A further advantage that may have an impact on the quality of life is alleviating the burden of travel times, which is of particular importance for specific populations such as patients with reduced mobility or hampered by other limitations, but also for very professionally or socially active patients who wish to spend their time more efficiently. Reassurance and reinforced confidence in APD through accurate daily monitoring is also a key feature of RPM for both patients and nephrologists. Further improvement of clinical follow-up through availability of relevant data such as blood pressure and weight is also valuable. The main limitation currently, is potential voluntary or involuntary human errors, as the values have to be manually registered. Bluetooth enabling would be a considerable enhancement for the reliability of data and reduction of patient tasks.
As illustrated by the Italian study, RPM has the potential to offer a more personalized therapy, tailored to patients’ needs. It may also have an impact on healthcare costs, owing to the reduction of the number of documented in-person visits in the incident RPM group.
These advantages make RPM a very promising tool to help clinicians further improve the quality of care of APD patients. It should, however, not be used to represent a burden and a disturbance in their privacy; of note, no such complaint has been documented yet and patients seem to work well with their RPM. Furthermore, it remains a tool in the therapeutic armamentarium and should not under any circumstances become a substitute for clinical evaluation as the latter is, together with doctor-to-patient communication, a cornerstone of good care.
In the future, the long-term impacts of RPM on important patient outcomes such as morbidity, mortality, hospitalization rate, and quality of life, as well as on healthcare costs and on technique survival will have to be determined.
From a more global point of view, it will be interesting to see whether RPM may have an impact on global uptake of PD; indeed, given its significant positive impact on the preservation of residual renal function, and the latter being associated with better survival, any means that can reinforce confidence in embracing this technique and lead to its broader use is valuable.
Acknowledgments
I am grateful to Mrs. Teresa Gmür for her help in copyediting the manuscript.
Disclosure Statement
V.J.D. has received grant support and honoraria from Baxter Healthcare.
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18Milan