Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts.
Maastricht University Medical Center, Maastricht, The Netherlands; and.
Kidney360. 2020 Feb 17;1(3):191-202. doi: 10.34067/KID.0000302019. eCollection 2020 Mar 26.
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.
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.
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; =0.002), 24% (IRR=0.76; <0.001), 23% (IRR=0.77; ≤0.001), and 26% (IRR=0.74; ≤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; =0.013), 35% (IRR=0.65; =0.001), 34% (IRR=0.66; ≤0.001), and 32% (IRR=0.68; <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; =0.020), 31% (HR=0.69; =0.003), 31% (HR=0.69; =0.001), and 27% (HR=0.73; =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; =0.023) and 21% (HR=0.79; =0.054) lower after 9 and 12 months, respectively, in frequent users versus nonusers.
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.
一家综合性肾脏病医疗保健公司于 2016 年实施了腹膜透析（PD）远程治疗监测（RTM）应用程序。我们评估了 RTM 的使用是否与住院率和技术失败率有关。
我们使用了 2016 年 10 月至 2019 年 5 月期间接受 PD 治疗的成年（年龄≥18 岁）患者的数据，这些患者在网上注册了 RTM。根据注册后 30 天的基线期内 RTM 的使用情况对患者进行分类。组分为：非使用者（从未输入数据）、中度使用者（输入 1 至 15 次治疗）和频繁使用者（输入>15 次治疗）。我们使用泊松和 Cox 模型比较了 3、6、9 和 12 个月随访期间的住院日/天率和持续技术失败率（需要连续 6 周以上血液透析），调整了患者/临床特征。
在 6343 名患者中，65%为非使用者，11%为中度使用者，25%为频繁使用者。与非使用者相比，频繁使用者在 3、6、9 和 12 个月后，住院率分别降低了 22%（发病率比[IRR]=0.78；=0.002）、24%（IRR=0.76；<0.001）、23%（IRR=0.77；≤0.001）和 26%（IRR=0.74；≤0.001）。住院天数的发病率分别降低了 38%（IRR=0.62；=0.013）、35%（IRR=0.65；=0.001）、34%（IRR=0.66；≤0.001）和 32%（IRR=0.68；<0.001），在 3、6、9 和 12 个月后，频繁使用者与非使用者相比。3、6、9 和 12 个月时持续技术失败风险分别降低了 33%（风险比[HR]=0.67；=0.020）、31%（HR=0.69；=0.003）、31%（HR=0.69；=0.001）和 27%（HR=0.73；=0.001），频繁使用者与非使用者相比。在 12 个月随访的幸存者亚组中，9 个月和 12 个月时，频繁使用者的持续技术失败风险分别降低了 26%（HR=0.74；=0.023）和 21%（HR=0.79；=0.054）。
我们的研究结果表明，频繁使用 RTM 应用程序与住院次数减少、住院时间缩短和技术失败率降低有关。RTM 应用程序的采用有可能提高对并发症的及时识别/干预能力。
