Sanabria Mauricio, Vesga Jasmin, Lindholm Bengt, Rivera Angela, Rutherford Peter
Baxter Renal Care Services-Latin America, Bogotá, DC, Colombia.
Baxter Renal Care Services Colombia, Bucaramanga, Colombia.
Int J Nephrol. 2022 Aug 22;2022:8646775. doi: 10.1155/2022/8646775. eCollection 2022.
Remote patient monitoring (RPM) of patients undergoing automated peritoneal dialysis (APD-RPM) may potentially enhance time on therapy due to possible improvements in technique and patient survival.
To evaluate the effect of APD-RPM as compared to APD without RPM on time on therapy.
Adult incident APD patients undergo APD for 90 days or more in the Baxter Renal Care Services (BRCS) Colombia network between January 1, 2017, and June 30, 2019, with the study follow-up ending June 30, 2021. The exposure variable was APD-RPM vs. APD-without RPM. The outcomes of time on therapy and mortality rate over two years of follow-up were estimated in the full sample and in a matched population according to the exposure variable. A propensity score matching (PSM) 1:1 without replacement utilizing the nearest neighbor within caliper (0.035) was used and created a pseudopopulation in which the baseline covariates were well balanced. Fine & Gray multivariate analysis was performed to assess the effect of demographic, clinical, and laboratory variables on the risk of death, adjusting for the competing risks of technique failure and kidney transplantation.
In the matched sample, the time on APD therapy was significantly longer in the RPM group than in the non-RPM group, 18.95 vs. 15.75 months, < 0.001. The mortality rate did not differ between the two groups: 0.10 events per patient-year in the RPM group and 0.12 in the non-RPM group, =0.325.
Over two years of follow-up, the use of RPM vs. no RPM in APD patients was associated with a significant increase in time on therapy, by 3.2 months. This result indicates that RPM-supported APD therapy may improve the clinical effectiveness and the overall quality of APD.
对于接受自动化腹膜透析的患者进行远程患者监测（APD-RPM），由于技术和患者生存率可能得到改善，有可能延长治疗时间。
评估与未进行RPM的APD相比，APD-RPM对治疗时间的影响。
2017年1月1日至2019年6月30日期间，哥伦比亚百特肾脏护理服务（BRCS）网络中，成年初发APD患者接受APD治疗90天或更长时间，研究随访至2021年6月30日。暴露变量为APD-RPM与未进行RPM的APD。根据暴露变量，在全样本和匹配人群中估计两年随访期内的治疗时间和死亡率。采用倾向得分匹配（PSM）1:1无替换法，使用卡尺内最近邻法（0.035），创建了一个基线协变量平衡良好的伪人群。进行Fine & Gray多变量分析，以评估人口统计学、临床和实验室变量对死亡风险的影响，并对技术失败和肾移植的竞争风险进行调整。
在匹配样本中，RPM组的APD治疗时间显著长于非RPM组，分别为18.95个月和15.75个月，<0.001。两组死亡率无差异：RPM组为每患者年0.10例事件，非RPM组为0.12例，=0.325。
在两年的随访中，APD患者使用RPM与不使用RPM相比，治疗时间显著增加3.2个月。这一结果表明，RPM支持的APD治疗可能会提高APD的临床疗效和整体质量。
