Abstract: PO0965
Remote Monitoring of Patients with Automated Peritoneal Dialysis May Improve Clinical Outcomes: Analysis by Competing-Risk Regression Models
Session Information
- Home Dialysis: Disparities and Modality Choice
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Paniagua, Ramón, Instituto Mexicano del Seguro Social, Ciudad de Mexico, DF, Mexico
- Avila, Marcela, Instituto Mexicano del Seguro Social, Ciudad de Mexico, DF, Mexico
- Ramos, Alfonso, Baxter México, Mexico City, Mexico
- Qureshi, Abdul Rashid Tony, Baxter Novum CLINTEC | Karolinska Institutet, Stokolm, Sweden
- Lindholm, Bengt, Baxter Novum CLINTEC | Karolinska Institutet, Stokolm, Sweden
Group or Team Name
- Mexican Nephrology Collaborative Study Group
Background
Current information technologies allow remote monitoring (RM) of patients on automatic peritoneal dialysis (APD) and the adoption of proactive behaviors to prevent complications and improve treatment quality. We analyzed the effect of RM-APD on survival and preventable complications through a controlled clinical trial.
Methods
In a two-branched cluster RCT, hospitals with >100 prevalent, >50 new patients per year, and >5 years APD experience were randomly assigned to perform RM-APD or conventional APD with equivalent APD-equipment in adults beginning APD. The primary outcome was a composite index (CI) of death, first adverse event (AE) or first hospitalization. Secondary outcomes were the same variables considered individually and for their specific causes. All-cause and cardiovascular disease (CVD) mortality risk and AEs were analyzed with competing-risk regression with transplantation as competing risk.
Results
Eleven hospitals per arm were included and 815 patients were followed-up by at least one year, 417 using RM-APD and 398 on APD. Patients in hospitals using APD reached earlier the CI as well as its individual components. Patients with APD as compared to RM-APD were older, more inflamed, and had higher all-cause and CVD mortality. In competing risk analysis, after adjusting for age, sex, presence of smoking, hypertension, CVD and diabetes, APD as compared with RM-APD associated with higher subdistribution hazard ratio (sHR) for all-cause mortality (sHR 1.79, 95%CI (1.15-2.81); p=0.01), CVD-related mortality ( sHR 2.21, 95%CI (1.07-4.58); p=0.03), and AE ( sHR 1.74, 95% (1.34-2.25); p=0.001).
Conclusion
Use of RM-APD may improve survival and prolong the time to first AE and hospitalization in comparison with APD, suggesting that RM-APD may improve clinical outcomes in APD patients.
Funding
- Commercial Support –