Daily Treatment Monitoring for Patients Receiving Home-Based Peritoneal Dialysis and Prediction of Heart Failure Risk: mHealth Tool Development and Modeling Study.

Abstract

Background: Peritoneal dialysis is one of the major renal replacement modalities for patients with end-stage renal disease. Heart failure is a common adverse event among patients who undergo peritoneal dialysis treatment, especially for those who undergo continuous ambulatory peritoneal dialysis at home, because of the lack of professional input-output volume monitoring and management during treatment.

Objective: This study aims to develop novel mobile health (mHealth) tools to improve the quality of home-based continuous ambulatory peritoneal dialysis treatment and to build a prediction model of heart failure based on the system's daily treatment monitoring data.

Methods: The mHealth tools with a 4-layer system were designed and developed using Spring Boot, MyBatis Plus, MySQL, and Redis as backend technology stack, and Vue, Element User Interface, and WeChat Mini Program as front-end technology stack. Patients were recruited to use the tool during daily peritoneal dialysis treatment from January 1, 2017, to April 20, 2023. Logistic regression models based on real-time treatment monitoring data were used for heart failure prediction. The sensitivity, specificity, accuracy, and Youden index were calculated to evaluate the performance of the prediction model. In the sensitivity analysis, the ratio of patients with and without heart failure was set to 1:4 and 1:10, respectively, to better evaluate the stability of the prediction model.

Results: A WeChat Mini Program named Futou Bao for patients and a patient data management platform for doctors was developed. Futou Bao included an intelligent data upload function module and an auxiliary function module. The doctor's data management platform consisted of 4 function modules, that is, patient management, data visualization and marking, data statistics, and system management. During the study period, the records of 6635 patients who received peritoneal dialysis treatment were uploaded in Futou Bao, with 0.71% (47/6635) of them experiencing heart failure. The prediction model that included sex, age, and diastolic blood pressure was considered as the optimal model, wherein the sensitivity, specificity, accuracy, and Youden index were 0.75, 0.91, 0.89, and 0.66, respectively, with an area under the curve value of 0.879 (95% CI 0.772-0.986) using the validation dataset. The sensitivity analysis showed stable results.

Conclusions: This study provides a new home-based peritoneal dialysis management paradigm that enables the daily monitoring and early warning of heart failure risk. This novel paradigm is of great value for improving the efficiency, security, and personalization of peritoneal dialysis.