Impact of remote monitoring in home dialysis: 5-year observation results

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Massimo Morosetti

Massimo Morosetti 1, Michelina Peccerillo 1, Daniele Frattarelli1, Maria Iolanda Famà2

1 UOC Nefrologia e Dialisi. Ospedale G.B. Grassi. ASL Roma 3. Roma, Italia
2 Vree Health Italia s.r.l. Roma, Italia

Corresponding author:
Prof. Massimo Morosetti
UOC di Nefrologia e Dialisi, Ospedale G.B. Grassi. ASL Roma 3. Roma, Italia
Tel +39 0656482018
E-mail: massimo.morosetti@aslroma3.it

 

Abstract

Dialysis (hemodialysis and peritoneal dialysis) is one of the main therapeutic alternatives for patients with end-stage renal disease. It can be provided in different settings, including the home setting. Published literature shows that home dialysis improves both survival and quality of life, while producing economic advantages. However, there are also significant barriers. Home dialysis patients often report “abandonment issues” by healthcare personnel.

This work aimed at assessing the efficiency of the Doctor Plus® Nephro telemedicine system (adopted in the Nephrology Center of the P.O. G.B. Grassi di Roma-ASL Roma 3) in monitoring patient health status and improving the quality of care. From 2017 to 2022, N=26 patients were included in the analysis (mean duration of observation: 2.3 years). The analysis showed that the program was able to promptly identify possible anomalies of the vital parameters and activate a series of interventions aimed at normalizing the altered profile. During the study period, the system issued N=41,563 alerts (N=1.87 alerts per patient/day), of which N=16,325 (39.3%) were clinical and N=25,238 (60.7%) were missed measurements. These warnings ensured stabilization of the parameters, with clear benefits on patients’ quality of life. A trend of improvement was reported by patients, regarding their perception of the health state (EQ-5D questionnaire; +11.1 points on the VAS scale), the number of hospital admissions (-0.43 accesses/patient in 4 months), and of working days lost (-3.6 days lost in 4 months). Therefore, Doctor Plus® Nephro represents a useful and efficient tool for home dialysis patients’ management.

Keywords: chronic renal insufficiency, dialysis, hemodialysis, Doctor Plus® Nephro, remote monitoring

Sorry, this entry is only available in Italian.

Introduzione

L’insufficienza renale cronica (IRC) è una malattia severa che se non trattata adeguatamente può avere un impatto negativo sulla qualità e l’aspettativa di vita. Storicamente, i pazienti affetti da IRC dispongono di due alternative terapeutiche: il trapianto d’organo, attuabile in una casistica selezionata, e la dialisi (emodialisi e dialisi peritoneale) [1–3]. A livello globale, le stime del 2010 segnalavano una prevalenza di 2.050 milioni di soggetti dializzati, un numero destinato a raddoppiare, almeno, intorno al 2030 [4]. In Italia, si stima che il numero di pazienti attualmente in dialisi sia pari a circa 45-49.000 [2].

La dialisi può essere erogata in diversi setting, tra cui quello domiciliare. Nonostante questa pratica sia stata introdotta ormai da circa 60 anni, la dialisi domiciliare non è il setting utilizzato più comunemente in Italia, rappresentando circa il 15% [3]. 

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Controversy in estimating glomerular filtration rate through traditional equations in transgender people: discussion through a case report

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Ingrid Sarmento Guedes

Ingrid Sarmento Guedes1, Luiz Valério Costa Vasconcelos1, Ana Paula Pires Lázaro de Oliveira1, Elizabeth De Francesco Daher2, Geraldo Bezerra da Silva Junior1,2

1 Corso di Medicina, Centro di Scienze della Salute, Universidade de Fortaleza. Fortaleza, Ceará, Brasile.
2 Dipartimento di Medicina Clinica, Facoltà di Medicina, Universidade Federal do Ceará. Fortaleza, Ceará, Brasile.

Corresponding author:
Prof. Geraldo Bezerra da Silva Junior.
Universidade de Fortaleza. Av. Washington Soares, 1321, Bloco E, Sala E-01. CEP: 60811-905.
Fortaleza, Ceará, Brasile.
E-mail: geraldobezerrajr@unifor.br

 

Abstract

Introduction: Chronic kidney disease (CKD) and the number of transgender people is on the rise. Hormone replacement therapy may be associated with the development of adverse effects, including kidney disease.
Objective: To report the case of a transgender patient using hormone therapy who developed CKD.
Case Report: Male transgender patient, 28 years old, using testosterone cypionate every 15 days, without any comorbidity. Evolved with hypertensive peaks of 160-150/110 mmHg and loss of kidney function (Ur 102 mg/dl, Cr 3.5 mg/dl, estimated Glomerular Filtration Rate (eGFR) of 22 ml/min/1.73m2 considering male gender and 16.6 ml/min/1.73m2 considering female gender). Abdominal ultrasound showed chronic parenchymal nephropathy. Due to the significant reduction in eGFR, the patient was referred for kidney transplantation, but he was not included in the list because he had a creatinine clearance of 23 ml/min/1.73m2 for males and 21.5 ml/min/1.73m2 for females in the most recent tests.
Conclusion: Hormone replacement may have contributed to the increase in the patient’s blood pressure and, consequently, to the development of CKD. There is still no well-established consensus on the best way to estimate the GFR in transgender people, and it seems to be more appropriate to consider the gender to which the person self-identifies or to perform the calculation for both genders, obtaining an estimate of the range in which the patient’s GFR lies.

Keywords: Transgender persons, chronic renal insufficiency, hypertension, hormone replacement therapy.

Sorry, this entry is only available in Italian.

Introduzione

La malattia renale cronica (MRC) è un grave problema di salute pubblica in tutto il mondo, che colpisce tra il 9,1% e il 15% degli adulti [1, 2]. In Brasile, l’insufficienza renale cronica ha mostrato un numero crescente negli ultimi decenni, con oltre 144 000 pazienti attualmente in dialisi [3]. Parallelamente, c’è un numero crescente di persone transgender, con una stima di oltre 1 milione negli Stati Uniti e 150 000 in Canada [4–6]. In un recente studio epidemiologico, è stato stimato che in Brasile l’1,9% della popolazione si identifica come non binaria e lo 0,69% come transgender [7], che corrisponderebbe a circa 1,4 milioni di transgender. 

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