Authors (including presenting author) :
OR PC(1), Liu MS(1), Chan PY(1), Tang SK(1), Wong SW(1), Chan YHE(1), Ma LTA(1)
Affiliation :
(1)Paediatric Nephrology Centre, Hong Kong Children’s Hospital, Kowloon Bay, Hong Kong SAR
Introduction :
In Hong Kong, pediatric patients with kidney failure are first offered automated peritoneal dialysis (APD) to facilitate children’s normal life. However, peritoneal dialysis (PD) associated problems such as treatment non-adherence or mechanical problems are concerns among them, which resulted in unplanned admissions and interrupt their normal life.
Cloud-based Remote Patient Monitoring (RPM) in APD is available in recent years in Hong Kong. This system allows medical personnel to (1)observe patient’s therapy adherence, (2)adjust PD prescription online, (3)observe patient’s ultrafiltration, (4)observe patient’s alarms during PD therapy, (5)observe patient’s blood pressure and (6)body weight. This system promotes early detection of any issues related to PD by designated renal specialists. So, timely management could be arranged. Hence, children enjoy better clinical outcomes.
Objectives :
1. To improve adherence to PD.
2. To decrease unplanned hospitalization episodes.
3. To improve blood pressure control.
4. To reduce anxiety related to PD therapy among patients and their careers.
Methodology :
This was a single center, observation prospective study. All patients who required APD were reviewed. Inclusion criteria included history of PD related problem like non-adherence, unplanned hospitalizations more than twice a year, fluid overload, poor ultrafiltration and poor blood pressure control. Patients who would be transferred to adult unit, migration and transplanted during study period were excluded.
Six months pre-and post-RPM data review was conducted by designated pediatric renal nurses. Phone follow-up for any problems noted. Joint meetings with doctors, nurses and product specialist would be arranged regularly reviewing patients PD program and adjust treatment as indicated.
‘Flag’ rules were set in the RPM platform for any abnormal finding during PD treatment. Questionnaire adopted from PedsQL 3.0 ESRD module was used to assess the quality of life.
Result & Outcome :
Twenty-seven percent of kidney failure patients who requiring APD were recruited. Total 72 RPM online data review was done by nurses, 330 ‘flags’ were noted, phone follow up with total 222.9 minutes and 8.1 phone consultations per patient were done. During post-RPM period, total 11 joints meeting were held.
During post-RPM period, all patients shown satisfactory treatment adherence without any self-skip of PD. Episodes of unplanned hospitalization and length reduced by 45% and 42% respectively. Furthermore, patients shown systolic blood pressure control which was statistically significant reduction for 4.8% (p=0.02). All patients reported the use of RPM was beneficial and improved sense of security.
