Key result
Remote patient management for APD successfully detects catheter displacement and low adherence in ESKD.
Why the study?
Remote patient management has potential to detect early issues in automated peritoneal dialysis but requires evaluation of clinical impact and optimal use.
Case Report (n=1)
Remote patient management in automated peritoneal dialysis can help detect early clinical issues like catheter displacement and non-adherence, though it requires a learning curve for staff.
May aid early detection of catheter issues in automated peritoneal dialysis; hypothesis-generating and requires prospective validation before broader adoption.
Remote patient management (RPM) has the potential to help clinicians detect early issues, allowing intervention prior to development of more significant problems. A 23-year-old end-stage kidney disease patient required urgent start of renal replacement therapy. A newly available automated peritoneal dialysis (APD) RPM system with cloud-based connectivity was implemented in her care. Pre-defined RPM threshold parameters were set to identify clinically relevant issues. Red flag dashboard alerts heralded prolonged drain times leading to clinical evaluation with subsequent diagnosis of and surgical repositioning for catheter displacement, although it took several days for newly-RPM-exposed staff to recognize this issue. Post-PD catheter repositioning, drain times were again normal as indicated by disappearance of flag alerts and unremarkable cycle volume profiles. Identification of < 90% adherence to prescribed PD therapy was then documented with the RPM system, alerting the clinical staff to address this important issue given its association with significant negative clinical outcomes. Healthcare providers face a "learning curve" to effect optimal utilization of the RPM tool. Larger scale observational studies will determine the impact of RPM on APD technique survival and resource utilization.
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Drepper et al. (2018) conducted a case report in End-stage kidney disease (n=1). Automated peritoneal dialysis (APD) remote patient management (RPM) system was evaluated. A remote patient management system for automated peritoneal dialysis successfully detected catheter displacement and <90% therapy adherence in a 23-year-old patient with end-stage kidney disease.
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