

Background An integrated kidney disease healthcare company implemented a peritoneal dialysis (PD) remote treatment monitoring (RTM) application in 2016. We assessed if RTM utilization associates with hospitalization and technique failure rates.Methods We used data from adult (age $18 years) patients on PD treated from October 2016 through May 2019 who registered online for the RTM. Patients were classified by RTM use during a 30-day baseline after registration. Groups were: nonusers (never entered data), moderate users (entered one to 15 treatments), and frequent users (entered .15 treatments). We compared hospital admission/day and sustained technique failure (required .6 consecutive weeks of hemodialysis) rates over 3, 6, 9, and 12 months of follow-up using Poisson and Cox models adjusted for patient/clinical characteristics.Results Among 6343 patients, 65% were nonusers, 11% were moderate users, and 25% were frequent users. Incidence rate of hospital admission was 22% (incidence rate ratio [IRR]50.78; P50.002), 24% (IRR50.76; P,0.001), 23% (IRR50.77; P#0.001), and 26% (IRR50.74; P#0.001) lower in frequent users after 3, 6, 9, and 12 months, respectively, versus nonusers. Incidence rate of hospital days was 38% (IRR50.62; P50.013), 35% (IRR50.65; P50.001), 34% (IRR50.66; P#0.001), and 32% (IRR50.68; P,0.001) lower in frequent users after 3, 6, 9, and 12 months, respectively, versus nonusers. Sustained technique failure risk at 3, 6, 9, and 12 months was 33% (hazard ratio [HR]50.67; P50.020), 31% (HR50.69; P50.003), 31% (HR50.69; P50.001), and 27% (HR50.73; P50.001) lower, respectively, in frequent users versus nonusers. Among a subgroup of survivors of the 12-month follow-up, sustained technique failure risk was 26% (HR50.74; P50.023) and 21% (HR50.79; P50.054) lower after 9 and 12 months, respectively, in frequent users versus nonusers.Conclusions Our findings suggest frequent use of an RTM application associates with less hospital admissions, shorter hospital length of stay, and lower technique failure rates. Adoption of RTM applications may have the potential to improve timely identification/intervention of complications.

The case for increased peritoneal dialysis utilization in low‐ and lower‐middle‐income countries

“…In a study of 49 patients on PD in Colombia, 118 remote monitoring led to improved pre‐emptive consultations, prescription adjustments and better blood pressure control. Another study from USA that evaluated telemedicine use in 6343 patients on PD, showed that hospital admission, hospital days and technique failure were 26% (IRR = 0.737; p = <.001), 32% (IRR = 0.680; p < .001) and 27% (HR = 0.726; p = .001) lower respectively in frequent users after 12 months versus non‐users 119 . While telemedicine offers several advantages, a few challenges in LLMICs must be recognized (Table 3), which should be addressed through optimal use of local resources.…”

“…116 Also, a nationwide cohort study from Qatar has reported a higher but non- (HR = 0.726; p = .001) lower respectively in frequent users after 12 months versus non-users. 119 While telemedicine offers several advantages, a few challenges in LLMICs must be recognized (Table 3), which should be addressed through optimal use of local resources.…”

Technique failure in remote patient monitoring program in patients undergoing automated peritoneal dialysis: A retrospective cohort study

“…The present study joins others showing a beneficial impact of RPM on outcomes, such as hospitalization or resource consumption. 10,11,27 These RPM programs, supported by the new technological tool, can be a lever for improving PD therapy, analogously to the positive experiences of RPM that have been reported in other areas of medicine, such as cardiology and neurology, to name a few. 32 –34…”

“…31 The present study joins others showing a beneficial impact of RPM on outcomes, such as hospitalization or resource consumption. 10,11,27 These RPM programs, supported by the new technological tool, can be a lever for improving PD therapy, analogously to the positive experiences of RPM that have been reported in other areas of medicine, such as cardiology and neurology, to name a few. [32][33][34] The strengths of this study include the relatively large number of patients that is greater than in previous reports and that we applied robust statistical matching techniques to deal with the problem of confounding that is inherent in observational studies.…”

“…Consistent with the previous point, the literature has shown that RPM programs have several theoretical and demonstrated clinical advantages that could be paths through which this technology can improve outcomes, such as early diagnosis of catheter dysfunction, lower incidence of peritonitis, achieving a better therapy adherence and improvements in reaching ultrafiltration goals. 8,10,11,27 With the use of a standardized APD-RPM program in our centres, we have reported that this allows early detection and timely resolution of problems related to treatment, including some benefits in terms of blood pressure control, achieving ultrafiltration goals, adherence to therapy, and was associated with lower hospitalization rates and fewer hospitalization days. [9][10][11] It is important to highlight that the technique failure rate in our study is lower compared with rates reported in some other studies.…”