Homechoice Claria machine next to the patient's bedside

Evidence Supporting Automated Peritoneal Dialysis With Remote Patient Management

A substantial body of evidence endorses the benefits of automated peritoneal dialysis (APD) cyclers with two-way remote patient management (RPM) technology.

Key benefits of APD with RPM

Our APD cyclers with two-way RPM technology are equipped with modems and linked to hospitals and clinics through secure data connections. RPM allows doctors and nurses to remotely and proactively manage dialysis patients, amending treatment programs as necessary, and thus potentially improving patient outcomes and reducing hospitalisations.

#1

APD with RPM facilitates greater awareness of treatment adherence, which may allow for early intervention.1

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In a multi-centre retrospective cohort study, patients using APD with RPM had a statistically significant lower rate of hospitalisation compared to APD without RPM.2

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Clinicians switching from APD to APD with RPM spent a greater proportion of time on proactive care activities.3

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APD with two-way RPM technology allows nurses to individualise therapy and adjust PD programs, remotely.4

APD with RPM may reduce hospitalisations

Implementation of APD cyclers with RPM technology may improve clinical outcomes. RPM enables APD patients to have their treatment proactively monitored by nurses and clinicians, but without having to spend as much time in the hospital and clinic to the detriment of their care. This may improve treatment adherence and thus reduce the risk of complications.2

In a multi-centre retrospective cohort study, patients using APD with RPM demonstrated a statistically significant lower rate of hospitalisation and duration of hospital stay, compared to patients using APD without RPM.2

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Abstract

Remote management technology that is specifically designed to be integrated into APD systems may improve adherence to treatment and provide the potential for early intervention should therapy complications be encountered.2

Clinical outcomes of incident adult patients treated with APD and RPM were compared to patients treated with APD alone. Patients using APD with RPM had a statistically significant lower rate of hospitalisation and duration of stay compared to APD without RPM.2

Rationale

Remote management technology, specifically designed to be integrated into APD systems, offers both patients and their clinical team a powerful tool. Via enhanced communication, the tool may improve adherence to treatment and provide the opportunity for early intervention should therapy complications be encountered.2

The purpose of this study was to compare the hospitalisation rates in incident adult patients on automated peritoneal dialysis with and without remote patient management.2

Method

A multi-centre retrospective cohort study in incident adult patients performing APD with and without remote monitoring was conducted. Patients were enrolled from 1st October 2016 to 30th June 30 2017, from 28 renal clinics within the Renal Therapy Service, Colombia network.2

Individuals were matched 1:1 using propensity score matching. The APD therapy with RPM and ADP therapy without RPM groups each yielded 63 individuals. Hospitalisations and days spent in hospital were recorded over 1 year.2

Findings

In the APD with RPM patient group, there was a statistically significant reduction in hospitalisations (39% reduction, p=0.029) and duration of stay (54% fewer days, p=0.0028), compared to patients using APD without RPM.2

Implementation of APD cyclers with a remote management program may improve clinical outcomes, such as rate of hospitalisation and days spent in hospital.2

Woman on laptop viewing Sharesource remote patient management

APD with RPM at Vantive

Discover how Vantive utilises remote patient monitoring technology in renal care. 

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RPM may increase time spent on proactive care

APD combined with RPM potentially improves adherence to treatment and provides the potential for early intervention if therapy complications are encountered. 

Proactive patient management allows nurses and clinicians to care for and treat their patients with an anticipatory, preventative approach, rather than in a reactive or urgent manner.

An evaluative study showed that when PD nurses implemented RPM, their time spent on proactive patient care activities increased from 2% without RPM to 34% with RPM, while the time spent on reactive activities decreased.3

A nurse surrounded by happy patients in a care home environment
Abstract

RPM systems automate the sending of dialysis data to renal units and allow nurses and clinicians to adjust dialysis cycler programs remotely. To identify whether RPM helps improve patient management and clinic efficiency, four PD nurses were monitored in terms of the proportion of time they spent on proactive, reactive and routine care. Proactive patient care activities increased from 2% of nurses' time without RPM to 34% with the implementation of RPM.3

Rationale

New APD cyclers with two-way RPM technology allow nurses to view dialysis details remotely in a timely manner, proactively manage clinical issues and make program changes as necessary. It is important to evaluate the impact of RPM on nurses’ behaviour and practice when caring for home-based APD patients and to identify whether RPM helps improve patient management and clinic efficiency.3

Method

Four PD nurses from four UK hospitals were observed prior to implementing APD with RPM (July 2015 – July 2016; before the introduction of APD with RPM) and after implementing APD with RPM (September 2016 – March 2017; 6-13 months after APD with RPM was established).3

A tool was designed to log the time PD nurses spent on different types of task, specifically whether the tasks was:

  • Proactive: Anticipatory, preventative and change-oriented (e.g., clinician discussions, phone calls/visits to patients and reviewing daily dialysis records)

  • Reactive: Responsive (e.g., urgent patient consultations and assessments)

  • Routine: Regular planned activities (e.g., scheduled line changes and review consultations)3

Findings

The amount of time that nurses were able to spend on proactive patient care activities increased from 2% without RPM to 34% with RPM. The time spent on reactive patient care decreased from 44% to 27% following the implementation of RPM while time spent on routine care decreased by 10%.3

RPM may be an effective method of increasing the time nurses and doctors spend on proactive care by reducing time spent on routine and reactive care.3

Find out more about how Vantive proactively manages PD therapy

Vantive and Sharesource are trademarks of Vantive Health LLC or its affiliates.

References

  1. Firanek C, Salas M, Gellens M, Gatesman RD, Wiebenson D, Sloand J. Discrepancy between prescribed and actual APD prescription delivery: Identification using cycler remote management technology. Neph Dial Trans. 2017;32(suppl 3):iii633.

  2. Sanabria M, Buitrago G, Lindholm B, et al. Remote patient monitoring program in automated peritoneal dialysis: impact on hospitalizations. Perit Dial Int. 2019;39(5):472-478. 

  3. Wood E, McCarthy K, Roper M. Remote monitoring of peritoneal dialysis: evaluating the impact of the Claria Sharesource system. J Kidney Care. 2019;4(1):16-24.

  4. Firanek C, Knowles M, Sloand J. Impact of remote patient management in hospitals conducting APD: shifting the nursing care paradigm. Neph Dial Trans. 2017;32(suppl 3): iii300.