1
|
Outcomes of Remote Patient Monitoring in Peritoneal Dialysis: A Meta-Analysis and Review of Practical Implications for COVID-19 Epidemics. ASAIO J 2023; 69:e142-e148. [PMID: 36867191 DOI: 10.1097/mat.0000000000001891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
The present study seeks to determine clinical outcomes associated with remote patient monitoring of peritoneal dialysis (RPM-PD), with potential implications during COVID-19 outbreaks. We performed a systematic review in the PubMed, Embase, and Cochrane databases. We combined all study-specific estimates using the inverse-variant weighted averages of logarithmic relative risk (RR) in the random-effects models. Confidence interval (CI) including the value of 1 was used as evidence to produce a statistically significant estimate. Twenty-two studies were included in our meta-analysis. Quantitative analysis demonstrated that RPM-PD patients had lower rates of technique failure (log RR = -0.32; 95% CI, -0.59 to -0.04), lower hospitalization rates (standardized mean difference = -0.84; 95% CI, -1.24 to -0.45), and lower mortality rates (log RR = -0.26; 95% CI, -0.44 to -0.08) compared with traditional PD monitoring. RPM-PD has better outcomes in multiple spheres of outcomes when compared with conventional monitoring and likely increases system resilience during disruptions of healthcare operations.
Collapse
|
2
|
Tombocon O, Tregaskis P, Reid C, Chiappetta D, Fallon K, Jackson S, Frawley F, Peart D, Weston A, Wong K, Palaster L, Flanc R, Macdonald S, Wilson S, Walker R. Home before Hospital: a whole of system re-design project to improve rates of home-based dialysis therapy: Experience and outcomes over 8 years. Int J Qual Health Care 2021; 33:6324347. [PMID: 34282840 DOI: 10.1093/intqhc/mzab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/29/2021] [Accepted: 07/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite evidence that clinical outcomes for patients treated with peritoneal dialysis (PD) or home haemodialysis are better than for patients treated with conventional satellite or hospital-based haemodialysis, rates of home-based dialysis therapies world-wide remain low. Home-based dialysis care is also cost-effective and indeed the favoured dialysis option for many patients. METHODS & OBJECTIVES Using a lean-thinking framework and established change management methodology, a project embracing a system-wide approach at making a change where a 'Home before Hospital' philosophy underpinned all approaches to dialysis care was undertaken. Three multidisciplinary working groups (pathway, outreach and hybrid) were established for re-design and implementation. The primary aim was to improve home-based dialysis therapy prevalence rates from a baseline of 14.8% by ≥2.5%/year to meet a target of 35%, whilst not only maintaining but improving the quality of care provided to patients requiring maintenance dialysis. A 'future' state pathway was developed after review of the 'current' state (Pathway Working Group) and formed the basis on which a nurse-led outreach service (Outreach Working Group) was established. With the support of the multidisciplinary team, the outreach service model focussed on early, consistent, and frequent education, patient support in decision-making, and clinician engagement. RESULTS A target prevalence of >30% for home-based therapies (mainly achieved with PD) was achieved within 2 years. This prevalence rate reached 35% within 3 years and was maintained at 8 years. In addition, selected patients already on maintenance satellite-based haemodialysis (Hybrid Working Group) were educated to achieve high levels of proficiencies in self-care. CONCLUSION Having the system-wide approach to a Quality Improvement Process and using established principles and change management processes, the successful implementation of a new sustainable model of care focussed on home-based dialysis therapy was achieved. A key feature of the model (through outreach) was early nurse-led education and support of patients in decision-making and ongoing support through multidisciplinary care.
Collapse
Affiliation(s)
- Omar Tombocon
- Department of Renal Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Peter Tregaskis
- Department of Renal Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Catherine Reid
- Department of Renal Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Daniella Chiappetta
- Department of Renal Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Kethly Fallon
- Department of Renal Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Susannah Jackson
- Department of Renal Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Fiona Frawley
- Department of Renal Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Dianne Peart
- Department of Renal Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Ann Weston
- Department of Renal Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Kim Wong
- Renal Service, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199, Australia
| | - Leanne Palaster
- Renal Service, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199, Australia
| | - Robert Flanc
- Renal Service, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199, Australia
| | - Sandra Macdonald
- Renal Service, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199, Australia
| | - Scott Wilson
- Department of Renal Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Rowan Walker
- Department of Renal Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| |
Collapse
|
3
|
Mudge DW, Boudville N, Brown F, Clayton P, Duddington M, Holt S, Johnson DW, Jose M, Saweirs W, Sud K, Voss D, Walker R. Peritoneal dialysis practice in Australia and New Zealand: A call to sustain the action. Nephrology (Carlton) 2017; 21:535-46. [PMID: 26807739 DOI: 10.1111/nep.12731] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/09/2015] [Accepted: 01/19/2016] [Indexed: 01/08/2023]
Abstract
This paper updates a previous 'Call to Action' paper (Nephrology 2011; 16: 19-29) that reviewed key outcome data for Australian and New Zealand peritoneal dialysis patients and made recommendations to improve care. Since its publication, peritonitis rates have improved significantly, although they have plateaued more recently. Peritoneal dialysis patient and technique survival in Australian and New Zealand have also improved, with a reduction in the proportion of technique failures attributed to 'social reasons'. Despite these improvements, technique survival rates overall remain lower than in many other parts of the world. This update includes additional practical recommendations based on published evidence and emerging initiatives to further improve outcomes.
Collapse
Affiliation(s)
- David W Mudge
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Fiona Brown
- Monash Medical Centre, Melbourne, Victoria, Australia
| | - Philip Clayton
- Department of Renal Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Stephen Holt
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Matthew Jose
- Department of Nephrology, Royal Hobart Hospital & Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Walaa Saweirs
- Renal Unit, Whangarei Hospital, Whangarei, New Zealand
| | - Kamal Sud
- Nepean Clinical School, and Department of Renal Medicine, Nepean Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - David Voss
- Renal Department, Middlemore Hospital, Auckland, New Zealand
| | - Rowan Walker
- Department of Renal Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Gupta A, Ahmed K, Kynaston HG, Dasgupta P, Chlosta PL, Aboumarzouk OM. Laparoendoscopic single-site donor nephrectomy (LESS-DN) versus standard laparoscopic donor nephrectomy. Cochrane Database Syst Rev 2016; 2016:CD010850. [PMID: 27230690 PMCID: PMC6823261 DOI: 10.1002/14651858.cd010850.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Advances in minimally invasive surgery for live kidney donors have led to the development of laparoendoscopic single site donor nephrectomy (LESS-DN). At present, laparoscopic donor nephrectomy is the technique of choice for donor nephrectomy globally. Compared with open surgical approaches, laparoscopic donor nephrectomy is associated with decreased morbidity, faster recovery times and return to normal activity, and shorter hospital stays. LESS-DN differs from standard laparoscopic donor nephrectomy; LESS-DN requires a single incision through which the procedure is performed and donor kidney is removed. Previous studies have hypothesised that LESS-DN may provide additional benefits for kidney donors and stimulate increased donor rates. OBJECTIVES This review looked at the benefits and harms of LESS-DN compared with standard laparoscopic nephrectomy for live kidney donors. SEARCH METHODS We searched the Cochrane Kidney and Transplant's Specialised Register to 28 January 2016 through contact with the Information Specialist using search terms relevant to this review. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared LESS-DN with laparoscopic donor nephrectomy in adults. DATA COLLECTION AND ANALYSIS Three authors independently assessed studies for eligibility and conducted risk of bias evaluation. Summary estimates of effect were obtained using a random-effects model and results were expressed as risk ratios (RR) or risk difference (RD) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes. MAIN RESULTS We included three studies (179 participants) comparing LESS-DN with laparoscopic donor nephrectomy. There were no significant differences between LESS-DN and laparoscopic donor nephrectomy for mean operative time (2 studies, 79 participants: MD 6.36 min, 95% CI -11.85 to 24.57), intra-operative blood loss (2 studies, 79 participants: MD -8.31 mL, 95% CI -23.70 to 7.09), or complication rates (3 studies, 179 participants: RD 0.05, 95% CI -0.04 to 0.14). Pain scores at discharge were significantly less in the LESS-DN group (2 studies, 79 participants: MD -1.19, 95% CI -2.17 to -0.21). For all other outcomes (length of hospital stay; length of time to return to normal activities; blood transfusions; conversion to another form of surgery; warm ischaemia time; total analgesic requirement; graft loss) there were no significant differences observed.Although risk of bias was assessed as low overall, one study was assessed at high risk of attrition bias. AUTHORS' CONCLUSIONS Given the small number and size of included studies it is uncertain whether LESS-DN is better than laparoscopic donor nephrectomy. Well designed and adequately powered RCTs are needed to better define the role of LESS-DN as a minimally invasive option for kidney donor surgery.
Collapse
Affiliation(s)
- Ameet Gupta
- University Hospital WalesDepartment of UrologyHeath ParkCardiffUKCF14 4XW
| | - Kamran Ahmed
- King's College LondonMRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of MedicineSt Thomas StreetLondonEnglandUKSE1 9RT
| | - Howard G Kynaston
- University Hospital WalesDepartment of UrologyHeath ParkCardiffUKCF14 4XW
| | - Prokar Dasgupta
- King's College LondonMRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of MedicineSt Thomas StreetLondonEnglandUKSE1 9RT
| | - Piotr L Chlosta
- Jagiellonian University, Collegium MedicumDepartment of UrologyGrzegorzecka 18KrakowPoland31531
| | - Omar M Aboumarzouk
- Islamic University of GazaDepartment of UrologyCollege of MedicineGazaPalestine
| | | |
Collapse
|