Remote Monitoring in Automated Peritoneal Dialysis Improves Treatment Adherence and Reduces Hospitalization Burden: A Prospective Multicenter Cohort Study.

INTRODUCTION: Remote patient monitoring (RPM) in peritoneal dialysis (PD) has the potential to improve adherence and clinical outcomes, yet comparative real-world data among PD modalities are limited. This study aimed to compare PD treatment adherence, hospitalization burden, fluid status, and health care costs among patients undergoing continuous ambulatory PD (CAPD), automated PD (APD), and remote monitoring-assisted APD (RM-APD). METHODS: In this prospective multicenter cohort study, 73 patients maintained on a single PD modality for ≥1 year were enrolled (CAPD: n = 26; APD: n = 23; RM-APD: n = 24). Treatment adherence was defined as the proportion of prescribed PD treatments actually performed (sessions for APD/RM-APD; exchanges for CAPD), expressed on a per-treatment-day basis derived from each patient's prescription and dialysate supply records. In RM-APD patients, supply-based estimates were cross-validated against Sharesource treatment records. Fluid status was evaluated using the overhydration-to-extracellular water ratio (OH/ECW%). Hospitalization days, emergency department visits, health care costs, and clinical parameters were assessed over 1 year. RESULTS: The RM-APD group showed the highest treatment adherence (median 83.4%, interquartile range 81.0-88.2), compared with 81.0% in CAPD and 78.4% in APD (Kruskal-Wallis p = 0.010). Adjusted analysis confirmed superior adherence in RM-APD compared with APD (p = 0.013) and CAPD (p = 0.041). In a subset of RM-APD patients, the supply-based estimate correlated well with Sharesource-recorded treatment delivery. RM-APD patients had significantly fewer hospitalization days (adjusted incidence rate ratio 0.34; 95% confidence interval 0.23-0.49; p < 0.001) and lower inpatient costs than APD (p = 0.037). OH/ECW% reduction was greater in RM-APD than CAPD (p = 0.042), while nutritional markers, dialysis adequacy (Kt/V), and ejection fraction were comparable across groups. CONCLUSIONS: Integration of remote monitoring into APD was associated with improved adherence, reduced hospitalization burden, and better volume control compared with conventional PD modalities. These findings provide real-world evidence that RPM-enabled home dialysis can enhance both clinical outcomes and health care efficiency, supporting broader implementation of telehealth-based care models for patients with end-stage kidney disease.