Introduction
Methods
Search strategy
Eligibility criteria and outcome measures
Data-extraction and analysis
Results
Study and patient characteristics
Study | Country | Population | Study design | Intervention | Comparison | Follow-up | Outcomes | Results | Risk of bias |
---|---|---|---|---|---|---|---|---|---|
Cao 2018 [28] | China |
N = 160 Age 52.2 ± 15y M = 58% CAPD | RCT | Internet-based instant messaging software (N = 80) | Traditional follow-up (N = 80) | 11.4 ± 1.5 months | Patient-satisfaction [modified from] [37] | Higher in the intervention group (p < 0.001, 98.1% vs 92.1%) | Unclear |
Mortality | Lower in intervention group (p = 0.058, number of events not reported) | ||||||||
Exit-site infection | N.S. difference | ||||||||
Peritonitis | Higher in intervention group (60 cases in 80 patients (75%) vs 40 cases in 80 patients (50%) statistical significance not reported) | ||||||||
Transfer to HD (was not a pre-specified outcome) | N.S. difference | ||||||||
Hospitalizations | N.S. difference | ||||||||
Li 2014 [30] | China |
N = 135 Age 56.3 ± 12.4y M = 59% CAPD | RCT | Post-discharge nurse-led telephone support (N = 69) | Routine hospital discharge care (N = 66) | 12 weeks | QoL (KDQOL-SF) | N.S. difference | Unclear |
Patient satisfaction (sub-item of KDQOL-SF) | Higher in intervention group (p < 0.01, 73.7% vs 70.5%) | ||||||||
Peritonitis | N.S. difference | ||||||||
Catheter-infections | N.S. difference (data not shown) | ||||||||
Readmissions | N.S. difference | ||||||||
Clinical visits | Less in intervention group (71% vs 47%, p = 0.039) | ||||||||
Sanabria 2019 [36] | Colombia |
N = 360 Age 57 ± 17y M = 56% APD incident patients | Retrospective cohort study | RPM-APD (N = 65)
N = 63 used for propensity score matching Mean duration = 0.76 ± 0.27 years | APD without RPM (N = 295). N = 63 used for propensity score matching | 0.86 + − 0.27y in APD-RPM vs 0.74 + − 0.34y in APD without RPM | Hospitalizations | Less in intervention group (42.6% vs 68.1%, p = 0.029) | Low |
Number of hospital days | Less in intervention group (5.59 vs 12.16 days per patients-year, p = 0.028) | ||||||||
Harrington 2014 [29] | USA | N = 6 Age 52.2 ± 6.5y M = 50% CAPD | Pilot study | A tablet computer application allowing real-time monitoring and two-way communication Mean duration = 92 days, SD = not reported | No comparison | 8 months | Patient satisfaction (Likert scale (1-10)) | 5.2 on Likert scale | Moderate |
Milan- Manani 2020 [21] | Italy |
N = 73 Age 60,4 [47.4–75.1] y M: 77% in intervention group; 71% in control group APD | Retrospective cohort study | APD-RM (N = 35) | APD standard care (N = 38) | 6 months | QoL (KDQOL-SF) | N.S. difference | Moderate |
Peritonitis | N.S. difference | ||||||||
Transfer to HD (duration not specified) | 0 in intervention group, 1 in control group | ||||||||
Hospitalizations | N.S. difference in all-causeLess disease-specific hospitalizations in the intervention group (18.2% vs 77.8%, p = 0.022) | ||||||||
Frequency of visits | N.S. difference in all-cause (p = 0.095)Less urgent visits due to overhydration (p = 0.042) | ||||||||
Dey 2016 [35] | UK | N = 22 Age 61.6 [IQR 26.4–93.4] y M = 55% APD | Pilot study | Computer tablets (PODs) with integrated software for weighing scales and blood pressure machines; patient vital data recording; questionnaire regarding complaints (at beginning and end of study); twice-weekly dietary questionnaire; access to medical and educational information. Mean duration = 341.9 days, SD = not reported | Pre-intervention with PODs | 15 months | Quality of life (KDQOL-36) | N.S. difference | Serious |
Patient satisfaction (QUEST) | N.S. difference | ||||||||
Chaudhuri 2020 [31] | U.S.A. |
N = 6343 Age 56. 9 ± 15.2y M = 57% % CAPD not specified | Retrospective study | RTM ‘PatientHub’ moderate users (N = 673) frequent users (N = 1577) RTM involves patients viewing their dialysis orders, laboratory results, medications, supply orders and documenting their daily PD treatment data, vital signs, complications | RTM non-users (N = 4093) | 12 months | Transfer to HD (> 6wks) | Lower in frequent users versus non-users (p = 0.001, on average 30.5 ± 2.5% lower) | Moderate |
Hospitalizations | Lower in frequent users versus non-users (on average 23.75 ± 1.71% lower, p ≤ 0.001) | ||||||||
Number of hospital days | Lower in frequent users versus non-users (on average 34.75 ± 2.5% lower, p ≤ 0.001) | ||||||||
Corzo 2020 [34] | Colombia |
N = 558 Age 53.8 ± 16.9y M = 60%, APD | Retrospective, multicenter, observational cohort study | APD-RPM (N = 148) | APD without RPM (N = 410)
N = 148 used for propensity score matching | 1.1 ± 0.6 years | Transfer to HD (>30d) | Lower in intervention group (p = 0.03) | Moderate |
Mortality | N.S. difference(only reported for the non-matched population) | ||||||||
Nayak 2012 [17] | India | N = 246 Age 51.5 ± 12.8y in rural group 52.3 ± 12.6y in urban group M: 70% in rural group; 69% in urban group %CAPD not specified | Observational | Internet-based RM system (including online log of dialysis data, pictures, access to laboratory results, health records and prescriptions, possibility to schedule appointments and to receive alerts) in rural patients (N = 115) | Internet-based RM system (including online log of dialysis data, pictures, access to laboratory results, health records and prescriptions, possibility to schedule appointments and to receive alerts) in urban patients (N = 131) | 2008 patient-months in the rural group; 2288 patient-months in the urban group | Peritonitis | N.S. difference | Moderate |
Exit-site infection | N.S. difference | ||||||||
Bunch 2020 [19] | Colombia |
N = 1.023 Age 63 [IQR 51–72] y M = 61% APD | Observational cohort study | RPM-APD during pandemic (on-site evaluation only for special indications, weekly telephonic triage, daily review APD treatments, technique review through videos sent by patients) | RPM-APD before the covid-19 pandemic (track patient’s adherence, blood pressure, ultrafiltration, and weight daily; perform proactive telephone interventions anticipating possible urgent care requirements) | 3 months | Peritonitis | N.S. difference | Serious |
On-site evaluations perpatient/month | Lower in the intervention group p < 0.01 (the absolute number of evaluations was not reported) | ||||||||
Teleconsultations per patient/month | Higher in the intervention group p < 0.01 (the absolute number of teleconsultations was not reported) | ||||||||
Polanco 2020 [16] | Dominican Republic | N = 913 Age 51 [IQR 19–96] y M = 62% 99.6% CAPD | Observational prospective study | Telemedicine-facilitated PD protocol (monthly telephone contact, psychological and nutritional surveys, pictures of daily dialysis records and lower limbs (possible edema) through Whatsapp if internet was available). Duration = 3 months | Standard PD protocol 3 months prior to implementation of intervention | 3 months | Transfer to HD (duration not specified) | N.S. difference | Serious |
Peritonitis | N.S. difference | ||||||||
Hospitalizations | N.S. difference | ||||||||
Viglino 2020 [18] | Italy |
N = 107 Age 72.2 ± 13.1y M = 59% %CAPD not specified | Observational study | VideoDialysis assisted PD (N = 15) Mean duration = 19.0 ± 12.9 months | Traditional assisted PD (N = 62) and self-PD (N = 30) | 285 months/1869 patient-months | Peritonitis | N.S. difference | Serious |
Time free from first peritonitis | N.S. difference | ||||||||
Transfer to HD (duration not specified) | N = 3 (20%) in intervention group versus 17 (18%) in the control group (no statistical analysis performed) | ||||||||
Lew 2019 [15] | U.S.A. |
N = 125 Age 56 [IQR 43.6–64.3] y M = 57% < 10% CAPD | Pilot observational study | RBM of weight and bloodpressure and two-way videoconferencing between patient and nurse (n = 125) Duration not reported | Costs pre-intervention | No information | Overall costs of care | N.S. difference for overall costs | Serious |
Outpatient visit claim payment amounts decreased post-intervention relative to pre-intervention for those at age 18–54 years. (p = 0.0155) In other subgroups (gender, race) non- or nearly significant changes were found. | |||||||||
Hospitalizations and length of hospitalization | Less for RBM-collected weight and higher for RBM-collected blood pressure (number of events and length not reported) | ||||||||
Milan- Manani 2019 [20] | Italy |
N = 85 Age 56.5 ± 15.5y M = 75% APD | Observational cohort study | RM-APD (N = 43) Duration = at least 12 months | Patients with APD without RM (historical cohort) (N = 42) | 13.28 [IQR 6.65–14.65] months in the invention group 12 months (fixed) in the control group | Hospital savings | €9130 for personnel and €5810 for logistics (p < 0.01) | Serious |
In-person visits | Lower in the intervention group (3.56 vs 5.14 visits per patient/year, p < 0.01) | ||||||||
Dey 2016 [35] | UK | N = 22 Age 61.6 [IQR 26.4–93.4] y M = 55% APD | Pilot study | Computer tablets (PODs) with integrated software for weighing scales and blood pressure machines; patient vital data recording; questionnaire regarding complaints (at beginning and end of study); twice-weekly dietary questionnaire; access to medical and educational information. Mean duration = 341.9 days, SD = not reported | Pre-intervention with PODs | 15 months | Quality of life (KDQOL-36) | N.S. difference | Serious |
Patient satisfaction (QUEST | N.S. difference | ||||||||
Kiberd 2014 [32] | Canada | N = 17 Age 57.1 ± 1.9y M = 52% %CAPD not specified | Pilot study | Web-based portal allowing communication between patients and healthcare team; Duration = 12 months | Pre-intervention | 6 and 12 months | Quality of life (CQI and EQ-5D) | N.S. difference as compared to baseline | Critical |
Patient satisfaction (Likert scale (1-10) modified from) [38] | 6.5 ± 0.6 on Likert scale | ||||||||
Magnus 2017 [33] | USA | N = 200 Mean age = not reported M = 51% % CAPD not specified | Observational study | RBM of blood pressure, weight and glucose (if diabetic), including video chat with the healthcare team; access to online educational resources. Duration = not reported | Pre-intervention with RBM; video-chat and/or access to online educational videos | Not reported | Patient satisfaction (26-item TSUQ) [39] | Number of persons that were satisfied or completely satisfied (90.7%) was higher than at baseline (p < 0.001) | Critical |
Exit-site infection | 10.5% post-intervention and 7.3% pre-intervention (no statistical analysis) | ||||||||
Hospitalizations | 20.8% pre-intervention and 15.1% post-intervention (no statistical analysis) |
Telehealth interventions
Remote monitoring (RM)
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Study
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Intervention
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Outcomes
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Results
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Risk of bias
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Quality of Life
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Harrington 2014 [29] | RM-CAPD N = 6 | Patient satisfaction | 5.2 on Likert scale (1-10) | Moderate |
SONG-PD clinical outcomes
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Milan-Manani 2020 [21] | RM-APD
N = 35 | Peritonitis Transfer to HD (duration not specified) | N.S. difference 0 in intervention group, 1 in control group | Moderate |
Corzo 2020 [34] | RPM-APD N = 148 | Transfer to HD (>30d) | Lower in intervention group (p = 0.03) | Moderate |
Mortality | N.S. difference, only reported for the non-matched population | |||
Cost-effectiveness
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Milan-Manani 2019 [20] | RM-APD N = 43 | Hospital savings | €9130 for personnel and €5810 for logistics (p < 0.01) | Serious |
Hospitalizations and health-care consumption
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Sanabria 2019 [36] | RPM-APD
N = 65 | Hospitalizations | Less in intervention group (p = 0.029) | Low |
Number of hospital days | Less in intervention group (p = 0.028) | |||
Milan-Manani 2020 [21] | RM-APD N = 35 | Hospitalizations | N.S. difference in all-cause Less disease-specific hospitalizations in intervention group (p = 0.022) | Moderate |
Frequency of visits | N.S. difference in all-causeLess urgent visits due to overhydration (p = 0.042) | |||
Milan-Manani 2019 [20] | RM-APD N = 43 | In-person visits | Lower in the intervention group (p < 0.01) | Serious |
Remote monitoring (RM) with additional features
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Quality of Life
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Dey 2016 [35] | RM-APD + access to medical data and online questionnaires N = 22 | Quality of life (KDQOL-36) | N.S. difference | Serious |
Patient satisfaction (QUEST) | N.S. difference | |||
Magnus 2017 [33] | RBM-APD +videochat and access to educational material
N = 200 | Patient satisfaction | 80.1% of participants were either satisfied or completely satisfied with the intervention | Critical |
SONG-PD clinical outcomes
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Chaudhuri 2020 [31] | RM-APD + viewing laboratory results, medication prescriptions, supply ordersN = 2284 | Transfer to HD (>6wks) | Lower in frequent users versus non-users (p = 0.001) | Moderate |
Nayak 2012 [17] | RM-APD + send pictures, view healthcare-records and schedule appointments N = 246 | Peritonitis | N.S. difference | Moderate |
Exit-site infection | N.S. difference | |||
Bunch 2020 [19] | RPM-APD + videochat N = 1023 | Peritonitis rates | N.S. difference | Serious |
Magnus 2017 [33] | RBM-APD + videochat and access to educational material N = 200 | Exit-site infections | 10.5% post-intervention and 7.3% pre-intervention (no statistical analysis | Critical |
Cost-effectiveness
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Lew 2019 [15] | RPM-APD + videochat N = 125 | Overall costs of care | N.S. difference (except for in certain subgroups) | Serious |
Hospitalizations and health-care consumption
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Chaudhuri 2020 [31] | RM-APD + viewing laboratory results, medication prescriptions, supply orders N = 2284 | Hospitalizations | Lower in frequent users versus non-users (p ≤ 0.001) | Moderate |
Number of hospital days | Lower in frequent users versus non-users (p ≤ 0.001) | |||
Lew 2019 [15] | RPM-APD + videochat N = 125 | Hospitalizations and length of hospitalization | Less for RBM-collected weight and higher for RBM-collected blood pressure | Serious |
Bunch 2020 [19] | RPM-APD + videochat N = 1023 | Teleconsultations | Higher in the intervention group (p < 0.01) | Serious |
On site evaluations | Lower in the intervention group (p < 0.01) | |||
Magnus 2017 [33] | RBM-APD + videochat and access to educational material N = 200 | Hospitalizations | 20.8% pre-intervention and 15.1% post-intervention (no statistical analysis) | Critical |
Online bi-directional communication between patients and healthcare team
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Quality of Life
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Cao 2018 [28] | Internet-based instant messaging N = 80 | Patient-satisfaction | Higher in the intervention group (p < 0.001) | Unclear |
Li 2014 [30] | Post-discharge nurse-led telephone support N = 69 | QoL (KDQOL-SF) | N.S. difference | Unclear |
Patient satisfaction | N.S. difference | |||
Kiberd 2018 [32] | Online communication between patient and healthcare team via web-based portal N = 17 | Quality of life (CQI and EQ-5D) | N.S. difference as compared to baseline | Critical |
Patient satisfaction (Likert scale (1-10)) | 6.5 on Likert-type scale | |||
SONG-PD clinical outcomes
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Cao 2018 [28] | Internet-based instant messaging N = 80 | Exit-site infection | N.S. difference | Unclear |
Peritonitis | Higher in intervention group (60 cases in 80 patients (75%) vs 40 cases in 80 patients (50%) statistical significance not reported) | |||
Mortality | Lower in intervention group (p = 0.058) | |||
Transfer to HD (was not a pre-specified outcome) | N.S. difference | |||
Li 2014 [30] | Post-discharge nurse-led telephone support N = 69 | Peritonitis | N.S. difference | Unclear |
Catheter-infections | N.S. difference | |||
Polanco 2020 [16] | Telemedicine-facilitated PD protocol (daily transfer of dialysis records and pictures, monthly contact by telephone N = 913 | Transfer to HD (duration not specified) | N.S. difference | Serious |
Peritonitis | N.S. difference | |||
Viglino 2020 [18] | Video-assisted PD N = 15 | Peritonitis | N.S. difference | Serious |
Time free from first peritonitis | N.S. difference | |||
Transfer to HD (duration not specified) | N = 3 (20%) in intervention group versus 17(18%) in the control group (no statistical analysis performed) | |||
Hospitalizations and health-care consumption
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Cao 2018 [28] | Internet-based instant messaging N = 80 | Hospitalizations | N.S. difference | Unclear |
Li 2014 [30] | Post-discharge nurse-led telephone support N = 69 | Readmissions | N.S. difference | Unclear |
Clinical visits | Less in intervention group (71% vs 47%, p = 0.039) | |||
Polanco 2020 [16] | Telemedicine-facilitated PD protocol (daily transfer of dialysis records and pictures, monthly contact by telephone
N = 913 | Hospitalizations | N.S. difference | Serious |