Prognostic Value of Remote Monitoring Alarms for Technique Failure in Automated Peritoneal Dialysis

INTRODUCTION: While remote patient monitoring (RPM) is associated with decreased hospitalization and technique failure in automated peritoneal dialysis (APD), the prognostic utility of individual alarm patterns remains unclear. METHODS: We performed a retrospective, single-center cohort study of adult APD patients managed with the Sharesource RPM platform at National Cheng Kung University Hospital. Three predefined red-flag alarms, including initial drain variance > 50%, lost therapy volume > 10%, and lost treatment time > 30 min, were recorded from September 2019 to May 2020. Alarm burden was expressed as episodes per patient-month and categorized into tertiles. Patients were followed for three years for death-censored technique failure, defined as permanent transfer to hemodialysis. Associations were evaluated using logistic regression. Fine and Gray competing-risk models and generalized estimating equations (GEE) served as sensitivity analyses. RESULTS: Sixty-seven patients (mean age 45 ± 13 years; 61.2% male) generated 272 alarm episodes. The initial drain variance accounted for 54.8% of alarms, lost treatment time for 39.3%, and lost therapy volume for 5.9%. Technique-failure occurred in eight patients (11.9%), with rates rising across alarm-frequency tertiles (4.5%, 9.1%, and 21.7%; P for trend = 0.074). In multivariable analysis, initial drain variance > 50% independently predicted technique failure (adjusted odds ratio [OR] 1.48; 95% confidence interval [CI] 1.13-2.04; P = 0.006). Results were consistent in sensitivity analyses (Fine and Gray subdistribution hazard ratio 1.55, 95% CI 1.07-2.25; GEE OR 2.58, 95% CI 1.00-6.62). The other two alarm types were not significantly associated with outcomes. CONCLUSION: An RPM alarm for initial drain variance > 50% emerged as an early marker of technique failure in APD. Incorporating alarm-pattern analysis into routine RPM review may facilitate targeted surveillance and timely intervention for high-risk patients.