Remote Patient Monitoring Program in Automated Peritoneal Dialysis: Impact on Hospitalizations

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

Blood Purification ◽

10.1159/000511407 ◽

2020 ◽

pp. 1-4

Author(s):

Alfonso Bunch ◽

Freddy Ardila ◽

Ricardo Castaño ◽

Sylvia Quiñonez ◽

Leyder Corzo

Keyword(s):

Peritoneal Dialysis ◽

Patient Monitoring ◽

Remote Patient Monitoring ◽

Automated Peritoneal Dialysis ◽

Remote Patient

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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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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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P1151CLINICAL OUTCOMES IN REMOTE PATIENT MONITORING IN AUTOMATED PERITONEAL DIALYSIS : A COLOMBIAN EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1151 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Leyder Corzo ◽

Jasmin Vesga ◽

Mauricio Sanabria ◽

Angela Rivera

Keyword(s):

Peritoneal Dialysis ◽

Propensity Score ◽

Propensity Score Matching ◽

Patient Monitoring ◽

Therapy Outcomes ◽

Baxter Healthcare ◽

Observational Cohort ◽

Therapy Services ◽

Remote Patient ◽

Technique Failure

Abstract Background and Aims Patients with remote monitoring are followed-up daily by clinical teams, allowing early detection and correction of problems, which could result in improvements in therapy outcomes. Aims: To evaluate the association between Remoted Patient Monitoring (RPM) program and clinical outcomes (technique failure and peritonitis rates). Method A historical, multicenter, observational cohort study in Automatized Peritoneal Dialysis (APD) prevalent patients, included between October 1, 2016, and June 30, 2017 with follow-up until June 30, 2018, at Renal Therapy Services (RTS) network. Patients were older than 18 years, divided into two cohorts based on the RPM use: 1) APD-RPM cohort: patients using the HomeChoice Claria® device with Sharesource® technology (Baxter Healthcare, Deerfield, USA) and 2) APD-Without RPM cohort: patients using APD systems HomeChoice Legacy® without RPM. Socio-demographic and clinical characteristics of all patient were summarized descriptively. Propensity score matching 1:1 was used. Results 558 patients met the inclusion criteria for data analysis. The mean age was 54 years, 40% were female, 26% had APD RPM, see Table 1. After propensity score matching, APD therapy with RPM (n=148) as compared to APD-Without RPM (n=148) was associated with significant reduction in technique failure, IRR= 0.46 95% CI: [0.24 - 0 .89], and a trend in peritonitis rate reduction, IRR= 0.87 [0.41 - 1.00], P= 0.051, see table 2. Main reasons of technique failure are presented in table 3. Conclusion The use of RPM program in APD patients is associated with lower technique failure rate, supporting the role of this technology as performance enhancer.

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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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Understanding the Effects of Participation in a Large-scale Remote Diabetes Monitoring Program: A Qualitative Survey and Retrospective Analysis Study (Preprint)

10.2196/preprints.27851 ◽

2021 ◽

Author(s):

Yee Chieh Chew ◽

Michael Swiernik ◽

Thomas McCormick ◽

Angie Stevens

Keyword(s):

Health Outcomes ◽

Care Management ◽

Patient Monitoring ◽

Monitoring Program ◽

Care Providers ◽

Remote Patient Monitoring ◽

Kaiser Permanente ◽

Program Adherence ◽

Remote Patient ◽

Diabetic Care

BACKGROUND Remote patient monitoring has shown promise in helping management of population health by facilitating care management between providers and patients by providing real-time accurate data of relevant readings for chronic conditions from outside a medical facility. Kaiser Permanente offers remote patient monitoring as part of a holistic care management program for its members. OBJECTIVE The purpose of this study was to examine qualitative and quantitative measures of patient and provider feedback of Kaiser Permanente’s remote patient monitoring program for diabetes, patient perspectives on ability to manage diabetic care, patient health outcomes and program adherence, and utilization of Kaiser Permanente services under the program. METHODS In this study, patients who were enrolled in the RPM program in Southern California from 2017 onwards as well as care providers who had enrolled at least one patient in the program were studied. For qualitative data, online surveys were deployed. For quantitative analysis, clinical and demographic data drawn from existing data systems, which included Kaiser Permanente membership records, encounter records, electronic medical records, and administrative data repositories were used. RESULTS Providers (N=160) and patients (N=1,106) responded to the survey and reported many qualitative benefits from participating in the study, including improved coordination of clinical care and increased accountability. Patients who were enrolled in the program experienced a mean decrease of 1.25 in HbA1c results and an increase in encounters over 90 days which gradually come back to pre-enrollment encounter levels around 6 months. Those who actively upload glucose readings met the program upload goals within the first month a majority (92%) of the time. CONCLUSIONS There are many qualitative benefits for patients and providers incorporating Kaiser Permanente’s remote patient monitoring program as part of diabetic care. The quantitative descriptions of health outcomes, service utilization, and program adherence speak to the feasibility and value of deploying remote monitoring tools at scale within healthcare organizations.

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