Original Title: Telemonitorización y gestión informatizada de pacientes en diálisis domiciliaria y actividades de rehabilitación

Authors' objectives: To evaluate the efficacy and safety of remote monitoring (telemonitoring) through automated dialysis, as well as digital rehabilitation/physical exercise interventions for patients with chronic kidney disease (CKD) receiving home dialysis, and secondly, to identify organisational, ethical and legal considerations associated with both strategies, as well as the evidence of the cost-effectiveness of these types of interventions.

Authors' results and conclusions: Of the publications identified in the initial search, nine were selected: 1) three SRs on the efficacy and safety of telemonitoring in patients on home dialysis; 2) one SR on the use of mobile devices for the rehabilitation of patients with CKD on home dialysis; 3) another SR on the preferences of patients with CKD regarding digital interventions promoting healthy lifestyles; 4) one SR on the economic evaluation of telemonitoring in patients with chronic illnesses in general; and 5) three relevant individual studies: one on the impact of a telemonitoring system for automated peritoneal dialysis (APD) at organisational and economic levels, the second on the cost-effectiveness of remote monitoring of APD and the third analysing comments in online forums among patients on CKD. A further 35 studies were included in the update: 8 on the efficacy and/or safety of telemonitoring in patients with APD; 6 on the effect of digital interventions on physical exercise; 9 on ethical, legal and organisational issues; 10 on the values and preferences of patients and/or health professionals, and two reviews on the environmental impact of dialysis-based treatment. Four additional studies for rehabilitation were included from the new specific search on digital interventions, so, as a result, a total of 39 studies were added. Having rated the quality of the evidence using the GRADE approach, it was concluded that automated telemonitoring in patients with APD can reduce all-cause mortality and dialysis failure, but there is insufficient evidence to demonstrate a reduction in the risk of peritoneal infection. Regarding quality of life, significant differences were found only on the vitality and general health subscales. The results regarding all-cause hospitalisation range from a lower rate to insignificant differences comparing automated telemonitoring to usual care. However, both the length of hospital stay (in days) and disease-specific hospitalisation were significantly lower. Regarding economic evaluations, in studies performed in other settings, telemonitoring of APD seems to be cost-effective compared to usual care. On the other hand, while some patients prefer care modalities that provide independence, flexibility, convenience, more regular check-ups and fewer journeys, others are concerned about the loss of face-to-face contact with health professionals and/or compromising their personal data. Regarding organisational factors, barriers were identified related to patients, health professionals and funding policies. Education and skills training for clinicians and patients could facilitate the implementation of telemonitoring. Other key factors that could influence its implementation include the quality of internet connections, the technical support available, the technical characteristics of the remote monitoring systems, as well as their interoperability and integration with hospital systems. Finally, although APD has a lower environmental impact than haemodialysis, there is still room for improvement in some areas. These include more local production of the equipment and reductions in the waste generated and the water needed to run the systems. In the case of digital interventions related to rehabilitation/physical exercise, evidence shows increases in patient functional capacity and number of steps per day. They also improve mental health-related quality of life and perceived self-efficacy. Regarding costs, digital interventions were found to be more cost-effective than usual care. On the other hand, there may be differences in patients’ willingness to use mobile health applications as a function of age, literacy, mobility, and area of residence. Concerning facilitators, it was found that apps should have an appealing design and simple instructions, be personalised, provide reminders, include educational sections and action plans, offer a gradual programme, and enable patients to share experiences with other patients. CONCLUSIONS. The evidence gathered indicates that telemonitoring of automated dialysis reduces mortality, disease-specific hospitalisation, dialysis failure and hospital stay (in days per patient-year). Nonetheless, the evidence is inconclusive regarding its effectiveness in reducing peritoneal infections or improving quality of life compared with usual care. In any case, given the overall low quality of the evidence, larger and higher quality studies should be conducted to increase the confidence on the evidence for effectiveness and safety. On the other hand, although cost-effectiveness studies performed in other countries suggest that these technologies are cost-effective, the costeffectiveness of implementing these interventions in our setting needs to be evaluated. The indirect costs of different RRT modalities for patients, related to rates of employment and participation in education, also need to be investigated to determine whether the introduction of these technologies could help reduce costs and positively influence patient quality of life. To facilitate the implementation of telemonitoring interventions, healthcare professionals highlight the need for the systems to provide automated alerts and two-way communication. Education and skills training would also facilitate their implementation. Regarding environmental issues, measures that may reduce the environmental impact of these technologies have also been identified. In relation to programmes encouraging physical exercise, although the evidence was of low to very low quality, results indicate that they may improve patient functional capacity and quality of life. Further, to be implemented successfully, they need to consider patients’ characteristics and values, be tailored and provide ongoing follow-up. However, the studies identified to answer this question did not only include patients with CKD on home dialysis. Therefore, further studies are warranted on this specific type of patient.

Authors' methods: An initial literature search was conducted to identify relevant SRs and meta-analyses. Subsequently, the search was updated at the individual study level, using two different approaches: repeating the initial search and conducting a new search focused on digital rehabilitation and physical exercise interventions for patients with CKD receiving home dialysis. The quality of the SRs was assessed using the updated version of A Measurement Tool to Assess Systematic Reviews (AMSTAR 2), while for individual studies, the appraisal tool used depended on the study design. Further, the SRs of economic evaluation studies were assessed using the Criteria for Cost (-Effectiveness) Review Outcomes (CICERO) checklist, and individual studies using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. In the case of qualitative or mixedmethod studies, no formal assessment of study quality was performed. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used for evidence synthesis and evaluation.

Project Status: Completed

Year Published: 2026

URL for published report: https://www.euskadi.eus/contenidos/informacion/osteba_publicacion/es_def/adjuntos/Telemonitorizacion_y_Gestion_Informatizada.pdf

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>