Effectiveness of a smart management system in improving adherence and clinical outcomes of patients receiving peritoneal dialysis: a retrospective cohort analysis.

BACKGROUND

Peritoneal dialysis (PD) is a widely used form of home dialysis. However, the efficacy of telehealth care in long-term management for PD patients remains unclear.

OBJECTIVE

The objective of this study is to assess the effectiveness of a smart management system in improving adherence, quality of life, and clinical outcomes in PD patients.

METHODS

The study was a retrospective cohort analysis on PD patients who underwent new catheter placement between January 2022 and June 2023. The smart PD management system, an artificial intelligence (AI)-driven, nurse-led, patient-centered management system, was used to remotely monitor patients' health at home and assist healthcare team in patient management, serving as a complement to conventional clinic visits. Patient data, including dialysis diary, symptoms, laboratory test results, and medication records, were collected through a smartphone app and uploaded to a cloud server. An AI system conducted real-time data analysis and promptly notified the healthcare team upon detecting any abnormalities. Online health coaches and nurses provided personalized guidance and interventions to patients, addressing issues in real-time. The primary endpoints of the study were changes and achievement rates in blood pressure and laboratory test results associated with complications. Secondary endpoints included changes in adherence and quality of life at recruitment and end of follow-up.

RESULTS

A total of 127 patients participated in the smart management system from January 2022 to June 2023 were included in the analysis. Most of them (94.5%) were receiving continuous ambulatory PD (CAPD). Over an average follow-up period of 11.0 (IQR 5.0-16.0) months, the average systolic blood pressure of the patients decreased from a baseline of 132.1 (SD 13.2) mmHg to 122.6 (SD 14.1) mmHg (P < 0.001). The overall blood pressure achievement rate (< 140/90 mmHg) increased from 61.4% at baseline to 79.5% (P = 0.001) at the end of the follow-up period. Regarding anemia, the average hemoglobin and the achievement rate increased from 98.8 (SD 19.8) g/L at baseline to 114.4 (SD 18.4) g/L (P < 0.001), and from 50.0 to 78.4% (P < 0.001), respectively. Improvements of varying degrees were observed in mineral and bone disorder, electrolyte balance, and nutritional status, even though they did not reach statistical significance. The patients' adherence to uploading dialysis diaries significantly increased from 78 to 95.7% (P < 0.001) during the last week of follow-up period compared to the first week after enrollment. Furthermore, there were observed improvements in the quality of life, including diet, sleep, and daily activities.

CONCLUSIONS

The utilization of the smart PD management system was associated with enhanced patient adherence, improved quality of life, and superior clinical outcomes in PD patients.