Remote monitoring of automated peritoneal dialysis reduces mortality, adverse events and hospitalizations: a cluster-randomized controlled trial
Authors: Paniagua Ramón , Ramos Alfonso , Ávila Marcela , Ventura María-de-Jesús , Nevarez-Sida Armando , Qureshi Abdul Rashid , Lindholm Bengt ,   Mexican Nephrology Collaborative Study Group, Pérez-Morán Diana , Trejo-Villeda Miguel A , Zavaleta-Diaz María D , Hernández-Franco Beatriz , Hinojosa-Rojas Alejandro B , Rosales-Chavarría Leysy , Romano-Bárcenas María R , Morales-Monterrosas Juana , Hijui-Xopa Jovita , Suárez-López María-Guadalupe , Domínguez Belisario , Rojas-Díaz Mario , Ávila-Ortega Nancy , McGregor Carlos , Cruz-Baltazar Angelica , Acosta-Jurado Rubén , Begonia-Ilabaca María , Gómez-Torres Patricia , Cantoral-Farfán Emilia , Ávila-Osorio Norberto , Rodríguez-Esquivel Cristina , Hernández-Cervantes Lucina , Reyes Fabiola , Ramírez-Loera Clara V , Camarillo Maritoña , Sánchez-Mendoza Alejandro , Chávez-Palacios Israel , Ramírez-Cárdenas Adrián , Galván-Vela Ofelia , García-Velásquez Diana P , De-León-Lagunas Edith M , Sáenz-Flores Ofelia , Utrera-Ruiz David , Rivera-Juárez María I , Soto-Gómez María A , Jiménez-Garzón Margarita , De Florencio Marco A Nepomuceno , Álvarez-Reséndiz José F , Rodríguez-Badillo Sandra , Solís-Gómez María E , Reyes-López-León María E , Romo-Flores María L , Tejeda-González Víctor I , Aguilar-Fletes Laura E , Plascencia-Coutiño Samara A , Uriarte-Loaiza Ámbar P , Martha A , Padilla-Mercado  , Arroyo-Cuevas Karina , Díaz-Canchola Laura M , Quezada-Jauregui Laura , Gil-Romero Daniel , Cansino-Villagómez Alma D , Lara-Robles Silverio , Muñoz-Rivera María T , Zurita-Rodríguez Rosenda A , Rodríguez-Vega Teresita J 
Published: October 2024

ABSTRACT

Background
Remote monitoring (RM) of patients on automated peritoneal dialysis (APD) prevents complications and improves treatment quality. We analyzed the effect of RM-APD on mortality and complications related to cardiovascular disease, fluid overload and insufficient dialysis efficiency.

Methods
In a cluster-randomized, open-label, controlled trial, 21 hospitals with APD programs were assigned to use either RM-APD (10 hospitals; 403 patients) or conventional APD (11 hospitals; 398 patients) for the treatment of adult patients starting PD. Primary outcomes were time to first event of: (i) Composite Index 1 comprising all-cause mortality, first adverse events and hospitalizations of any cause, and (ii) Composite Index 2 comprising cardiovascular mortality, first adverse event and hospitalizations related to cardiovascular disease, fluid overload and insufficient dialysis efficiency. Secondary outcomes were time to first event of individual components of the two composite indices, and rates of adverse events, hospitalizations, unplanned visits and transfer to hemodialysis. Patients were followed for a median of 9.5 months. Primary outcomes were evaluated by competing risk analysis and restricted mean survival time (RMST) analysis.

Results
While time to reach Composite Index 1 did not differ between the groups, Composite Index 2 was reached earlier (ΔRMST: –0.86 months; P = .02), and all-cause mortality [55 vs 33 deaths, P = .01; sub-hazard ratio (sHR) 1.69 (95% confidence interval 1.39–2.05), P &lt; .001] and hospitalizations of any cause were higher in APD group than in RM-APD as were cardiovascular deaths [24 vs 13 deaths, P = .05; sHR 2.44 (95% confidence interval 1.72–3.45), P &lt; .001] and rates of adverse events and hospitalizations related to cardiovascular disease, fluid overload or insufficient dialysis efficiency. Dropouts were more common in the APD group (131 vs 110, P = .048).

Conclusions
This randomized controlled trial shows that RM may add significant advantages to APD, including improved survival and reduced rate of adverse events and hospitalizations, which can favorably impact the acceptance and adoption of the therapy.