Prognostic Value of Remote Monitoring Alarms for Technique Failure in Automated Peritoneal Dialysis

While remote patient monitoring (RPM) is associated with decreased hospitalization and technique failure in automated peritoneal dialysis (APD), the prognostic utility of individual alarm patterns remains unclear.

We performed a retrospective, single-center cohort study of adult APD patients managed with the Sharesource RPM platform at National Cheng Kung University Hospital. Three predefined red-flag alarms, including initial drain variance >50%, lost therapy volume >10%, and lost treatment time >30 min, were recorded from September 2019 to May 2020. Alarm burden was expressed as episodes per patient-month and categorized into tertiles. Patients were followed for 3 years for death-censored technique failure, defined as permanent transfer to hemodialysis. Associations were evaluated using logistic regression. Fine and Gray competing-risk models and generalized estimating equations served as sensitivity analyses.

Sixty-seven patients (mean age 45 ± 13 years; 61.2% male) generated 272 alarm episodes. The initial drain variance accounted for 54.8% of alarms, lost treatment time for 39.3%, and lost therapy volume for 5.9%. Technique failure occurred in 8 patients (11.9%), with rates rising across alarm-frequency tertiles (4.5%, 9.1%, and 21.7%; p for trend = 0.074). In multivariable analysis, initial drain variance > 50% independently predicted technique failure (adjusted odds ratio [OR] 1.48; 95% confidence interval [CI]: 1.13-2.04; p = 0.006). Results were consistent in sensitivity analyses (Fine and Gray subdistribution hazard ratio 1.55, 95% CI: 1.07-2.25; GEE OR 2.58, 95% CI: 1.00-6.62). The other two alarm types were not significantly associated with outcomes.

An RPM alarm for initial drain variance >50% emerged as an early marker of technique failure in APD. Incorporating alarm-pattern analysis into routine RPM review may facilitate targeted surveillance and timely intervention for high-risk patients.