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      Remote Patient Management for Home Dialysis Patients

      brief-report

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          Abstract

          Remote patient management (RPM) offers renal health care providers and patients with end-stage kidney disease opportunities to embrace home dialysis therapies with greater confidence and the potential to obtain better clinical outcomes. Barriers and evidence required to increase adoption of RPM by the nephrology community need to be clearly defined. Ten health care providers from specialties including nephrology, cardiology, pediatrics, epidemiology, nursing, and health informatics with experience in home dialysis and the use of RPM systems gathered in Vienna, Austria to discuss opportunities for, barriers to, and system requirements of RPM as it applies to the home dialysis patient. Although improved outcomes and cost-effectiveness of RPM have been demonstrated in patients with diabetes mellitus and heart disease, only observational data on RPM have been gathered in patients on dialysis. The current review focused on RPM systems currently in use, on how RPM should be integrated into future care, and on the evidence needed for optimized implementation to improve clinical and economic outcomes. Randomized controlled trials and/or large observational studies could inform the most effective and economical use of RPM in home dialysis. These studies are needed to establish the value of existing and/or future RPM models among patients, policy makers, and health care providers.

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          Which components of heart failure programmes are effective? A systematic review and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: Abridged Cochrane Review.

          Sally C Inglis, John Cleland, Robyn Clark … (2011)
          Telemonitoring (TM) and structured telephone support (STS) have the potential to deliver specialized management to more patients with chronic heart failure (CHF), but their efficacy is still to be proven. The aim of this meta-analysis was to review randomized controlled trials (RCTs) of TM or STS for all-cause mortality and all-cause and CHF-related hospitalizations in patients with CHF, as a non-invasive remote model of a specialized disease-management intervention. We searched all relevant electronic databases and search engines, hand-searched bibliographies of relevant studies, systematic reviews, and meeting abstracts. Two reviewers independently extracted all data. Randomized controlled trials comparing TM or STS to usual care in patients with CHF were included. Studies that included intensified management with additional home or clinic-visits were excluded. Primary outcomes (mortality and hospitalizations) were analysed; secondary outcomes (cost, length of stay, and quality of life) were tabulated. Thirty RCTs of STS and TM were identified (25 peer-reviewed publications (n= 8323) and five abstracts (n= 1482)). Of the 25 peer-reviewed studies, 11 evaluated TM (2710 participants), 16 evaluated STS (5613 participants) with two testing both STS and TM in separate intervention arms compared with usual care. Telemonitoring reduced all-cause mortality {risk ratio (RR) 0.66 [95% confidence interval (CI) 0.54-0.81], P< 0.0001 }and STS showed a similar, but non-significant trend [RR 0.88 (95% CI 0.76-1.01), P= 0.08]. Both TM [RR 0.79 (95% CI 0.67-0.94), P= 0.008], and STS [RR 0.77 (95% CI 0.68-0.87), P< 0.0001] reduced CHF-related hospitalizations. Both interventions improved quality of life, reduced costs, and were acceptable to patients. Improvements in prescribing, patient-knowledge and self-care, and functional class were observed. Telemonitoring and STS both appear effective interventions to improve outcomes in patients with CHF. Systematic Review Number: Cochrane Database of Systematic Reviews. 2008:Issue 3. Art. No.: CD007228. DOI: 10.1002/14651858.CD007228.
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            Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients.

            David T Gilbertson, Susan J. Snyder, Eric D Weinhandl … (2010)
            Contemporary comparisons of mortality in matched hemodialysis and peritoneal dialysis patients are lacking. We aimed to compare survival of incident hemodialysis and peritoneal dialysis patients by intention-to-treat analysis in a matched-pair cohort and in subsets defined by age, cardiovascular disease, and diabetes. We matched 6337 patient pairs from a retrospective cohort of 98,875 adults who initiated dialysis in 2003 in the United States. In the primary intention-to-treat analysis of survival from day 0, cumulative survival was higher for peritoneal dialysis patients than for hemodialysis patients (hazard ratio 0.92; 95% CI 0.86 to 1.00, P = 0.04). Cumulative survival probabilities for peritoneal dialysis versus hemodialysis were 85.8% versus 80.7% (P < 0.01), 71.1% versus 68.0% (P < 0.01), 58.1% versus 56.7% (P = 0.25), and 48.4% versus 47.3% (P = 0.50) at 12, 24, 36, and 48 months, respectively. Peritoneal dialysis was associated with improved survival compared with hemodialysis among subgroups with age <65 years, no cardiovascular disease, and no diabetes. In a sensitivity analysis of survival from 90 days after initiation, we did not detect a difference in survival between modalities overall (hazard ratio 1.05; 95% CI 0.96 to 1.16), but hemodialysis was associated with improved survival among subgroups with cardiovascular disease and diabetes. In conclusion, despite hazard ratio heterogeneity across patient subgroups and nonconstant hazard ratios during the follow-up period, the overall intention-to-treat mortality risk after dialysis initiation was 8% lower for peritoneal dialysis than for matched hemodialysis patients. These data suggest that increased use of peritoneal dialysis may benefit incident ESRD patients.
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              Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials

              Labib Faruque, Natasha Wiebe, Arash Ehteshami-Afshar … (2017)
              Telemedicine, the use of telecommunications to deliver health services, expertise and information, is a promising but unproven tool for improving the quality of diabetes care. We summarized the effectiveness of different methods of telemedicine for the management of diabetes compared with usual care.
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                Author and article information

                Contributors
                Eric L. Wallace
                Journal
                Journal ID (nlm-ta): Kidney Int Rep
                Journal ID (iso-abbrev): Kidney Int Rep
                Title: Kidney International Reports
                Publisher: Elsevier
                ISSN (Electronic): 2468-0249
                Publication date PMC-release: 29 July 2017
                Publication date Collection: November 2017
                Publication date (Electronic): 29 July 2017
                Volume: 2
                Issue: 6
                Pages: 1009-1017
                Affiliations
                [1 ]Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
                [2 ]Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia, USA
                [3 ]Department of Internal Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
                [4 ]Center for Pediatric and Adolescent Medicine, Division of Pediatric Nephrology, University of Heidelberg, Heidelberg, Germany
                [5 ]Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada, Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, London, Ontario, Canada
                [6 ]Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
                [7 ]Baxter Healthcare Inc, Deerfield, Illinois, USA
                [8 ]Department of Center for Telehealth, University of Virginia Health System, Charlottesville, Virginia, USA
                [9 ]Department of Biomedical Informatics, Texas A & M University, College Station, Texas, USA
                [10 ]Universidad de Pontificia Bolivariana a Escuela de Ciencias de la Salud, Medellin, Columbia
                [11 ]George Institute for Global Health, Syndey, New South Wales, Australia
                [12 ]Department of Renal Medicine, Duke−National University of Singapore Graduate Medical School, Singapore
                [13 ]Department of Nephrology and Dialysis, Flevo Hospital, Almere, Flevoland, Netherlands
                [14 ]Baxter Healthcare (Asia) Pte Ltd, Singapore
                [15 ]Counties Manukau Health, Auckland, New Zealand
                [16 ]Renal Therapy Services, Bogota, Colombia
                Author notes
                [∗ ] Correspondence: Eric L. Wallace, Paula Building 229, 728 Richard Arrington Boulevard, Birmingham, Alabama 35294, USA.Paula Building 229, 728 Richard Arrington BoulevardBirminghamAlabama 35294USA ericlwallace@ 123456uab.edu
                Article
                Publisher ID: S2468-0249(17)30317-0
                DOI: 10.1016/j.ekir.2017.07.010
                PMC ID: 5733746
                SO-VID: 0fb0ef8f-898a-4ede-bdf7-a61d32f13196
                Copyright © © 2017 International Society of Nephrology. Published by Elsevier Inc.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 17 May 2017
                Date revision received : 9 July 2017
                Date accepted : 24 July 2017
                Categories
                Subject: Meeting Report

                Keywords: end-stage kidney disease,home dialysis,patient monitoring,peritoneal dialysis,remote,telehealth
                Data availability:
                Keywords: end-stage kidney disease, home dialysis, patient monitoring, peritoneal dialysis, remote, telehealth

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