Background: Hypertension is a major cause of cardiovascular disease, chronic kidney disease (CKD), and death. Several studies have demonstrated the efficacy of home blood pressure telemonitoring (HBPT) for blood pressure (BP) control and outcomes, but the effects of this intervention remain unclear in patients with CKD. Objective: To determine the impact of HBPT on cardiovascular–related and kidney disease–related outcomes in patients with CKD. Design: Systematic review and meta-analysis. Setting: All studies that met our criteria regardless of country of origin. Participants: Patients with chronic kidney disease included in studies using HBPT for BP assessment and control. Measurements: Descriptive and quantitative analysis of our primary and secondary outcomes. Methods: We searched MEDLINE, Embase, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Web of Science, and gray literature from inception for observational and randomized controlled studies in nondialysis (ND) CKD using HBPT for BP control. We selected studies that used HBPT as intervention (with or without a control arm) for BP control in ND-CKD populations. The primary outcome was change in mean systolic BP (SBP) and mean diastolic BP (DBP). Results: We selected 7 studies from 1669 articles that were initially identified. Overall, pooled estimates in the mean difference (MD) for SBP and DBP were −8.8 mm Hg; 95% confidence interval (CI): −16.2 to −1.4; P = .02 and −2.4 mm Hg; 95% CI: −3.8 to −1.0; P < .001, respectively. For studies comparing intervention with usual care (UC), pooled estimate in MD for SBP was −8.0 mm Hg (P = .02) with no significant reduction for DBP (−2.6 mm Hg; P = .18). In studies without a UC arm, both SBP and DBP were not significantly reduced (P > .05). The pooled estimate in MD for estimated glomerular filtration rate showed a significant improvement (5.4 mL/min/1.73 m2; P < .001). Limitations: Heterogeneity and few available studies for inclusion limited our ability to identify a robust link between HBPT use and BP and kidney function improvement. Conclusion: Home blood pressure telemonitoring is associated with mild lowering of BP and moderately improved kidney function in patients with CKD. However, larger studies with improved designs and prolonged interventions are still needed to assess the effects of HBPT on patients’ outcomes. PROSPERO registration ID CRD42020190705

https://journals.sagepub.com/doi/pdf/10.1177/20543581221106248

Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-Analysis

Despite a strong consensus that treatment of hypertension is fundamental to strategies seeking to slow chronic kidney disease (CKD) progression and reduce the associated risk of cardiovascular events (CVE), controversy persists regarding optimal blood pressure (BP) targets. This article reviews the evidence for different targets, discusses associated controversies and suggests approaches to improve BP control.Landmark clinical trials established the principle that lower BP targets are associated with slower progression of CKD in people with a greater magnitude of proteinuria and previous guidelines recommended a target BP of <130/80 mmHg for those with proteinuria. However, the Systolic Blood Pressure Intervention Trial provided new evidence that a systolic BP target of <120 mmHg was associated with a reduced risk of CVE, though there was no impact on CKD progression and there was concern about an increase in renal adverse events. Nevertheless, 2021 Kidney Disease Improving Global Outcomes guidelines recommended systolic BP <120 mmHg, though other updated guidelines did not follow this trend. All guidelines emphasise the importance of standardised BP measurement and a personalised approach.An individualised and shared decision-making approach to BP target setting and management is recommended, guided by standardised BP measurement. 

Blood pressure targets in chronic kidney disease: still no consensus

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Assisted reality device to guide cardiac implantable device programming in distant rural areas

Telehealth and Management Support for Hypertension in CKD: Time to Raise the Bar.

<sec> <title>BACKGROUND</title> The prevalence of CKD puts pressure on health systems providing care to patients and has led to an increase in mobile apps seeking to improve self-management for CKD patients. However, the impact of apps on the CKD population in different clinical locations and health systems remains unclear. </sec> <sec> <title>OBJECTIVE</title> This project developed SuYi APP for follow-up of CKD patients based on patient self-management theory. It was applied in clinic to determine which remote follow-up intervention (Simple APP remote follow-up vs. outpatient follow-up +APP remote follow-up) leads to improved endpoints in patients with chronic kidney disease (CKD). </sec> <sec> <title>METHODS</title> This was a retrospective cohort study. The subjects with stage 1-5 CKD without renal replacement therapy were enrolled at the CKD management center from January 2015 to December 2019 for long-term follow-up. The subjects were divided into the Simple APP remote follow-up group and outpatient follow-up +APP group. After 3 years of follow-up in December 2022, data on all-cause mortality and kidney replacement treatment were collected and compared between the two groups. </sec> <sec> <title>RESULTS</title> 5326 patients were included in the study, including 2492 in the APP group and 2834 in the outpatient+APP group. After IPTW virtualization matching, the final matched APP group consisted of 2489 cases (IQR, 33-55) and 2850 (IQR, 33-55) in the outpatient+APP group. By the end of the study, there were 34 deaths (1.4%) in the APP group and 16 deaths (1.6%) in the outpatient+APP group, with a rate difference of -0.26 (95% CI[-0.91-0.39], P=.49). The two groups were comparable after matching for renal replacement therapy outcomes (95% CI[0.72-1.08], P=.23) and survival curves, which were not significantly different. However, the selection rate of kidney transplantation in the outpatient+APP group was higher than that in the APP group (95% CI[0.09-0.81], P=.02), and the use of temporary catheters was lower in the outpatient+APP group during initial hemodialysis (95% CI[8.4%-29.8%], P&lt;.001). </sec> <sec> <title>CONCLUSIONS</title> The development and application of the app combined with outpatient follow-up management can avoiding the initiation of urgent dialysis and improve kidney transplantation selectivity. Applying outpatient follow-up+APP pattern intervention will benefit chronic disease management and health care. </sec> <sec> <title>CLINICALTRIAL</title> ChiCTR2200060627 </sec> 

Effectiveness of self-management APP in different follow-up intervention among patients with chronic kidney disease: a retrospective cohort study with a 3-year follow-up (Preprint)

Background: Hypertension, together with poorly controlled blood pressure (BP) are known risk factors for kidney disease and progression to kidney failure as well as increased cardiovascular (CV) morbidity and mortality. Several studies in patients without kidney disease have demonstrated the efficacy of home BP telemonitoring (HBPT) for BP control. Objective: The primary aim of this study is to assess the mean difference in systolic BP (SBP) at 12 months, from baseline in remote dwelling patients with hypertension and chronic kidney disease (CKD) in Northern Alberta, Canada, comparing HBPT + usual care versus HBPT + a case manager. Other secondary objectives, including cost-effectiveness and acceptability of HBPT as well as occurrence of adverse events will also be assessed. Methods Design: This study is designed as a pragmatic randomized controlled trial (RCT) of HBPT plus clinical case management compared to HBPT with usual care. Setting: Peace River region in Northern Alberta Region, Canada. Patients: Primary care patients with CKD and hypertension. Measurements: Eligible patients will be randomized 1:1 to HBPT + BP case management versus HBPT + usual care. In the intervention arm, BP will be measured 4 times daily for 1 week, with medications titrated up or down by the study case manager until guideline targets (systolic BP [SBP]: <130 mmHg) are achieved. Once BP is controlled, (ie, to guideline-concordant targets), this 1-week protocol will be repeated every 3 months for 1 year. Patients in the control arm will also follow the same BP measurement protocol; however, there will be no interactions with the case manager; they will share their BP readings with their primary care physicians or nurse practitioners at scheduled visits. Limitations: Potential limitations of this study include the relatively short duration of follow-up, possible technological pitfalls, and need for patients to own a smartphone and have access to the internet to participate. Conclusions: As this study will focus on a high-risk population that has been characterized by a large care gap, it will generate important evidence that would allow targeted and effective population-level strategies to be implemented to improve health outcomes for high-risk hypertensive CKD patients in Canada’s remote communities. Trial Registration: www.clinicaltrials.gov (NCT number: NCT04098354)

https://journals.sagepub.com/doi/pdf/10.1177/20543581221077500

Telemonitoring and Case Management for Hypertensive and Remote-Dwelling Patients With Chronic Kidney Disease—The Telemonitoring for Improved Kidney Outcomes Study (TIKO): A Clinical Research Protocol

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Impact of Home Telemonitoring and Management Support on Blood Pressure Control in Nondialysis CKD: A Systematic Review and Meta-Analysis

Telemonitoring and Case Management for Hypertensive and Remote-Dwelling Patients With Chronic Kidney Disease—The Telemonitoring for Improved Kidney Outcomes Study (TIKO): A Clinical Research Protocol