Remote Patient Monitoring Automated Peritoneal Dialysis and Clinical Outcomes

Introduction: Remote patient monitoring (RPM) of automated peritoneal dialysis (APD) patients enables real-time access to treatment data and has the potential to improve clinical outcomes. However, large-scale, nationwide real-world evidence comparing RPM-enabled APD (RPM-APD) with conventional APD remains limited. Methods: We conducted a nationwide retrospective cohort study using Taiwan’s National Health Insurance Research Database between 2016 and 2023. Patients initiating APD in medical centers during 2016–2018 (conventional APD) were compared with those starting RPM-APD equipped with a remote monitoring device during 2020–2022. Baseline covariates were balanced using inverse probability of treatment weighting (IPTW). The primary outcomes were all-cause death and hemodialysis (HD) transfer. Secondary outcomes included peritonitis, major adverse cardiac events (MACE), and hospitalization. Patients were followed until outcome occurrence, death, HD transfer, kidney transplantation, or the end of follow-up (December 31, 2019 for conventional APD and December 31, 2023 for RPM-APD). Results: Among the 2,477 patients (RPM-APD, n=1,258; conventional APD, n=1,219), the mean age was 53.6 years, 54.6% were male, and the mean follow-up duration was 2.0 years. After IPTW adjustment, RPM-APD group was associated with lower risks of all-cause death (4.4 vs. 5.3 events per 100 person-years; hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.69–0.99) and HD transfer (12.7 vs. 15.1 events per 100 person-years; subdistribution HR 0.86, 95% CI 0.77–0.96). The risks of peritonitis and MACE were similar between groups, whereas patients receiving RPM-APD experienced significantly fewer annual hospitalizations (1.6 vs. 2.1 times; rate ratio 0.70, 95% CI 0.68–0.73). Conclusions: In this Taiwan nationwide real-world cohort study with long-term follow-up, RPM-APD was associated with improved patient survival, reduced HD transfer, and fewer annual hospitalizations compared with conventional APD. These findings support a potential role for RPM-APD in contemporary peritoneal dialysis care.