Telemedicine and Clinical Outcomes in Peritoneal Dialysis: A Propensity-Matched Study

Abstract

<b><i>Introduction:</i></b> Telemedicine (TM) has shown to provide potential benefits on clinical outcomes in patients with chronic kidney disease but limited evidences published in the peritoneal dialysis (PD) population. This study aimed to explore the long-term effects of TM on the mortality and technique failure. <b><i>Methods:</i></b> The Peritoneal Dialysis Telemedicine-assisted Platform Cohort Study (PDTAP Study) was conducted prospectively in 27 hospitals in China since 2016. Patient and practice data were collected through the doctor-end of the TM app (Manburs) for all participants. TM including self-monitoring records, on-line education materials, and real-time physician-patient contact was only performed for the patient-end users of the Manburs. The primary outcome was all-cause mortality. The secondary outcomes were cause-specific mortality and all-cause and cause-specific permanent transfer to hemodialysis. <b><i>Results:</i></b> A total of 7,539 PD patients were enrolled between June 2016 and April 2019, with follow-up till December 2020. Patients were divided into two cohorts: TM group (39.1%) and non-TM group (60.9%). A propensity score was used to create 2,160 matched pairs in which the baseline covariates were well-balanced. There were significantly lower risks of all-cause mortality (HR 0.59 [0.51, 0.67], <i>p</i> < 0.001), CVD mortality (HR 0.59 [0.49, 0.70], <i>p</i> < 0.001), all-cause transfer to hemodialysis (0.57 [0.48, 0.67], <i>p</i> < 0.001), transfer to hemodialysis from PD-related infection (0.67 [0.51, 0.88], <i>p</i> = 0.003), severe fluid overload (0.40 [0.30, 0.55], <i>p</i> < 0.001), inadequate solute clearance (0.49 [0.26, 0.92], <i>p</i> = 0.026), and catheter-related noninfectious complications (0.41 [0.17, 0.97], <i>p</i> = 0.041) in the TM group compared with the non-TM group. <b><i>Conclusion:</i></b> This study indicated real-world associations between TM usage and reduction in patient survival and technique survival through a multicenter prospective cohort.

Functionality and Usability of mHealth Apps in Patients with Peritoneal Dialysis: A Systematic Review

“…Three studies were conducted in Mexico [ 29 , 30 , 31 ], two in Canada [ 32 , 33 ], two in China [ 10 , 34 ], and one each in Korea [ 35 ], the United Kingdom [ 11 ], Thailand [ 7 ], and Italy [ 36 ] ( Table 1 ). The study designs varied, with three using experimental designs (randomized controlled trials (RCTs) [ 10 , 32 , 35 ], six using observational–analytic designs [ 7 , 29 , 31 , 33 , 34 , 36 ], and two being observational–descriptive studies [ 11 , 30 ]. mHealth apps were used on various devices: 27.2% (3/11) on smartphones, 18.2% (2/11) on tablets, 9.1% (1/11) on computers, and 72.7% (8/11) on unspecified devices.…”

“…For acceptance, which was studied in one study, positive results were reported [ 29 ]. Regarding effectiveness, a lesser number of patients from the intervention group switched from PD to HD or kidney transplantation compared with those from the control group [ 34 ]; however, three studies reported no significant differences [ 10 , 31 , 36 ]. In two studies, re-hospitalization rates showed no significant differences [ 10 , 31 ].…”

Delivering Person-Centered Peritoneal Dialysis

“…Some of these data are automatically collected by the APD cycler, whereas some are dependent on patient or caregiver entry using dedicated equipment or a phone app. 40 Data are then reviewed by health care professionals, which may trigger actions such as remote changes of the dialysis prescription or direct support to the person doing PD either through phone calls or in-person review. This movement of data underpins the need for transparency with patients about the collection of data, alongside careful governance of the confidentiality and data security of all remote patient monitoring.…”

“…41 The expected benefits of remote monitoring in PD arise from the greater support available for the person dialyzing at home, given that the inability to manage PD-related complications and the lack of specialist support are seen as a barrier to PD uptake. 42 Remote patient monitoring when used with APD has been shown in multicenter observational studies to lead to reduced rates of transfer to hemodialysis 40,43,44 and reduced hospitalization rates 44 possibly through improved adherence to therapy, reduction of patients and caregivers burnout, and early diagnosis of catheter dysfunction as well as high levels of patient satisfaction. 45,46 These studies are confounded by the increased uptake of monitoring in individuals with significantly higher levels of income, literacy, 40,47 comorbidity, 40 and shorter dialysis vintage 44 as well as industry support.…”

“…42 Remote patient monitoring when used with APD has been shown in multicenter observational studies to lead to reduced rates of transfer to hemodialysis 40,43,44 and reduced hospitalization rates 44 possibly through improved adherence to therapy, reduction of patients and caregivers burnout, and early diagnosis of catheter dysfunction as well as high levels of patient satisfaction. 45,46 These studies are confounded by the increased uptake of monitoring in individuals with significantly higher levels of income, literacy, 40,47 comorbidity, 40 and shorter dialysis vintage 44 as well as industry support. Qualitative work suggests that monitoring can reduce the burden on people and caregivers while strengthening partnerships between health care providers and patients as well as improving access to treatment, with the caveat that remote patient monitoring cannot replace face-to-face consultations.…”