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Water removal during automated peritoneal dialysis assessed by remote patient monitoring and modelling of peritoneal tissue hydration.

ABSTRACT: Water removal which is a key treatment goal of automated peritoneal dialysis (APD) can be assessed cycle-by-cycle using remote patient monitoring (RPM). We analysed ultrafiltration patterns during night APD following a dry day (APD_DD; no daytime fluid exchange) or wet day (APD_WD; daytime exchange). Ultrafiltration for each APD exchange were recorded for 16 days using RPM in 14 patients. The distributed model of fluid and solute transport was applied to simulate APD and to explore the impact of changes in peritoneal tissue hydration on ultrafiltration. We found lower ultrafiltration (mL, median [first quartile, third quartile]) during first and second vs. consecutive exchanges in APD_DD (-61 [-148, 27], 170 [78, 228] vs. 213 [126, 275] mL; p < 0.001), but not in APD_WD (81 [-8, 176], 81 [-4, 192] vs. 115 [4, 219] mL; NS). Simulations in a virtual patient showed that lower ultrafiltration (by 114 mL) was related to increased peritoneal tissue hydration caused by inflow of 187 mL of water during the first APD_DD exchange. The observed phenomenon of lower ultrafiltration during initial exchanges of dialysis fluid in patients undergoing APD_DD appears to be due to water inflow into the peritoneal tissue, re-establishing a state of increased hydration typical for peritoneal dialysis.

SUBMITTER: Stachowska-Pietka J

PROVIDER: S-EPMC8329227 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

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Water removal during automated peritoneal dialysis assessed by remote patient monitoring and modelling of peritoneal tissue hydration.

Stachowska-Pietka Joanna J Naumnik Beata B Suchowierska Ewa E Gomez Rafael R Waniewski Jacek J Lindholm Bengt B

Scientific reports 20210802 1

Water removal which is a key treatment goal of automated peritoneal dialysis (APD) can be assessed cycle-by-cycle using remote patient monitoring (RPM). We analysed ultrafiltration patterns during night APD following a dry day (APD<sub>DD</sub>; no daytime fluid exchange) or wet day (APD<sub>WD</sub>; daytime exchange). Ultrafiltration for each APD exchange were recorded for 16 days using RPM in 14 patients. The distributed model of fluid and solute transport was applied to simulate APD and to e ...[more]

PMID: 34341373

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Project description:BackgroundNumerous factors influence patient recruitment to, and retention on, peritoneal dialysis (PD), but a major challenge is a perceived "inaccessibility" to treating clinicians. It has been suggested that remote patient monitoring (RPM) could be a means of improving such oversight and, thereby, uptake of PD.ObjectiveTo describe patient and clinician perspectives toward RPM and the use of applications (Apps) suitable for mobiles, tablets, or computers to support the provision of PD care.DesignQualitative design using semi-structured interviews.SettingAll patient participants perform PD treatment at home under the oversight of an urban PD unit in Sydney, Australia. Patient and clinician interviews were conducted within the PD unit.Participants14 participants (5 clinicians [2 nephrologists, 3 PD nurses] and 9 patients treated with PD).MethodsSemi-structured interviews were conducted using interview guides tailored for clinician and patient participants. Transcripts were coded and analyzed by a single researcher using thematic analysis.ResultsSix themes were identified: perceived benefits of RPM implementation (offering convenience and efficiency, patient assurance through increased surveillance, more complete data and monitoring adherence), uncertainty regarding data governance (protection of personal data, data reliability), reduced patient engagement (transfer of responsibility leading to complacency), changing patient-clinician relationships (reduced patient-initiated communication, the need to maintain patient independence), increased patient and clinician burden (inadequate technological literacy, overmanagement leading to frequent treatment changes), and clinician preference influencing patient behavior.LimitationsThe interviews were conducted in English only and with participants from a single urban dialysis unit, which may limit generalizability.ConclusionsFor patients and clinicians, advantages from the use of RPM in PD may include increased patient confidence and assurance, improved treatment oversight, more complete data capture, and overcoming barriers to data documentation. Careful patient selection and patient and clinician education may help to optimize the benefits of RPM, maintain patient independence, and reduce the risks of patient disengagement. The use of an App may support RPM; however, participants expressed concerns about increasing the burden on some patients through the use of unfamiliar technology.Human research ethics committee approval numberCH62/6/2019-028.

Dataset Information

Water removal during automated peritoneal dialysis assessed by remote patient monitoring and modelling of peritoneal tissue hydration.

Publications

Water removal during automated peritoneal dialysis assessed by remote patient monitoring and modelling of peritoneal tissue hydration.

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