Abstract: SA-PO674

Higher Likelihood of Home Hemodialysis Training Graduation in Patients Using Nx2me Connected Health Technology

Session Information

Category: Dialysis

  • 604 Home and Frequent Dialysis

Authors

  • Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
Background

In the United States, approximately 1 in 6 patients who initiate home hemodialysis (HHD) training fail to complete training. Strategies that increase the likelihood of training graduation would permit more patients to dialyze at home and improve the economics of home dialysis programs. Digital tools that are introduced during HHD training and that "go home" may accelerate development of patient understanding about HHD equipment and procedures. We assessed whether introduction of the Nx2me iPad app during HHD training was associated with higher likelihood of training graduation.

Methods

We ascertained HHD patients that initiated use of Nx2me during the first 2 weeks of HHD training with the NxStage System One. For each Nx2me user who was prescribed q treatments per week and had accumulated t training days with the System One at first use of Nx2me, we identified potential controls who were prescribed q treatments per week and had accumulated at least t training days (without use of Nx2me), and we randomly selected 3. We followed Nx2me users and their respective matched controls from t days after training initiation until either HHD training graduation or training dropout. We used Cox regression to model incidence of training graduation, with stratification by matched cluster and adjustment for age, race, sex, vascular access modality, and center-level metrics of training activity and success (number of trainees during the past 12 months, probability of graduation among trainees, and mean duration of training among graduates).

Results

We identified 94 Nx2me users. The mean number of days between HHD training initiation and Nx2me introduction was 7.2. In Nx2me users (matched controls, but without adjustment), the cumulative incidence of training graduation was 5.3% (5.5%) after 1 week of follow-up, 23.1% (18.0%) after 2 weeks, 46.9% (34.9%) after 3 weeks, 71.6% (49.8%) after 4 weeks, 88.0% (66.0%) after 6 weeks, and 93.6% (71.9%) after 8 weeks. The adjusted hazard ratio of training graduation for Nx2me users versus matched controls was 1.53 (95% confidence interval, 1.02-2.29).

Conclusion

Introduction of the Nx2me iPad app during the first 2 weeks of HHD training is associated with significantly higher likelihood of training graduation, even after adjustment for center-level performance metrics.