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

Corzo, Leyder; Vesga, Jasmin; Sanabria, Mauricio; Rivera, Angela

doi:10.1093/ndt/gfaa142.P1151

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.

Table 2.

Clinical outcomes associated with RPM in matched sample

Outcomes	n=148	n= 148	IRR^b [95%CI]	P value
	APD- RPM	APD- Without RPM
Technique failure rate [95% CI] (Episodes per patient-year)	0.07 [0.03 - 0.12]	0.15 [0.10 - 0.19]	0.46 [0.24 - 0 .89]	0.023
Peritonitis rate [95% CI] (Episodes per patient-year)	0.21 [ 0.14 - 0.30]	0.24 [0.17 - 033]	0.87 [0.41 - 1.00]	0.051

Outcomes	n=148	n= 148	IRR^b [95%CI]	P value
	APD- RPM	APD- Without RPM
Technique failure rate [95% CI] (Episodes per patient-year)	0.07 [0.03 - 0.12]	0.15 [0.10 - 0.19]	0.46 [0.24 - 0 .89]	0.023
Peritonitis rate [95% CI] (Episodes per patient-year)	0.21 [ 0.14 - 0.30]	0.24 [0.17 - 033]	0.87 [0.41 - 1.00]	0.051

b

IRR: Incidence Rate Ratio is defined as APD-RPM/APD-Without RPM

Table 2.

Clinical outcomes associated with RPM in matched sample

Outcomes	n=148	n= 148	IRR^b [95%CI]	P value
	APD- RPM	APD- Without RPM
Technique failure rate [95% CI] (Episodes per patient-year)	0.07 [0.03 - 0.12]	0.15 [0.10 - 0.19]	0.46 [0.24 - 0 .89]	0.023
Peritonitis rate [95% CI] (Episodes per patient-year)	0.21 [ 0.14 - 0.30]	0.24 [0.17 - 033]	0.87 [0.41 - 1.00]	0.051

Outcomes	n=148	n= 148	IRR^b [95%CI]	P value
	APD- RPM	APD- Without RPM
Technique failure rate [95% CI] (Episodes per patient-year)	0.07 [0.03 - 0.12]	0.15 [0.10 - 0.19]	0.46 [0.24 - 0 .89]	0.023
Peritonitis rate [95% CI] (Episodes per patient-year)	0.21 [ 0.14 - 0.30]	0.24 [0.17 - 033]	0.87 [0.41 - 1.00]	0.051

b

IRR: Incidence Rate Ratio is defined as APD-RPM/APD-Without RPM

Table 1.

Baseline demographic and clinical characteristics

Characteristics	n=148	n= 410	Standardized differences
	APD- RPM	APD- Without RPM
Age, year	53.93	53.83	0.01
Sex: Female	37.84	40.98	-0.06
Caregiver: Yes	36.48	35.60	0.02
Social level
Low	31.08	53.66	Reference
Medium	66.22	43.66	0.46
High	2.70	2.68	0.00
School level
Elementary or none	30.41	48.05	Reference
High school	52.03	40.98	0.22
University degree	17.57	10.98	0.19
Hypertension history	87.84	85.37	0.07
Diabetes history	37.16	39.51	-0.05
Cardiovascular disease history	24.32	24.39	0.00
Hemoglobin, g/dL	11.89	11.72	0.09
Phosphorus, mg/dL	5.31	5.26	0.04
Potasium, mEq/L	4.77	4.78	-0.01
Albumin, g/dL	3.62	3.82	0.34
Vintage dialysis
< 1 year	23.65	32.44	Reference
1 to 3 years	38.51	30.24	0.17
> 3 years	37.84	37.32	0.01
Follow-up time, years	0.93	1.22	-0.56

Characteristics	n=148	n= 410	Standardized differences
	APD- RPM	APD- Without RPM
Age, year	53.93	53.83	0.01
Sex: Female	37.84	40.98	-0.06
Caregiver: Yes	36.48	35.60	0.02
Social level
Low	31.08	53.66	Reference
Medium	66.22	43.66	0.46
High	2.70	2.68	0.00
School level
Elementary or none	30.41	48.05	Reference
High school	52.03	40.98	0.22
University degree	17.57	10.98	0.19
Hypertension history	87.84	85.37	0.07
Diabetes history	37.16	39.51	-0.05
Cardiovascular disease history	24.32	24.39	0.00
Hemoglobin, g/dL	11.89	11.72	0.09
Phosphorus, mg/dL	5.31	5.26	0.04
Potasium, mEq/L	4.77	4.78	-0.01
Albumin, g/dL	3.62	3.82	0.34
Vintage dialysis
< 1 year	23.65	32.44	Reference
1 to 3 years	38.51	30.24	0.17
> 3 years	37.84	37.32	0.01
Follow-up time, years	0.93	1.22	-0.56

Table 1.

Baseline demographic and clinical characteristics

Characteristics	n=148	n= 410	Standardized differences
	APD- RPM	APD- Without RPM
Age, year	53.93	53.83	0.01
Sex: Female	37.84	40.98	-0.06
Caregiver: Yes	36.48	35.60	0.02
Social level
Low	31.08	53.66	Reference
Medium	66.22	43.66	0.46
High	2.70	2.68	0.00
School level
Elementary or none	30.41	48.05	Reference
High school	52.03	40.98	0.22
University degree	17.57	10.98	0.19
Hypertension history	87.84	85.37	0.07
Diabetes history	37.16	39.51	-0.05
Cardiovascular disease history	24.32	24.39	0.00
Hemoglobin, g/dL	11.89	11.72	0.09
Phosphorus, mg/dL	5.31	5.26	0.04
Potasium, mEq/L	4.77	4.78	-0.01
Albumin, g/dL	3.62	3.82	0.34
Vintage dialysis
< 1 year	23.65	32.44	Reference
1 to 3 years	38.51	30.24	0.17
> 3 years	37.84	37.32	0.01
Follow-up time, years	0.93	1.22	-0.56

Characteristics	n=148	n= 410	Standardized differences
	APD- RPM	APD- Without RPM
Age, year	53.93	53.83	0.01
Sex: Female	37.84	40.98	-0.06
Caregiver: Yes	36.48	35.60	0.02
Social level
Low	31.08	53.66	Reference
Medium	66.22	43.66	0.46
High	2.70	2.68	0.00
School level
Elementary or none	30.41	48.05	Reference
High school	52.03	40.98	0.22
University degree	17.57	10.98	0.19
Hypertension history	87.84	85.37	0.07
Diabetes history	37.16	39.51	-0.05
Cardiovascular disease history	24.32	24.39	0.00
Hemoglobin, g/dL	11.89	11.72	0.09
Phosphorus, mg/dL	5.31	5.26	0.04
Potasium, mEq/L	4.77	4.78	-0.01
Albumin, g/dL	3.62	3.82	0.34
Vintage dialysis
< 1 year	23.65	32.44	Reference
1 to 3 years	38.51	30.24	0.17
> 3 years	37.84	37.32	0.01
Follow-up time, years	0.93	1.22	-0.56

Table 3.

Main reasons by technique failure in matched sample

Main reasons for technique failure	APD-RPM N= 148		APD-Without RPM N=148
	n	%	n	%
Peritonitis/ Infection	7	63.64	4	18.18
Loss of Dialysis Adequacy	1	9.09	5	22.73
Catheter Problems	1	9.09	4	18.18
Psychological/Medical	2	18.18	7	31.82
Patient desire	0	0.00	2	9.09
Total	11	100	22	100

Main reasons for technique failure	APD-RPM N= 148		APD-Without RPM N=148
	n	%	n	%
Peritonitis/ Infection	7	63.64	4	18.18
Loss of Dialysis Adequacy	1	9.09	5	22.73
Catheter Problems	1	9.09	4	18.18
Psychological/Medical	2	18.18	7	31.82
Patient desire	0	0.00	2	9.09
Total	11	100	22	100

Table 3.

Main reasons by technique failure in matched sample

Main reasons for technique failure	APD-RPM N= 148		APD-Without RPM N=148
	n	%	n	%
Peritonitis/ Infection	7	63.64	4	18.18
Loss of Dialysis Adequacy	1	9.09	5	22.73
Catheter Problems	1	9.09	4	18.18
Psychological/Medical	2	18.18	7	31.82
Patient desire	0	0.00	2	9.09
Total	11	100	22	100

Main reasons for technique failure	APD-RPM N= 148		APD-Without RPM N=148
	n	%	n	%
Peritonitis/ Infection	7	63.64	4	18.18
Loss of Dialysis Adequacy	1	9.09	5	22.73
Catheter Problems	1	9.09	4	18.18
Psychological/Medical	2	18.18	7	31.82
Patient desire	0	0.00	2	9.09
Total	11	100	22	100

Figure:

Distribution of propensity scores for the two cohorts before and after the matching

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P1151
CLINICAL OUTCOMES IN REMOTE PATIENT MONITORING IN AUTOMATED PERITONEAL DIALYSIS : A COLOMBIAN EXPERIENCE

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

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P1151
CLINICAL OUTCOMES IN REMOTE PATIENT MONITORING IN AUTOMATED PERITONEAL DIALYSIS : A COLOMBIAN EXPERIENCE