#4753 TELEDIALYSIS: THE FIRST NORTHEAST ITALY EXPERIENCE OF TELEHEALTH IN PERITONEAL DIALYIS PATIENTS
Authors: Lentini Paolo , Laudadio Giorgio , Fuso Valeria , Benedetti Claudia , Previti Antonino , Andrighetto Sofia , Vienna Federica , Cremasco Daniela , Gambaro Giovanni 
Published: June 2023

Abstract

Background and Aims
During Covid19 epidemic, International Society of Peritoneal Dialysis recommend “ People on PD should stay at home. Hospital visits should be minimized for only urgent indications. Consultations should otherwise be conducted by telehealth”. In 2021 in Italy Government enforce plan to develop Telehealth and to create a new Nephrology home model to provide better oversight of care with remote monitoring.Telehealth has been used to manage patients with chronic kidney disease (CKD) and demonstrated equal outcomes in CKD care by either in-person or virtual visits. Telehealth also help facilitate patient education about home dialysis modalities and self-care, especially in peritoneal dialysis setting (PD). We report the first experience in the Northeast of Italy with Teledialysis, a combination of PD technique and new technology devices that we used together to overcome clinical, social and psychological barriers to PD.

Method
In our pilot study, we enrolled 12 consecutive Automated Peritoneal Dialysis (APD) patients from our Nephrology program in “San Bassiano Hospital”, Bassano del Grappa, Vi, Italy.
Teledialysis was perform with the combination of two systems:
1- A Web platform Sharesource (Baxter Renal care ®) that with a mod-M added to APD device supports remote patient management through secure communication with can allows details of the home dialysis treatment and provide to the clinician the ability to act on that assessment by updating the patient device setting to the cycler.
2-Totem eVISUS System (TesiSquare®) that is a plug and play system consisting of two units: a) a transportable remote station at the patient's home (Totem) equipped with high performance camera, touchscreen monitor, speaker microphone hand free and computers, internet routers for fixed and mobile phone, wireless access point and remote control to answer calls remotely and b) a Control Station (in our Hospital) that by a simple use of a mouse form our healthcare personnel can connect to one or more patients at the same time and check the Totem Camera. (Figure 1) Figure 1:The Teledialysis System: 1) Sharesource for remote control; 2) Totem at home access point with remote control. 3) Central station in the hospital for virtual evaluation. We control day by day PD sessions by sharesource and we provide virtual support to our patients for medications of catheter exit-site and catheter exit-site monitoring and instructions for PD training; we also perform clinical evaluation status, we check PD effluent color and we aid patients and care givers for PD session management.

Results
During an observation period of 11 months we enrolled 12 consecutive patients (4m/8F) with an average age of 73 yrs; cognitive impairment, diabetes, hypertension, chronic heart failure and peripheral vascular disease (PVD) were common comorbidities (see Figure 2). Figure 2:Characteristcs of the patients. We perform 60 teledialysis sessions with an average duration of 26’ minutes. We don’t detect any exit Site Infection (ESI), Tunnel infection or Peritonits in our population; none of our patients require urgently hospital or emergency room admission. Only once we suggest access to our department for fever and dyspnea and the patient require a one week hospitalization for acute bacterial pneumonia. (Table 1)

Conclusion
Our preliminary results shown that Teledialysis is a safe, reliable, flexible and effective system and is easy to use for our patients; we assert that technology really can help nephrologist to improve PD program and aid patients to overcome barriers to select PD and avoid fear of the failure. Teledialysis promote a real integration between Hospital and our territory by a new care pathway.