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. 2020 Feb 17;1(3):191-202.
doi: 10.34067/KID.0000302019. eCollection 2020 Mar 26.

Remote Treatment Monitoring on Hospitalization and Technique Failure Rates in Peritoneal Dialysis Patients

Sheetal Chaudhuri  1   2 , Hao Han  1 , Carlos Muchiutti  3 , Jessica Ryter  3 , Marta Reviriego-Mendoza  1 , Dugan Maddux  3 , John W Larkin  1 , Len A Usvyat  1 , Dinesh Chatoth  3 , Jeroen P Kooman  2 , Franklin W Maddux  1
Affiliations

Remote Treatment Monitoring on Hospitalization and Technique Failure Rates in Peritoneal Dialysis Patients

Sheetal Chaudhuri et al. Kidney360. .

Abstract

Background: An integrated kidney disease healthcare company implemented a peritoneal dialysis (PD) remote treatment monitoring (RTM) application in 2016. We assessed if RTM utilization associates with hospitalization and technique failure rates.

Methods: We used data from adult (age ≥18 years) patients on PD treated from October 2016 through May 2019 who registered online for the RTM. Patients were classified by RTM use during a 30-day baseline after registration. Groups were: nonusers (never entered data), moderate users (entered one to 15 treatments), and frequent users (entered >15 treatments). We compared hospital admission/day and sustained technique failure (required >6 consecutive weeks of hemodialysis) rates over 3, 6, 9, and 12 months of follow-up using Poisson and Cox models adjusted for patient/clinical characteristics.

Results: Among 6343 patients, 65% were nonusers, 11% were moderate users, and 25% were frequent users. Incidence rate of hospital admission was 22% (incidence rate ratio [IRR]=0.78; P=0.002), 24% (IRR=0.76; P<0.001), 23% (IRR=0.77; P≤0.001), and 26% (IRR=0.74; P≤0.001) lower in frequent users after 3, 6, 9, and 12 months, respectively, versus nonusers. Incidence rate of hospital days was 38% (IRR=0.62; P=0.013), 35% (IRR=0.65; P=0.001), 34% (IRR=0.66; P≤0.001), and 32% (IRR=0.68; P<0.001) lower in frequent users after 3, 6, 9, and 12 months, respectively, versus nonusers. Sustained technique failure risk at 3, 6, 9, and 12 months was 33% (hazard ratio [HR]=0.67; P=0.020), 31% (HR=0.69; P=0.003), 31% (HR=0.69; P=0.001), and 27% (HR=0.73; P=0.001) lower, respectively, in frequent users versus nonusers. Among a subgroup of survivors of the 12-month follow-up, sustained technique failure risk was 26% (HR=0.74; P=0.023) and 21% (HR=0.79; P=0.054) lower after 9 and 12 months, respectively, in frequent users versus nonusers.

Conclusions: Our findings suggest frequent use of an RTM application associates with less hospital admissions, shorter hospital length of stay, and lower technique failure rates. Adoption of RTM applications may have the potential to improve timely identification/intervention of complications.

Keywords: Chronic Kidney Disease; Dialysis; End Stage Kidney Disease; Hospitalization; Peritoneal Dialysis; Remote Monitoring; Technique Failure.

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Conflict of interest statement

S. Chaudhuri, H. Han, J. Larkin, F. Maddux, M. Mendoza, and L. Usvyat are employees of Fresenius Medical Care in the Global Medical Office. D. Chatoth, D. Maddux, C. Muchiutti, and J. Ryter are employees of Fresenius Medical Care North America. D. Maddux, F. Maddux, and L. Usvyat have share options/ownership in Fresenius Medical Care. F. Maddux has directorships in American National Bank & Trust and is chairman of Pacific Care Renal Foundation 501(c)(3) nonprofit.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Schematic of paper and electronic charting workflows. (A) Schematic of how the paper flowsheets were submitted manually for review by clinicians once a month. (B) Schematic of how electronic flowsheets are submitted via PatientHub RTM for daily review by clinicians.
Figure 2.
Figure 2.
Preview of the PatientHub RTM application. PD, peritoneal dialysis.
Figure 3.
Figure 3.
Patient flow diagram. BMI, body mass index.
Figure 4.
Figure 4.
Sustained trend in the mean number of RTM entries in each month of the follow-up period by baseline RTM use group category. RTM, remote treatment monitoring.
Figure 5.
Figure 5.
Improvement in hospitalization rates associated with RTM use. (A) Hospital admission rate by baseline RTM use after 3, 6, 9, and 12 months of follow-up. (B) Hospital day rate by baseline RTM use after 3, 6, 9, 12 months of follow-up. PPY, per patient year.
Figure 6.
Figure 6.
Improvement in PD technique failure rates associated with baseline RTM use after 3, 6, 9, and 12 months of follow-up.
Figure 7.
Figure 7.
Longer time on PD modality associates with higher RTM use. (A) Kaplan Meier curve plot to assess the associations in the time on PD modality over the 12 months follow-up for non-users, moderate-users and frequent-users. Frequent-users of the RTM remained on a PD modality 13 days longer in comparison to the non-users group. (B) Kaplan-Meier plot for survivors of the 12-month follow-up period to assess the associations in technique failure rates and the time on PD modality in a group of patients who had equivalent opportunities to experience a technique failure. Frequent-users of the RTM in the survivor subgroup remained on a PD modality 11 days longer than non-users.
See this image and copyright information in PMC

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