App Decreases Hospital Admissions for Home Peritoneal Dialysis Patients

Dinesh Chatoth, MD

Frequent use of a remote treatment monitoring application was associated with less hospital admissions, shorter hospital stays, and lower technique failure rates for patients undergoing home peritoneal dialysis, according to study findings.

Dinesh Chatoth, MD, and colleagues assessed the efficacy of a peritoneal dialysis remote treatment monitoring application called PatientHub. The findings suggested that the adoption of such applications could improve timely identification or intervention of complications.

Chatoth, the associate chief medical officer for Fresenius Kidney Care, and a team of investigators conducted a retrospective analysis to assess the associations between the frequency of use of PatientHub in peritoneal dialysis patients and outcomes after deployment in a US dialysis facility.

PatientHub is a health record portal available to all peritoneal dialysis patients who have internet access. Patients create a profile and use the platform to view their dialysis orders, laboratory results, concomitant medications, and supply orders, and document their daily treatment data, vital signs, and complications.

The investigators used data from adult peritoneal dialysis patients >18 years old who were treated from October 2016-May 2019. The patients were registered online and created a remote treatment monitoring account, were treated continuously with peritoneal dialysis for >30 days after registration, and were not hospitalized <30 days after registration.

Daily treatment data documented included the treatment date; total ultrafiltration from cycler; dialysate type; bag size and number of bags used; medications added to the dialysate; and details on manual exchanges performed. Clinical data such as drain/fill, peritoneal dialysis fluid, and exit site issues were also documented. The care team received the data in their electronic health record (EHR) to review.

Among 36,577 peritoneal dialysis patients treated during the analysis period, 11,079 were treated for 30 days without being hospitalized during baseline and created a remote treatment monitoring profile. The investigators included data in their analysis from 6343 patients due to missing data from others.

Of the eligible patients, 64.5% never entered treatment data, 10.6% entered 1-15 treatment records, and 24.9% entered >15 treatment records during a 30-day baseline period.

Higher usage of PatientHub in the 30 days after the start date was associated with lower unadjusted hospital admission and date rates during follow up periods. An analysis showed the incidence rate of hospital admission was 22%, 24%, 23%, and 26% lower among patients who frequently used the application after 3, 6, 9, and 12 months, compared to non-users.

Hospital length of stay in days was 38%, 35%, 34%, and 32% lower in frequent users of PatientHub after 3, 6, 9, and 12 months versus non-users.

Higher application use in the 30 days after the start date was also associated with lower rates of sustained peritoneal dialysis technique failure. The adjusted risk of failure at 3, 6, 9, and 12 months of failure was 33%, 31%, 31%, and 27% lower in patients who frequently used the platform compared to those who did not.

Study authors noted that additional studies would be needed to test the efficacy of targeting interventions based on patient profiles.

Providers and peritoneal dialysis care teams should consider adopting remote treatment monitoring applications to better engage patients in their care, recognize and manage potential complications in a timely manner, and improve patient outcomes, the investigators suggested.

The study, “Remote Treatment Monitoring on Hospitalization and Technique Failure Rates in Peritoneal Dialysis Patients,” was published online in the journal Kidney 360.