Remote Patient Management in Automated Peritoneal Dialysis: A Promising New Tool

2018 ◽  
Vol 38 (1) ◽  
pp. 76-78 ◽  
Author(s):  
Valérie Jotterand Drepper ◽  
Pierre-Yves Martin ◽  
Catherine Stoermann Chopard ◽  
James A. Sloand
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Management ◽  
Healthcare Providers ◽  
Disease Patient ◽  
Automated Peritoneal Dialysis ◽  
Technique Survival ◽  
Rpm System ◽  
Remote Patient ◽  
End Stage ◽  
The Impact

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.

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
Keyword(s):  
Peritoneal Dialysis ◽  
Early Identification ◽  
Patient Management ◽  
Clinical Implications ◽  
Automated Peritoneal Dialysis ◽  
Potential Influence ◽  
Catheter Dysfunction ◽  
Rpm System ◽  
Physical Limitations ◽  
Remote Patient

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

Assisted Automated Peritoneal Dialysis (Aapd) for the Functionally Dependent and Elderly Patient

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 60-63 ◽  
Author(s):  
Johan V. Povlsen ◽  
Per Ivarsen
Keyword(s):  
Nursing Home ◽  
Peritoneal Dialysis ◽  
International Standards ◽  
University Hospital ◽  
Automated Peritoneal Dialysis ◽  
Technique Survival ◽  
Acute Peritonitis ◽  
Data Files ◽  
Stage Renal Disease ◽  
End Stage

♦ Objective To describe basic demographics and clinical outcomes among elderly end-stage renal disease (ESRD) patients physically dependent on a caregiver and maintained on an assisted automated peritoneal dialysis (AAPD) program. ♦ Design Retrospective single-center study based on patient records and data files. ♦ Setting University Hospital. ♦ Patients 64 physically dependent AAPD patients followed for 1.012 treatment months. Assistance and care was delivered by 52 briefly trained teams of visiting nurses or nursing home staff. ♦ Result Crude 1-year survival was 58% and 2-year survival was 48%. Crude 1- and 2-year survivals, excluding deaths within 90 days, were 66% and 54% respectively. We found no significant effect on survival by main causes of ESRD, gender, age, late referral, need for acute start, social isolation, physical dependency on help at inclusion, or residence in a nursing home. 10% of patient-days on AAPD were spent in hospital. 13 (20%) of the patients were converted permanently to hemodialysis due to PD technique failure. The incidence of peritonitis was 1 in every 25.3 treatment-months. ♦ Conclusions AAPD may be a feasible and safe option for renal replacement therapy for frail, elderly, and physically dependent patients with ESRD. Despite the special patient selection for this AAPD program, we achieved results of international standards for patient survival, PD technique survival, and incidence of acute peritonitis. These results do not justify withholding dialysis from this group of patients.

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

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” (&gt;45 min) 1006 (89%), “drain anticipation” (&gt;2 times) 22 (2%), “fill or dwell bypass” (&gt;3 times) 15 (1%), “various causes” (&gt;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&lt;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.

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

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.

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

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.

scholarly journals Correlations between gender, age and the risk of withdrawal from peritoneal dialysis

2020 ◽  
Author(s):  
Min Yan Zhang ◽  
Miao He ◽  
Sheng Wan ◽  
Qiong Yan Ding ◽  
Lei Liu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Serum Albumin ◽  
End Stage Renal Disease ◽  
Technique Survival ◽  
Gender And Age ◽  
Male Patients ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Abstract Background With the increasing incidence of end stage renal disease(ESRD),peritoneal dialysis(PD) has become the preferred method of kidney replacement therapy for an increasing number of patients with end stage renal disease due to its many advantages.The intent of this study was to explore the correlations between sex, age and risk of withdrawal from peritoneal dialysis.Methods All patients who underwent PD catheterization and initiated PD at Wuhan No.1 Hospital between 2013 and 2018 were screened.Clinical information of these patients was collected and compared according to gender and age,then was applied to the Cox proportional hazards model to determine the impact of factors of withdrawal from peritoneal dialysis.Results ①Hazard ratios(HRs) of withdrawal of PD associate with gender and age at initiation were 0.736(P = 0.289)、1.151༈P = 0.489༉respectively.Nonetheless,male patients under 60 years old had a 1.58-fold higher risk of withdrawal than others(HR 0.63,P = 0.031).②The withdrawal risk of patients with total Creatinine clearance rate (Ccr) above 60L/W was 82.4% higher than that of patients who did not meet the standard (HR 1.82,P = 0.005).③The withdrawal risk of patients with high D/P Creatinine༈Cr༉value which was calculated from peritoneal equilibration test(PET) were 2.06 times higher than low-average and high-average transport patients(HR2.06,P = 0.008).④Patients with serum albumin above 35 g/L were intended to withdraw from PD than those below 35 g/L (HR 0.56,P = 0.006).Conclusions There were significant differences in total KT/V, total Ccr,serum creatinine(Scr) and blood Urea nitrogen(BUN)among patients with PD of different gender and age.The analysis showed that male patients under 60 years old, Ccr, value of D/Pcr and serum albumin had a high correlation with the technical survival rates.While gender or age at PD initiation were not associated with technique survival,male patients under 60 years old had a 1.58-fold higher risk of withdrawal from PD than others.The outcome that the withdrawal risk of patients with Ccr above 60L/W was 82.4% higher than other patients who did not meet the standard suggested that Ccr was not suitable as an index for evaluating the adequacy of PD,especially for men under 60 years old.And patients with high D/Pcr value or with serum albumin under 35 g/L were related risk factors for technique survival.

scholarly journals Peritoneal Microbiome in End-Stage Renal Disease Patients and the Impact of Peritoneal Dialysis Therapy

2020 ◽  
Vol 8 (2) ◽  
pp. 173
Author(s):  
Liliana Simões-Silva ◽  
Ricardo Araujo ◽  
Manuel Pestana ◽  
Isabel Soares-Silva ◽  
Benedita Sampaio-Maia
Keyword(s):  
Peritoneal Dialysis ◽  
Human Microbiome ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Peritoneal Tissue ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Factors influencing the occurrence of peritoneal dialysis (PD)-related infections are still far from fully understood. Recent studies described the existence of specific microbiomes in body sites previously considered microbiome-free, unravelling new microbial pathways in the human body. In the present study, we analyzed the peritoneum of end-stage kidney disease (ESKD) patients to determine if they harbored a specific microbiome and if it is altered in patients on PD therapy. We conducted a cross-sectional study where the peritoneal microbiomes from ESKD patients with intact peritoneal cavities (ESKD non-PD, n = 11) and ESKD patients undergoing PD therapy (ESKD PD, n = 9) were analyzed with a 16S rRNA approach. Peritoneal tissue of ESKD patients contained characteristically low-abundance microbiomes dominated by Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidetes. Patients undergoing PD therapy presented lower species richness, with dominance by the Pseudomonadaceae and Prevotelaceae families. This study provides the first characterization of the peritoneal microbiome in ESKD patients, bringing new insight to the human microbiome. Additionally, PD therapy may induce changes in this unique microbiome. The clinical relevance of these observations should be further explored to uncover the role of the peritoneal microbiome as a key element in the onset or aggravation of infection in ESKD patients, especially those undergoing PD.

scholarly journals Predictors of Peritonitis and the Impact of Peritonitis on Clinical Outcomes of Continuous Ambulatory Peritoneal Dialysis Patients in Taiwan—10 Years’ Experience in a Single Center

2014 ◽  
Vol 34 (1) ◽  
pp. 85-94 ◽  
Author(s):  
Yao-Peng Hsieh ◽  
Chia-Chu Chang ◽  
Yao-Ko Wen ◽  
Ping-Fang Chiu ◽  
Yu Yang
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Drop Out ◽  
Kaplan Meier ◽  
Underlying Mechanisms ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact ◽  
Technique Failure

ObjectivePeritoneal dialysis (PD) has become more prevalent as a treatment modality for end-stage renal disease, and peritonitis remains one of its most devastating complications. The aim of the present investigation was to examine the frequency and predictors of peritonitis and the impact of peritonitis on clinical outcomes.MethodsOur retrospective observational cohort study enrolled 391 patients who had been treated with continuous ambulatory PD (CAPD) for at least 90 days. Relevant demographic, biochemical, and clinical data were collected for an analysis of CAPD-associated peritonitis, technique failure, drop-out from PD, and patient mortality.ResultsThe peritonitis rate was 0.196 episodes per patient–year. Older age (>65 years) was the only identified risk factor associated with peritonitis. A multivariate Cox regression model demonstrated that technique failure occurred more often in patients experiencing peritonitis than in those free of peritonitis ( p < 0.001). Kaplan–Meier analysis revealed that the group experiencing peritonitis tended to survive longer than the group that was peritonitis-free ( p = 0.11). After multivariate adjustment, the survival advantage reached significance (hazard ratio: 0.64; 95% confidence interval: 0.46 to 0.89; p = 0.006). Compared with the peritonitis-free group, the group experiencing peritonitis also had more drop-out from PD ( p = 0.03).ConclusionsThe peritonitis rate was relatively low in the present investigation. Elderly patients were at higher risk of peritonitis episodes. Peritonitis independently predicted technique failure, in agreement with other reports. However, contrary to previous studies, all-cause mortality was better in patients experiencing peritonitis than in those free of peritonitis. The underlying mechanisms of this presumptive “peritonitis paradox” remain to be clarified.

Nonclinical Factors Associated with Treatment with Peritoneal Dialysis in Esrd Patients in Taiwan

2010 ◽  
Vol 30 (6) ◽  
pp. 638-643 ◽  
Author(s):  
Hsiu-Chen Huang ◽  
Jiun-Yi Wang ◽  
Chia-Chu Chang ◽  
Ping-Fang Chiu ◽  
Ming-Che Chiang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Family Support ◽  
Univariate Analysis ◽  
Healthcare Providers ◽  
Early Referral ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage ◽  
To Receive ◽  
Esrd Patients

ObjectivesLess than 10% of end-stage renal disease (ESRD) patients in Taiwan receive peritoneal dialysis (PD), which reveals the situation of underutilization of PD. We thus aimed to investigate factors associated with treatment with PD in ESRD patients in Taiwan.PatientsPatients that were 18 years of age or older and had been on dialysis for at least 3 months since 2001 were recruited and interviewed with a structured questionnaire.Results98 hemodialysis (HD) and 102 PD patients were recruited. In univariate analysis, age, sex, level of education, employment status, marital status, traffic time, family support, patient cognition, and receptivity were correlated with treatment with PD. Multivariate analysis showed that patients that were not married ( p = 0.006), that spent more time traveling to the dialysis clinic ( p = 0.006), that were not emergent at the start of dialysis ( p = 0.003), and that had better family support ( p = 0.045), a higher cognition of dialysis ( p = 0.034), and stronger receptivity to dialysis ( p < 0.001) were more likely to receive PD.ConclusionsWe recommend patients follow the standard process to obtain more exhaustive information, consultation, and early referral. In addition, we suggest healthcare providers remind patients to take into account such nonclinical factors as family support and patient receptivity when they choose their dialysis modality.

Sign in / Sign up

Export Citation Format

Share Document