Digital monitoring in peritoneal dialysis: remote monitoring and risk stratification as a scalable model of care at the national level.

Abstract

Introduction: Peritoneal dialysis (PD) requires adherence to technique and continuous monitoring to prevent complications. Digital technologies enable expanded monitoring and optimized care. The objective was to describe the implementation of a nurse-led remote monitoring program and the results of a digital risk calculator for PD patients.

Materials and Methods: A prospective, descriptive, observational study was conducted between February and June 2026 within the PD program at the Calderón General Teaching Hospital. Zoom video calls were used to assess clinical status, dialysis technique, medication adherence, and the home environment. A digital calculator was developed using 24 variables grouped into five areas: clinical manifestations, dialysis technique, medication adherence, home environment, and mechanical failures. Patients were stratified into low (0–3), intermediate (4–7), and high (≥8 points) risk categories.

Results: Remote monitoring was performed on 20 patients (mean age 42.9 ± 12.9 years; 60% female; mean time on PD 24.2 ± 23.0 months). The calculator classified 12 patients (60%) as low risk and 8 (40%) as intermediate risk; no patients were classified as high risk. Situations requiring intervention were identified in the majority of patients during remote monitoring. The most frequent findings were errors in dialysis technique (11; 55%), clinical manifestations (10; 50%), and issues regarding medication adherence or recent hospitalization (8; 40%), followed by inadequate environmental conditions (3; 15%) and mechanical failures (1; 5%). Educational interventions and early re-evaluation were carried out for 8 patients (40%) without requiring an in-person visit, and the issues were resolved in a timely manner.

Conclusions: Remote monitoring enabled the identification of modifiable situations, and the digital calculator facilitated risk stratification and the definition of individualized interventions, demonstrating the feasibility of strengthening PD surveillance and promoting scalable digital models at the national level.