Remote monitoring of automated peritoneal dialysis reduces mortality, adverse events and hospitalizations: a cluster-randomized controlled trial.
In a cluster-randomized trial of 801 patients starting peritoneal dialysis across 21 hospitals, remote monitoring of automated peritoneal dialysis was associated with lower all-cause mortality (33 vs 55 deaths) and fewer cardiovascular deaths (13 vs 24) than conventional APD, although the primary composite endpoint of all-cause mortality, adverse events and hospitalizations did not differ between groups.
Study design
This was a cluster-randomized, open-label, controlled trial in which 21 hospitals with automated peritoneal dialysis (APD) programs were assigned to use either remote monitoring APD (10 hospitals; 403 patients) or conventional APD (11 hospitals; 398 patients) for adults starting peritoneal dialysis. The two primary outcomes were time to first event of Composite Index 1 (all-cause mortality, first adverse events and hospitalizations of any cause) and Composite Index 2 (cardiovascular mortality, first adverse event and hospitalizations related to cardiovascular disease, fluid overload and insufficient dialysis efficiency). Patients were followed for a median of 9.5 months, with primary outcomes evaluated by competing risk analysis and restricted mean survival time (RMST) analysis.
Key findings
Time to reach Composite Index 1 did not differ between the groups. Composite Index 2 was reached earlier in the conventional APD arm (ΔRMST −0.86 months; P = .02). All-cause mortality was higher in the conventional APD group than in the remote monitoring group (55 vs 33 deaths, P = .01; sub-hazard ratio 1.69, 95% CI 1.39–2.05, P < .001), as were hospitalizations of any cause. Cardiovascular deaths were also higher with conventional APD (24 vs 13 deaths, P = .05; sub-hazard ratio 2.44, 95% CI 1.72–3.45, P < .001), along with rates of adverse events and hospitalizations related to cardiovascular disease, fluid overload or insufficient dialysis efficiency. Dropouts were more common in the conventional APD group (131 vs 110, P = .048).
Clinical implications
The authors conclude that remote monitoring may add significant advantages to automated peritoneal dialysis, including improved survival and reduced rates of adverse events and hospitalizations. They argue these gains could favourably influence the acceptance and adoption of the therapy. The null result on the broader all-cause composite endpoint should be read alongside the positive signals on mortality and the cardiovascular/fluid-overload composite.
Category
Transplant
Source
Nephrol Dial Transplant
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.