How To Leverage Remote Patient Monitoring (RPM) to Address Gaps in Kidney Care

Nephrology is a medical specialty that focuses on kidney care and hence encompasses the prevention, diagnosis, and management of conditions affecting the kidneys. Many conditions affecting the kidneys are systemic, meaning these conditions affect more than one organ in the body. It is common for people with primary hypertension, obesity, diabetes, or heart failure to have secondary problems related to kidney function. Conversely, a primary diagnosis of chronic kidney disease (CKD) often manifests simultaneously with hypertension and diabetes. As a result, kidney specialists work closely with primary care, cardiology, and endocrinology specialists to tackle other existing (i.e., comorbid) problems. This article discusses how care teams can leverage RPM in kidney care to improve outcomes through proactive interventions.

Kidney Health Outcomes

The kidney disease population leads in hospital admissions metrics among chronic diseases. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) amount to $125 billion in Medicare costs in 2019, or 20% of the total annual spend. Management of chronic kidney disease spectrum involves everything from diet and medications in the early stages to dialysis and eventually kidney transplantation for end-stage renal disease.
Given the complexity and difficulty of management, kidney disease patients (especially those at risk for progression to ESRD) are at high risk for hospitalization, with ESRD often surpassing the admission rates of other chronic conditions such as heart failure. I believe that kidney care teams can address the gaps in the continuum of care for kidney disease with the targeted use of remote patient monitoring technology.

Gaps in Kidney Care

• Poor transitions of care – difficulty coordinating care at the provider and system level for different stages of kidney disease
• Insufficient patient education – lack of patient knowledge from the early stages of CKD through dialysis and transplantation
• Poor management of comorbidities – multiple comorbidities increase treatment complexity and the cost of care to patients and their health plans
• Low patient satisfaction – improve informed consent on various treatment options and encourage shared decision making; tackle transportation issues through rideshare technology

A Strong Case for Telehealth and Remote Patient Monitoring

The kidney disease population leads in hospital admissions metrics among chronic diseases. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) amount to $125 billion in Medicare costs in 2019, or 20% of the total annual spend. Management of chronic kidney disease spectrum involves everything from diet and medications in the early stages to dialysis and eventually kidney transplantation for end-stage renal disease.
Given the complexity and difficulty of management, kidney disease patients (especially those at risk for progression to ESRD) are at high risk for hospitalization, with ESRD often surpassing the admission rates of other chronic conditions such as heart failure. I believe that kidney care teams can address the gaps in the continuum of care for kidney disease with the targeted use of remote patient monitoring technology.

It’s now common knowledge that telehealth removes barriers to access for patients. When most people talk about telehealth, they mainly refer to telemedicine, virtual visits, and the additional touchpoints for communication these visits provide between in-person appointments. However, remote patient monitoring provides a unique opportunity to design high-touch programs to support existing patient care processes through digital care management.
With a well-designed RPM program, kidney patients gain access to a suite of support services and educational content to delay the progression of kidney disease and retain a good quality of life. The Hypertension RPM Program developed at PatientOne is one such example. Our protocol collects daily blood pressure, pulse, and weight readings from patients and engages them with short learning modules about their condition, risk factors for disease progression, and steps they can take to get healthier. The Hypertension RPM package includes:

• Electronic Blood Pressure Monitor: Our connected blood pressure devices enable the measurement of disease severity through physiologic data. Bluetooth and cellular-equipped devices encourage patients to measure their blood pressure daily and our monitoring software provides a trend for the kidney care team to mount proactive therapeutic interventions.
• Smart Weight Scale: Connected weight scales work right out of the box and connect over Bluetooth (to a smartphone) or directly to a cellular network to our HIPPA-compliant cloud software solution. Chronic kidney disease patients provide daily weight measurements that can approximate fluid status and prompt, timely interventions for fluid overload.

The beauty of RPM lies in the fact that daily patient recordings yield a more prognostic assessment of each patient’s condition. The PatientOne dashboard is an intuitive, interactive interface optimized for clinicians to visualize trends to inform therapeutic management. It can be customized to prioritize at-risk patients automatically. We can trend recordings that indicate worsening hypertension and heart failure (or diabetes via connected glucometers) in kidney disease patients to stratify patients based on risk. We can also track patient engagement and medication adherence and use AI to predict a risk of rapid CKD progression with the right amount of data. We have designed our Obstetrics RPM programs to work seamlessly with team-based care models that place the patient at the center. Our clinician-authored educational Pregnancy Remote Monitoring matches each patient’s stage in their care journey and can be programmed to target each identified risk factor.

Looking to the Future

RPM and patient engagement technology can be used in the management of patients on dialysis and perioperatively in pre- and post- transplant care. In situations where conventional treatments do not work as well, chronic kidney disease patients could be eligible to participate in innovative clinical trials that test new therapies before they become widely available. Our remote monitoring programs help bring decentralized clinical trials to more patients in the comfort of their homes.

References

1. Centers for Disease Control and Prevention. Chronic Kidney Disease Basics.  Accessed May 2, 2022.
2. American Heart Association. How High Blood Pressure Can Lead to Kidney Damage or Failure. Accessed May 2, 2022.