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

Abstract

Background: Remote patient monitoring (RPM) programs in automated peritoneal dialysis (APD) allow clinical teams to be aware of many aspects and events of the therapy that occur in the home. The present study evaluated the association between RPM use and APD technique failure. Methods: A retrospective, multicentre, observational cohort study of 558 prevalent adult APD patients included between 1 October 2016 and 30 June 2017 with follow-up until 30 June 2018 at Renal Therapy Services network in Colombia. Patients were divided into two cohorts based on the RPM use: APD-RPM ( n = 148) and APD-without RPM ( n = 410). Sociodemographic and clinical characteristics of all patients were summarized descriptively. A propensity score was used to create a pseudo-population in which the baseline covariates were well balanced. The association of RPM with technique failure was estimated adjusting for the competing events death and kidney transplant. Results: Five hundred fifty-eight patients were analyzed. 26.5% had APD-RPM. In the matched sample comprising 148 APD-RPM and 148 APD-without RPM patients, we observed a lower technique failure rate of 0.08 [0.05–0.15] episodes per patient-year in APD-RPM versus 0.18 [0.12–0.26] in APD-without RPM cohort; incidence rate ratio = 0.45 95% confidence interval: [0.22–0.91], p-value = 0.03. Conclusions: The use of an RPM program in APD patients may be associated with a lower technique failure rate. More extensive and interventional studies are needed to confirm its potential benefits and to measure other patient-centered outcomes.

Impact of telehealth interventions added to peritoneal dialysis-care: a systematic review

“…difference Chaudhuri 2020 [ 31 ] U.S.A. N = 6343 Age 56. 9 ± 15.2y M = 57% % CAPD not specified Retrospective study RTM ‘PatientHub’ moderate users ( N = 673) frequent users ( N = 1577) RTM involves patients viewing their dialysis orders, laboratory results, medications, supply orders and documenting their daily PD treatment data, vital signs, complications RTM non-users ( N = 4093) 12 months Transfer to HD (> 6wks) Lower in frequent users versus non-users (p = 0.001, on average 30.5 ± 2.5% lower) Moderate Hospitalizations Lower in frequent users versus non-users (on average 23.75 ± 1.71% lower, p ≤ 0.001) Number of hospital days Lower in frequent users versus non-users (on average 34.75 ± 2.5% lower, p ≤ 0.001) Corzo 2020 [ 34 ] Colombia N = 558 Age 53.8 ± 16.9y M = 60%, APD Retrospective, multicenter, observational cohort study APD-RPM ( N = 148) APD without RPM ( N = 410) N = 148 used for propensity score matching 1.1 ± 0.6 years Transfer to HD (>30d) Lower in intervention group (p = 0.03) Moderate Mortality N.S. difference(only reported for the non-matched population) Nayak 2012 [ 17 ] India N = 246 Age 51.5 ± 12.8y in rural group 52.3 ± 12.6y in urban group M: 70% in rural group; 69% in urban group %CAPD not specified Observational Internet-based RM system (including online log of dialysis data, pictures, access to laboratory results, health records and prescriptions, possibility to schedule appointments and to receive alerts) in rural patients ( N = 115) ...…”

“…Five studies investigated remote monitoring (RM) during predominantly APD as an intervention [ 20 , 21 , 29 , 34 , 36 ]. Other studies investigated the implementation of RM, including the possibility to: i. contact the health care team through video-chat [ 15 , 19 , 33 ]; ii.…”

The utility of remote patient management in peritoneal dialysis

“…Recently, Corzo et al . [ 11 ] showed that the RPM program was associated with higher technique survival in a multicentre, retrospective observational cohort study. Although this study was conducted with a large number of patients (148 patients with RPM and 410 patients without), it does not allow inference of causality due to the retrospective nature of the study.…”

“…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.…”