Charkviani Mariam, Kattah Andrea G, Rule Andrew D, Ferguson Jennifer A, Mara Kristin C, Kashani Kianoush B, May Heather P, Rosedahl Jordan K, Reddy Swetha, Philpot Lindsey M, Barreto Erin F
Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN.
Division of Epidemiology, Mayo Clinic, Rochester, MN.
Kidney Med. 2024 Sep 19;6(11):100905. doi: 10.1016/j.xkme.2024.100905. eCollection 2024 Nov.
RATIONALE & OBJECTIVE: Remote patient monitoring (RPM) could improve the quality and efficiency of acute kidney injury (AKI) survivor care. This study described our experience with AKI RPM and characterized its effectiveness.
A cohort study matched 1:3 to historical controls.
SETTING & PARTICIPANTS: Patients hospitalized with an episode of AKI who were discharged home and were not treated with dialysis.
Participation in an AKI RPM program, which included use of a home vital sign and symptom monitoring technology and weekly in-center laboratory assessments.
Risk of unplanned hospital readmission or emergency department (ED) visit within 6 months.
Endpoints were assessed using Cox proportional hazards models.
Forty of the 49 patients enrolled in AKI RPM (82%) participated in the program after hospital discharge. Seventy three percent of patients experienced one AKI RPM alert, most commonly related to fluid status. Among those with stage 3 AKI, the risk of unplanned readmission or ED visit within 6 months of discharge was not different between AKI RPM patients (n = 34) and matched controls (n = 102) (HR 1.33 [95% CI, 0.81-2.18]; = 0.27). The incidence of an ED visit without hospitalization was significantly higher in the AKI RPM group (HR 1.95, [95% CI, 1.05-3.62]; = 0.035). The risk of an unplanned readmission or ED visit was higher in those with baseline eGFR < 45 mL/min/1.73 m exposed to AKI RPM (HR 2.24 [95% CI, 1.19-4.20]; = 0.012) when compared with those with baseline eGFR ≥45 mL/min/1.73 m (HR 0.69 [95% CI, 0.29-1.67]; = 0.41) (test of interaction = 0.04).
Small sample size that may have been underpowered for the effectiveness endpoints.
AKI RPM, when used after hospital discharge, led to alerts and interventions directed at optimizing kidney health and AKI complications but did not reduce the risk for rehospitalization.
远程患者监测（RPM）可提高急性肾损伤（AKI）幸存者护理的质量和效率。本研究描述了我们在AKI RPM方面的经验并对其有效性进行了特征分析。
一项队列研究，按1:3与历史对照进行匹配。
因AKI发作住院且已出院且未接受透析治疗的患者。
参与AKI RPM项目，该项目包括使用家庭生命体征和症状监测技术以及每周的中心实验室评估。
6个月内计划外住院再入院或急诊就诊的风险。
使用Cox比例风险模型评估终点。
49名参与AKI RPM的患者中有40名（82%）在出院后参与了该项目。73%的患者经历过一次AKI RPM警报，最常见的与液体状态有关。在3期AKI患者中，AKI RPM患者（n = 34）和匹配对照（n = 102）在出院后6个月内计划外再入院或急诊就诊的风险无差异（风险比1.33 [95%置信区间，0.81 - 2.18]；P = 0.27）。AKI RPM组未住院的急诊就诊发生率显著更高（风险比1.95，[95%置信区间，1.05 - 3.62]；P = 0.035）。与基线估算肾小球滤过率（eGFR）≥45 mL/min/1.73 m²的患者（风险比0.69 [95%置信区间，0.29 - 1.67]；P = 0.41）相比，基线eGFR < 45 mL/min/1.73 m²且接受AKI RPM的患者计划外再入院或急诊就诊的风险更高（风险比2.24 [95%置信区间，1.19 - 4.20]；P = 0.012）（交互作用检验P = 0.04）。
样本量小，可能未达到有效性终点的足够检验效能。
出院后使用AKI RPM可引发针对优化肾脏健康和AKI并发症的警报及干预措施，但并未降低再住院风险。
