Effect of remote patient management in peritoneal dialysis on haemodynamic and volume control

Nephrology (Carlton). 2020 Nov;25(11):856-864. doi: 10.1111/nep.13751. Epub 2020 Aug 5.

Abstract

Aim: Reduced treatment compliance in patients with peritoneal dialysis facilitates the development of fluid overload and as a result increased blood pressure and vascular stiffness in the long term. We aimed to evaluate blood pressure change and anti-hypertensive needs of patients within 1 year after the changeover to remote monitoring automated peritoneal dialysis (RM-APD) and compare the effect of RM-APD and continuous ambulatory peritoneal dialysis (CAPD) on peripheral and central haemodynamic parameters, volume status of patients and anti-hypertensive drug needs.

Methods: This was an observational and cross-sectional study. We enrolled 15 patients performing CAPD, 20 patients performing RM-APD, and 38 age, and gender-matched healthy control. We measured pulse wave velocity to assess arterial stiffness, peripheral and central haemodynamic parameters. We measured the volume status of participants via bioimpedance spectroscopy.

Results: The mean excess hydration of patients who underwent CAPD were higher than those who performed RM-APD and healthy control (P = .02). We found that mean diastolic blood pressure, heart rate, central systolic and diastolic blood pressure, and central pulse pressure were significantly different between the RM-APD, CAPD and healthy control (P = .02, P = .05, P = .007, P = .05 and P = .005, respectively). Post hoc analysis of these results showed that the differences between the groups were caused by the healthy control group and the patients with underwent CAPD. Daily anti-hypertensive drug count in patients with performing RM-APD was reduced over time (P < .001).

Conclusion: The RM-APD provides better control of peripheral blood pressure and decrease of central haemodynamic parameters via controlling the excess body water.

Keywords: bioimpedance spectroscopy; peritoneal dialysis; pulse wave velocity; remote access technology.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure / physiology
  • Cross-Sectional Studies
  • Dielectric Spectroscopy
  • Electric Impedance
  • Female
  • Heart Rate / physiology
  • Humans
  • Kidney Failure, Chronic / physiopathology*
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Peritoneal Dialysis, Continuous Ambulatory*
  • Pulse Wave Analysis
  • Remote Sensing Technology*

Substances

  • Antihypertensive Agents