Remote Patient Monitoring‑Enabled Automated Peritoneal Dialysis and Clinical Outcomes: A Nationwide Real-World Cohort...

Remote patient monitoring-enabled automated peritoneal dialysis was associated with improved survival and technique survival compared with conventional automated peritoneal dialysis. Remote patient monitoring‑enabled automated peritoneal dialysis was associated with significantly fewer annual hospitalizations compared with conventional automated peritoneal dialysis. The association between remote patient monitoring-enabled automated peritoneal dialysis and reduced hemodialysis transfer was more pronounced in younger patients and icodextrin users.

Remote patient monitoring of patients on automated peritoneal dialysis (APD) enables real-time access to treatment data and has the potential to improve clinical outcomes. However, large-scale, nationwide real-world evidence comparing RPM-enabled APD (RPM-APD) with conventional APD remains limited.

We conducted a nationwide retrospective cohort study using Taiwan's National Health Insurance Research Database between 2016 and 2023. Patients initiating APD in medical centers during 2016-2018 (conventional APD) were compared with those starting RPM-APD equipped with a remote monitoring device during 2020-2022. Baseline covariates were balanced using inverse probability of treatment weighting. The primary outcomes were all-cause death and hemodialysis transfer. Secondary outcomes included peritonitis, major adverse cardiac events, and hospitalization. Patients were followed until outcome occurrence, death, hemodialysis transfer, kidney transplantation, or the end of follow-up (December 31, 2019, for conventional APD and December 31, 2023, for RPM-APD).

Among the 2477 patients (RPM-APD, n =1258; conventional APD, n =1219), the mean age was 53.6 years, 54.6% were male, and the mean follow-up duration was 2.0 years. After inverse probability of treatment weighting adjustment, the RPM-APD group was associated with lower risks of all-cause death (4.4 versus 5.3 events per 100 person-years; hazard ratio 0.82, 95% confidence interval [CI], 0.69 to 0.99) and hemodialysis transfer (12.7 versus 15.1 events per 100 person-years; subdistribution hazard ratio 0.86, 95% CI, 0.77 to 0.96). The risks of peritonitis and major adverse cardiac events were similar between groups, whereas patients receiving RPM-APD experienced significantly fewer annual hospitalizations (1.6 versus 2.1 times; rate ratio 0.70, 95% CI, 0.68 to 0.73).

In this Taiwan nationwide real-world cohort study with long-term follow-up, RPM-APD was associated with improved patient survival, reduced hemodialysis transfer, and fewer annual hospitalizations compared with conventional APD. These findings support a potential role for RPM-APD in contemporary peritoneal dialysis care.