Home Hemodialysis with Remote Monitoring and Warning System in Taiwan

Background: Home hemodialysis (HHD) with remote monitoring has emerged as a transformative approach in managing end-stage kidney disease (ESKD), offering patients greater autonomy while enabling clinicians to ensure safety and treatment efficacy. In Taiwan, where over 90% of dialysis patients receive in-center HD, the integration of remote-monitored HHD is nascent but gaining momentum amid healthcare digitization. In this report, we present our early clinical experience and patient outcomes of HHD with an innovative remote monitoring and warning system Methods: Our remote monitoring and warning system were conducted from July 2018 to December 2024 at a tertiary hospital in Taiwan piloting HHD. Vital signs and machine data including venous pressure, transmembrane pressure (TMP), ultrafiltration rate were monitored. Adult ESKD patients meeting inclusion criteria received structured HHD training and were equipped with internet-connected dialysis machines transmitting real-time data to the hospital servers. Vital signs and machine operating data were automatically screened every minute. We monitored following parameters, including high or low blood pressure, tachycardia or bradycardia, high ultrafiltration rate, HD duration, high or low venous pressure, high TMP etc. If data exceed thresholds, warning messages were sent to cell phones of patients and duty care teams for intervention if needed. Patient outcomes, treatment adherence, adverse events, quality of life (QoL), depression scores and technical data were collected for analysis. Results: We enrolled 28 patients (mean age 50.7 ± 12.7 years ; mean HHD duration 4.4 ± 2.9 years) to our study. Over 10,000 HHD treatments were monitored. No life-threatening events occurred. All patients had full treatment adherences(100%), excellent 5-year survival rate (92.9%) and low hospitalization rates (0.23 admissions/patient-year). In addition, six months after HHD, we noted significantly lower Beck depression scores (18.67±1.53 vs. 9.33±0.5, p=0.011 ) and improved SF36 QoL (55.00±3.00 vs. 66.33±3.06, p=0.036). High ultrafiltration rate, cardiac arrhythmia, and abnormal venous pressure or TMP were the alerts noted. Our patients expressed high satisfaction with this remote monitoring and warning system. Conclusion: Remote-monitoring and warning system for HHD is both feasible and effective to improve treatment compliance and safety of HD at home.