Adverse Events and Hospitalizations With Remote Monitoring of Patients on Automated Peritoneal Dialysis (APD)
Ramón Paniagua, Abdul Rashid T. Qureshi, Marcela Ignacchiti Lacerda Ávila, Alfonso Ramos, Bengt Lindholm · Journal of the American Society of Nephrology · 2022
Background: Remote monitoring (RM) of patients (pts) on APD provides new opportunities to prevent cardiovascular (CV) and metabolic complications derived from low ultrafiltration or insufficient dialysis. We analyzed the impact of RM-APD on adverse events (AdEv) and hospitalizations. Methods: In a cluster-randomized, open-label, controlled trial, 21 hospitals were randomly assigned to treat their APD patients with RM-APD (10 hospitals; 403 pts) or conventional APD (11 hospitals; 398 pts). Rates of AdEv and hospitalizations during follow up of one year were analyzed using Poisson regression, adjusting for pts' identity and centers. Incidence-rate ratio (IRR) was calculated with zero-inflated Poisson model. Results: Rates of AdVe including mechanical, hydric balance, CV-related, and metabolic AdEv, as well as all-cause mortality and CV mortality were significantly lower in RM-APD compared to conventional APD, see table chart. Hospitalizations due to mechanical AdEv (IRR 0.41 (95%CI)(0.22-0.66) p=0.001) and AdEv linked to fluid overload or insufficient dialysis efficiency (IRR 3.24 (95%CI)(1.24-7.53) p=0.03) were less frequent in RM-APD compared to conventional APD. Rates of AdVe and hospitalizations due to PD infection events were similar. Conclusions: This randomized controlled trial shows that remote monitoring adds important advantages to APD by reducing the rate of adverse events and hospitalizations, which may have economic benefits. Funding: Commercial Support - Baxter, Private Foundation Support