Baxter Renal Care Services (BRCS), Latin America, Bogotá, Colombia
Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.
Perit Dial Int. 2019 Sep-Oct;39(5):472-478. doi: 10.3747/pdi.2018.00287. Epub 2019 Jul 23.
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.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.After propensity score matching, APD therapy with RPM ( = 63) compared with APD-without RPM ( = 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]; = 0.029) and hospitalization days (6.57 fewer days per patient-year; IRR 0.46 [95% CI 0.23 - 0.92]; = 0.028).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.
自动化腹膜透析（APD）是一种不断发展的 PD 治疗模式，但与其他家庭透析方法一样，缺乏对患者遵医嘱情况的监测是一个局限性，可能对临床结果参数产生负面影响。远程患者监测（RPM）使临床团队能够获得透析数据并调整治疗，可能克服这一局限性。本研究旨在确定在接受 APD 治疗的新发病例患者中使用 RPM 的临床结果。
一项回顾性队列研究纳入了 2016 年 10 月 1 日至 2017 年 6 月 30 日期间在哥伦比亚 28 个 Baxter Renal Care Services（BRCS）单位接受 APD 治疗的 360 例平均年龄为 57 岁（糖尿病占 42.5%）的患者。在 65 例患者（APD-RPM 队列）中使用了 RPM 方案，295 例（82%）患者接受 APD 治疗但未使用 RPM。记录了 1 年内的住院和住院天数。使用倾向评分匹配 1:1，每组匹配 63 例，以评估 RPM 暴露与住院次数和住院天数的相关性。
在倾向评分匹配后，与 APD 无 RPM 治疗相比，APD 联合 RPM 治疗（n = 63）与住院率显著降低相关（患者每年每例减少 0.36 次住院；发病率比 [IRR] 为 0.61[95%置信区间（CI）0.39-0.95]；P = 0.029）和住院天数（每年每位患者减少 6.57 天；IRR 为 0.46[95%CI 0.23-0.92]；P = 0.028）。
在 APD 患者中使用 RPM 与较低的住院率和较少的住院天数相关；RPM 可能是改善 APD 治疗的一种工具。
