Operationalizing Home Blood Pressure Monitoring for Dialysis Patients: An Effectiveness-Implementation Hybrid Study

Blood pressure (BP) control in dialysis patients is often inadequate, partly owing to a lack of standardized home BP monitoring. We aimed to implement and evaluate a remote BP monitoring (RBPM) program for incenter hemodialysis (HD) patients.

An effectiveness-implementation hybrid study conducted as a quality improvement program.

We screened 79 patients with kidney failure receiving thrice-weekly incenter HD at a US academic medical center between February and September 2022.

Initiation of an RBPM program integrated into the electronic medical record.

The primary outcome was patient use of home BP monitoring. Secondary outcomes included changes in BP, number of antihypertensive medications, and target weight.

We compared 30-day average pre-HD BP, home BP measured 1 day after midweek HD, number of BP medications, and target weight before and after RBPM initiation using paired t test or Wilcoxon rank sum test. In addition, mixed-effects models were used to assess changes over time.

Among the 79 patients screened, 48 referred to RBPM, 30 started monitoring, and 27 completed the 3-month follow-up. The mean predialysis systolic BP before RBPM initiation was 145 (standard deviation, 20) mm Hg. During month 1, home systolic BP postmidweek HD was lower than pre-HD measurement by 14 mm Hg (P = 0.005). The median number of BP medication decreased from 2.5-2.0 in month 3 (P = 0.005). Median monthly home BP measurements decreased from 17 during month 1 to 6 during month 3 (P < 0.001). In month 3, 67% (18/27) of participants were actively monitoring their BP, with only 13 (48%) measuring BP postmidweek HD.

A single-center, observational study without a standardized protocol for medication management.

Our RPBM program confirmed significant discrepancies between home and pre-HD BP measurements, underscoring its potential use. However, the observed decline in patient engagement highlights the challenge of maintaining long-term adherence.