scholarly journals Clinical implications of the implementation of a new automated peritoneal dialysis remote patient management system with cloud-based

2018 ◽  
Vol 1 (3) ◽  
pp. 117-120
Author(s):  
Valérie Jotterand-Drepper

In the last decades, remote patient management (RPM) has been of growing interest in medical fields. In this article we describe the clinical implications of the implementation of a newly available automated peritoneal dialysis (APD) RPM system with cloud-based connectivity. This system provides data sent from the cycler about the course of the peritoneal dialysis (PD) therapy, offering the medical team the opportunity to analyse them on an everyday basis and subsequently remotely alter PD prescription.The main advantages discussed here are sparing of long or difficult travels, especially for patients with social, geographical or physical limitations, early identification and management of occurring issues such as catheter dysfunction or non-adherence to prescribed PD therapy, a potential clue to an imminent peritonitis, and finally a more personalized APD prescription. Further impacts of the implementation of RPM in peritoneal dialysis on patients outcomes, health costs and its potential influence on a greater take-on rate of the technique have still to be evaluated

2018 ◽  
Vol 38 (1) ◽  
pp. 76-78 ◽  
Author(s):  
Valérie Jotterand Drepper ◽  
Pierre-Yves Martin ◽  
Catherine Stoermann Chopard ◽  
James A. Sloand

Remote patient management (RPM) has the potential to help clinicians detect early issues, allowing intervention prior to development of more significant problems. A 23-year-old end-stage kidney disease patient required urgent start of renal replacement therapy. A newly available automated peritoneal dialysis (APD) RPM system with cloud-based connectivity was implemented in her care. Pre-defined RPM threshold parameters were set to identify clinically relevant issues. Red flag dashboard alerts heralded prolonged drain times leading to clinical evaluation with subsequent diagnosis of and surgical repositioning for catheter displacement, although it took several days for newly-RPM-exposed staff to recognize this issue. Post-PD catheter repositioning, drain times were again normal as indicated by disappearance of flag alerts and unremarkable cycle volume profiles. Identification of < 90% adherence to prescribed PD therapy was then documented with the RPM system, alerting the clinical staff to address this important issue given its association with significant negative clinical outcomes. Healthcare providers face a “learning curve” to effect optimal utilization of the RPM tool. Larger scale observational studies will determine the impact of RPM on APD technique survival and resource utilization.


2020 ◽  
Vol 40 (4) ◽  
pp. 363-367 ◽  
Author(s):  
Claudio Ronco ◽  
Sabrina Milan Manani ◽  
Anna Giuliani ◽  
Ilaria Tantillo ◽  
Thiago Reis ◽  
...  

2021 ◽  
Author(s):  
Michael Polsky ◽  
Neema Moraveji

BACKGROUND The adoption of remote patient monitoring (RPM) into routine medical care requires an increased understanding of how the physiologic changes accompanying disease development and what proactive interventions will improve outcomes. OBJECTIVE We present three case reports which highlight the capability of RPM to allow for early identification of viral infection with COVID-19 in chronic respiratory disease patients. METHODS Patients at a large pulmonary practice were identified who were enrolled in a respiratory RPM program and who had contracted COVID-19. The physiologic data was retrospectively reviewed and three instances were identified where the RPM system had notified clinicians of physiologic deviation due to the viral infection. RESULTS Physiologic deviations from respective patient baselines occurred during infection onset and, despite the infection manifesting differently in each case, had been identified by the RPM system. In one case, the patient was symptomatic, in another the patient was pre-symptomatic, and in the final the patient varied from asymptomatic to mildly symptomatic. CONCLUSIONS RPM systems meant for long-term use and which utilize patient-specific baselines can highlight physiologic changes early in the course of acute disease, such as COVID-19 infection. The cases demonstrate opportunities for earlier diagnosis, treatment, and isolation. This supports the need for further research into how RPM can be effectively integrated into clinical practice. CLINICALTRIAL


2020 ◽  
pp. 1-4
Author(s):  
Alfonso Bunch ◽  
Freddy Ardila ◽  
Ricardo Castaño ◽  
Sylvia Quiñonez ◽  
Leyder Corzo

Author(s):  
Carlo Crepaldi ◽  
Anna Giuliani ◽  
Sabrina Milan Manani ◽  
Nicola Marchionna ◽  
Paola Piasentin ◽  
...  

2019 ◽  
Vol 39 (5) ◽  
pp. 472-478 ◽  
Author(s):  
Mauricio Sanabria ◽  
Giancarlo Buitrago ◽  
Bengt Lindholm ◽  
Jasmin Vesga ◽  
Lars-Göran Nilsson ◽  
...  

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.


Author(s):  
Sabrina Milan Manani ◽  
Carlo Crepaldi ◽  
Anna Giuliani ◽  
Grazia Maria Virzì ◽  
Marta Proglio ◽  
...  

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