Practical Aspects on Use of Sharesource in Remote Patient Management.

Remote patient management (RPM) has been increasingly implemented in the care of chronic patients in the last decades with significant positive impact on clinical outcomes. Home-based dialysis therapies constitute an attractive alternative to in-center hemodialysis as they offer patients more flexibility and empowerment. Nonetheless, their remote nature and intrinsic problematic visibility to therapy-related issues occurring at home contribute to holding back both patients and nephrologists from adopting them. RPM has recently become available in automated peritoneal dialysis (APD) by means of a new cloud-based platform with a 2-way communication system (Sharesource), offering accurate daily monitoring of the therapy as well as ability to remotely alter the prescription. Its main documented advantage is the early identification of clinically relevant issues such as catheter dysfunction and non-adherence to prescribed PD therapy; its contribution to recognition of an imminent peritonitis has still to be evaluated. RPM is also of particular interest for patients with social, geographical or physical limitations in terms of travel reduction. Moreover, permanent access to data for PD teams may provide reassurance and alleviate anxiety generated by the remote nature of the method for both patients and nephrologists. Finally, RPM offers further advantages such as a more personalized APD prescription, tailored to patients' needs, as well as improved clinical follow-up and a more proactive care. Long-term impacts of RPM in PD on patients' outcomes, healthcare costs, and its potential influence on a greater take-up of the technique, notably through reinforced confidence for both patients and nephrologists through better visibility of the progress of the therapy, have still to be evaluated. Given the positive impact of PD on the preservation of residual renal function and association of the latter with better survival, any tool that may contribute to its broader use is most valuable.