Department of Community Medicine, University of Tromsø, Tromsø, Norway
Divison for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
BMJ Open. 2022 Dec 7;12(12):e061772. doi: 10.1136/bmjopen-2022-061772.
The purpose of the systematic review was to assess the effectiveness of remote patient monitoring (RPM) follow-up compared with standard care, for patients with chronic kidney disease (CKD) who perform dialysis at home.
We conducted a systematic review in accordance with international guidelines. We performed systematic searches for publications from 2015 to 2021 in five databases (eg, Medline, Cinahl, Embase) and a search for grey literature in reference lists. Included effect measures were quality of life, hospitalisation, technical failure as the cause for transfer to a different dialysis modality, infections and time patients use for travel. Screening of literature, data extraction, risk-of-bias assessment and certainty of evidence assessment (using the Grading of Recommendations Assessment, Development and Evaluation approach) were done by two researchers. We conducted meta-analyses when possible.
Seven studies met the inclusion criteria, of which two were randomised controlled trials and five were retrospective cohort studies with control groups. The studies included 9975 participants from 5 countries, who were a good representation of dialysis patients in high-income and upper-middle-income countries. The patients were on peritoneal dialysis (six studies) or home haemodialysis (one study). There was very low certainty of evidence for the outcomes, except for hospitalisations: there was low certainty evidence from three cohort studies for fewer hospitalisation days in the RPM group. No studies included data for time patients used for travel.
We found low to very low certainty evidence that indicate there may be positive effects of RPM follow-up, in comparison to standard care only, for adult patients with CKD who perform dialysis at home. Offering RPM follow-up for home dialysis patients as an alternative or supplement to standard care appears to be safe and provide health benefits such as fewer hospitalisation days. Future implementation should be coupled with robust, high-quality evaluations.
CRD42021281779.
本系统评价的目的是评估远程患者监测（RPM）随访与标准护理相比，对在家行透析的慢性肾脏病（CKD）患者的有效性。
我们按照国际指南进行了系统评价。我们对 2015 年至 2021 年期间五个数据库（如 Medline、Cinahl、Embase）的出版物进行了系统检索，并对参考文献中的灰色文献进行了检索。纳入的效应指标为生活质量、住院、因技术故障而转用不同透析方式、感染和患者出行时间。两名研究人员进行文献筛选、数据提取、偏倚风险评估和证据确定性评估（使用推荐评估、制定和评价方法）。当可能时进行荟萃分析。
有 7 项研究符合纳入标准，其中 2 项为随机对照试验，5 项为有对照组的回顾性队列研究。这些研究纳入了来自 5 个国家的 9975 名参与者，他们很好地代表了高收入和中上收入国家的透析患者。患者接受腹膜透析（6 项研究）或家庭血液透析（1 项研究）。除住院外，所有结局的证据确定性均为极低：3 项队列研究的低确定性证据表明 RPM 组的住院天数更少。没有研究纳入患者出行时间的数据。
我们发现，与仅接受标准护理相比，RPM 随访可能对在家行透析的 CKD 成年患者具有积极影响，但证据确定性为低至极低。为家庭透析患者提供 RPM 随访作为标准护理的替代或补充似乎是安全的，并可带来健康益处，如住院天数减少。未来的实施应结合稳健、高质量的评估。
PROSPERO 注册号：CRD42021281779。
