Through the Storm: Automated Peritoneal Dialysis with Remote Patient Monitoring during COVID-19 Pandemic

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.

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Water Removal Cycle-By-Cycle During Automated Peritoneal Dialysis: Assessment by Remote Patient Monitoring and Modelling of Peritoneal Tissue Hydration

10.21203/rs.3.rs-429738/v1 ◽

2021 ◽

Author(s):

Joanna Stachowska-Pietka ◽

Beata Naumnik ◽

Ewa Suchowierska ◽

Rafael Gomez ◽

Jacek Waniewski ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Patient Monitoring ◽

Water Removal ◽

Remote Patient Monitoring ◽

Automated Peritoneal Dialysis ◽

Fluid Exchange ◽

Tissue Hydration ◽

Peritoneal Tissue ◽

Remote Patient ◽

The Impact

Abstract Water removal which is a key treatment goal of automated peritoneal dialysis (APD) can be assessed cycle-by-cycle using remote patient monitoring (RPM). We analysed ultrafiltration patterns during night APD following a dry day (APDDD; no daytime fluid exchange) or wet day (APDWD; daytime exchange). Ultrafiltration for each APD exchange were recorded for 16 days using RPM in 14 patients. The distributed model of fluid and solute transport was applied to simulate APD and to explore the impact of changes in peritoneal tissue hydration on ultrafiltration. We found lower ultrafiltration (mL, median [first quartile-third quartile]) during first and second vs. consecutive exchanges in APDDD (-61 [-148—27], 170 [78—228] vs. 213 [126—275] mL; p<0.001), but not in APDWD (81 [-8—176], 81 [-4—192] and 115 [4—219] mL; NS). Simulations in a virtual patient showed that lower ultrafiltration (by 114 mL) was related to increased peritoneal tissue hydration caused by inflow of 187 mL of water during the first APDDD exchange. The observed phenomenon of lower ultrafiltration during initial exchanges of dialysis fluid in patients undergoing APDDD appears to be due to water inflow into the peritoneal tissue, re-establishing a state of increased hydration typical for peritoneal dialysis.

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Outcomes of Remote Patient Monitoring for Automated Peritoneal Dialysis: A Randomized Controlled Trial

Nephron ◽

10.1159/000518364 ◽

2021 ◽

pp. 1-9

Author(s):

Hee-Yeon Jung ◽

Yena Jeon ◽

Yon Su Kim ◽

Dong Ki Kim ◽

Jung Pyo Lee ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Patient Monitoring ◽

Controlled Trial ◽

Staff Satisfaction ◽

Remote Patient Monitoring ◽

Automated Peritoneal Dialysis ◽

Randomized Controlled ◽

Remote Patient

Introduction: We hypothesize that remote patient monitoring (RPM) for automated peritoneal dialysis (APD) and feedback could enhance patient self-management and improve outcomes. The aim of this study was to evaluate the efficacy of RPM-APD compared to traditional APD (T-APD) without RPM. Methods: In this multicenter, randomized controlled trial, patients on APD were randomized to T-APD (n = 29) or RPM-APD (n = 28) at 12 weeks and followed until 25 weeks. Health-related quality of life (HRQOL), patient and medical staff satisfaction with RPM-APD, and dialysis-related outcomes were compared between the 2 groups. Results: We found no significant differences in HRQOL scores at the time of enrollment and randomization between RPM-APD and T-APD. At the end of the study, the RPM-APD group showed better HRQOL for the sleep domain (p = 0.049) than the T-APD group and the T-APD group showed better HRQOL for the sexual function domain (p = 0.030) than the RPM-APD group. However, we found no significant interactions between the time and groups in terms of HRQOL. Different HRQOL domains significantly improved over time in patients undergoing RPM-APD (effects of kidney disease, p = 0.025) and T-APD (burden of kidney disease, p = 0.029; physical component summary, p = 0.048). Though medical staff satisfaction with RPM-APD was neutral, most patients were quite satisfied with RPM-APD (median score 82; possible total score 105 on 21 5-item scales) and the rating scores were maintained during the study period. We found no significant differences in dialysis adherence, accuracy, adequacy, overhydration status, blood pressure, or the number of unplanned visits between the 2 groups. Discussion/Conclusion: Although HRQOL and dialysis-related outcomes were comparable between RPM-APD and T-APD, RPM-APD was positive in terms of patient satisfaction. Further long-term and large-scale studies will be required to determine the efficacy of RPM-APD. Trial Registration: CRIS identifier: KCT0003390, registered on December 14, 2018 – retrospectively registered, https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=12348.

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

Peritoneal Dialysis International ◽

10.1177/0896860820982223 ◽

2020 ◽

pp. 089686082098222

Author(s):

Leyder Corzo ◽

Martin Wilkie ◽

Jasmin I Vesga ◽

Bengt Lindholm ◽

Giancarlo Buitrago ◽

...

Keyword(s):

Cohort Study ◽

Peritoneal Dialysis ◽

Failure Rate ◽

Patient Monitoring ◽

Monitoring Program ◽

P Value ◽

Remote Patient Monitoring ◽

Automated Peritoneal Dialysis ◽

Remote Patient ◽

Technique Failure

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.

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FP489MEASURED ADVANTAGES OF REMOTE PATIENT MONITORING IN AUTOMATED PERITONEAL DIALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy104.fp489 ◽

2018 ◽

Vol 33 (suppl_1) ◽

pp. i202-i202

Author(s):

Gianpaolo Amici ◽

Antonina Lo Cicero ◽

Giuseppa Natale ◽

Dino Romanini ◽

Fabiana Presello ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Patient Monitoring ◽

Remote Patient Monitoring ◽

Automated Peritoneal Dialysis ◽

Remote Patient

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Water removal during automated peritoneal dialysis assessed by remote patient monitoring and modelling of peritoneal tissue hydration

Scientific Reports ◽

10.1038/s41598-021-95001-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Joanna Stachowska-Pietka ◽

Beata Naumnik ◽

Ewa Suchowierska ◽

Rafael Gomez ◽

Jacek Waniewski ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Patient Monitoring ◽

Water Removal ◽

Remote Patient Monitoring ◽

Automated Peritoneal Dialysis ◽

Fluid Exchange ◽

Tissue Hydration ◽

Peritoneal Tissue ◽

Remote Patient ◽

The Impact

AbstractWater removal which is a key treatment goal of automated peritoneal dialysis (APD) can be assessed cycle-by-cycle using remote patient monitoring (RPM). We analysed ultrafiltration patterns during night APD following a dry day (APDDD; no daytime fluid exchange) or wet day (APDWD; daytime exchange). Ultrafiltration for each APD exchange were recorded for 16 days using RPM in 14 patients. The distributed model of fluid and solute transport was applied to simulate APD and to explore the impact of changes in peritoneal tissue hydration on ultrafiltration. We found lower ultrafiltration (mL, median [first quartile, third quartile]) during first and second vs. consecutive exchanges in APDDD (−61 [−148, 27], 170 [78, 228] vs. 213 [126, 275] mL; p < 0.001), but not in APDWD (81 [−8, 176], 81 [−4, 192] vs. 115 [4, 219] mL; NS). Simulations in a virtual patient showed that lower ultrafiltration (by 114 mL) was related to increased peritoneal tissue hydration caused by inflow of 187 mL of water during the first APDDD exchange. The observed phenomenon of lower ultrafiltration during initial exchanges of dialysis fluid in patients undergoing APDDD appears to be due to water inflow into the peritoneal tissue, re-establishing a state of increased hydration typical for peritoneal dialysis.

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Evaluating a remote patient monitoring program for automated peritoneal dialysis

Peritoneal Dialysis International ◽

10.1177/0896860819896880 ◽

2020 ◽

Vol 40 (4) ◽

pp. 377-383

Author(s):

Juan G Ariza ◽

Surrey M Walton ◽

Mauricio Sanabria ◽

Alfonso Bunch ◽

Jasmin Vesga ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Clinical Outcomes ◽

Patient Monitoring ◽

Patient Adherence ◽

Monitoring Program ◽

Cost Savings ◽

Sensitivity Analyses ◽

Remote Patient Monitoring ◽

Automated Peritoneal Dialysis ◽

Remote Patient

Background: The benefits of automated peritoneal dialysis (APD) have been established, but patient adherence to treatment remains a concern. Remote patient monitoring (RPM) programs are a potential solution; however, the cost implications are not well established. This study modeled, from the payer perspective, expected net costs and clinical consequences of a novel RPM program in Colombia. Methods: Amarkov model was used to project costs and clinical outcomes for APD patients with and without RPM. Clinical inputs were directly estimated from Renal Care Services data or taken from the literature. Dialysis costs were estimated from national fees. Inpatient costs were obtained from a recent Colombian study. The model projected overall direct costs and several clinical outcomes. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were also conducted to characterize uncertainty in the results. Results: The model projected that the implementation of an RPM program costing US$35 per month in a cohort of 100 APD patients over 1 year would save US$121,233. The model also projected 31 additional months free of complications, 27 fewer hospitalizations, 518 fewer hospitalization days, and 6 fewer peritonitis episodes. In the DSA, results were most sensitive to hospitalization rates and days of hospitalization, but cost savings were robust. The PSA found there was a 91% chance for the RPM program to be cost saving. Conclusion: The results of the model suggest that RPM is cost-effective in APD patients which should be verified by a rigorous prospective cost analysis.

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130 Remote Patient Monitoring (RPM) and Longevity on Peritoneal Dialysis (PD): An Analysis Controlling for Confounding by PD Start Year

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2019.03.132 ◽

2019 ◽

Vol 73 (5) ◽

pp. 675-676

Keyword(s):

Peritoneal Dialysis ◽

Patient Monitoring ◽

Remote Patient Monitoring ◽

Remote Patient

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Remote patient monitoring in peritoneal dialysis helps reduce risk of hospitalization during Covid-19 pandemic

Journal of Nephrology ◽

10.1007/s40620-020-00822-0 ◽

2020 ◽

Vol 33 (6) ◽

pp. 1123-1124

Author(s):

Roberto Scarpioni ◽

Alessandra Manini ◽

Paola Chiappini

Keyword(s):

Peritoneal Dialysis ◽

Patient Monitoring ◽

Remote Patient Monitoring ◽

Reduce Risk ◽

Remote Patient

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P1223PATIENT REMOTE MONITORING IN AUTOMATED PERITONEAL DIALYSIS: 2017-2019 CLINICAL EXPERIENCE IN A SINGLE CENTER

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1223 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Gianpaolo Amici ◽

Antonina Lo Cicero ◽

Mery Zuccolo ◽

Rosella Ferraro Mortellaro ◽

Dino Romanini ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Remote Patient Monitoring ◽

Automated Peritoneal Dialysis ◽

Telemedicine System ◽

Daily Monitoring ◽

Hill Area ◽

Remote Patient ◽

The Impact

Abstract Background and Aims We conducted an observational study in a group of patients in automated peritoneal dialysis (APD) to evaluate the impact of the introduction and the long-term use of a telemedicine system for remote patient monitoring (RPM, Claria Sharesource Baxter). Method From April 1 2017 to December 31 2019 (33 months) we followed 42 APD patients with RPM, sex F 20 M 22, age 70±14 years, on PD treatment for median 10 (IQR 3-23) months, distance from the center 18±14 km in mountain and hill area. Have been studied 505 months of RPM overall, per patient median 9 (IQR 3-19) months, corresponding to 11685 APD sessions overall, per patient median 206 (IQR 52-457) sessions. Results Have been registered 1125 alarms (red flags) overall, per patient median 9 (IQR 1-45) alarms, rate 2.2 alarms patient-month (0.1 alarms per session). Analyzing the causes of the alarms: “dwell time lost” (>45 min) 1006 (89%), “drain anticipation” (>2 times) 22 (2%), “fill or dwell bypass” (>3 times) 15 (1%), “various causes” (>10 times) 86 (8%). “Various causes” alarm group sums mainly slow drain for set kinking and insufficient drain volume. We count 195 remote modifications of dialysis program overall, median per patient 3 (IQR 1-7), rate 0.02 patient month with a ratio 0.2 modifications per alarm. Looking to program modification, the alarm type specifically linked to modifications has been insufficient drain volume of the “various causes” group (36 events, 18% of all modifications). We found a positive correlation between the number of treatments and alarms (r=0.534, p<0.001). In the observation period the overall hospitalization days were 403, rate 0.8 days patient month, ratio 0.02 hospitalization days per APD RPM session and ratio 0.4 hospitalization days per alarm. Conclusion The study shows that APD with RPM improves patients’ follow-up changing the organization of the center. In the long term the telemedicine system shows the advantages of a careful and daily monitoring. The rates of alarm, change of prescription and hospitalization resulted very low in our experience.

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