By Associate Professor Dr LIM SOO KUN

The modern healthcare landscape is always changing. Every day some new discovery is uncovered in the world of medical care – whether it is a new disease, a new treatment or a new finding, it is undeniable that the world of healthcare is constantly evolving.

In our parents’ generation, the diagnosis and treatment process were doctor-centred: you listened to your doctor, you didn’t question, and you followed instructions.

In today’s multi-connected world where every piece of information is available at our fingertips, we see a shift in the treatment process where patients are empowered with more knowledge and responsibility.

This shift has created a movement of increasingly independent patients who are taking the responsibility for their own care by being aware of their treatments options and prescribed medication and measuring their own vitals (for example monitoring their blood pressure and blood sugar at home).

This active participation in their care creates a true partnership between the patient and doctor, building their confidence and ability to get better while living a good quality of life.

We are also fortunate that we have seen many new technologies that have been discovered recently – all focused on empowering patients to be independent and improve the quality of care.

One such discovery has been cloud-based remote monitoring for patients. This discovery has created a paradigm shift in how end stage renal disease (ESRD) patients could be treated in the future.

End stage renal disease on the rise

ESRD is also known as the 5th stage of chronic kidney disease (CKD) where a kidney patient experiences complete and irreversible kidney damage.

Among patients with high risk of CKD include those with diabetes, hypertension and family history of kidney disease.

One of the most unfortunate things about CKD is that the symptoms are not noticeable until the disease has progressed to an advanced stage.

ESRD patients have several options for treatment, called renal replacement therapy, which include haemodialysis, peritoneal dialysis or kidney transplantation.

ESRD patients have several options for treatment, called renal replacement therapy (RRT), which include haemodialysis (HD), peritoneal dialysis (PD) or kidney transplantation.

HD requires patients to receive dialysis treatment at centres where they are connected to a machine that conducts the filtration. The minimum requirement is four hours per session, three sessions a week.

PD uses the lining of the abdomen (called peritoneal membrane), to filter blood inside the body, allowing patients to manage their treatment from the convenience of home.

PD patients have two options – Continuous Ambulatory Peritoneal Dialysis (CAPD), a manual method that allows them to conduct dialysis without the help of a machine. The typical CAPD prescription is four exchanges a day, with five to six hours interval between exchanges.

PD patients, especially those on automated PD, can benefit from taking a more active role in self-care. Photo:

The other option is known as Automated Peritoneal Dialysis (APD), which uses a machine to conduct peritoneal dialysis during sleep at night.

In Malaysia, the incidence and prevalence of patients with ESRD has been on the rise for the past 20 years. The 22nd Report of the Malaysian Dialysis and Transplant Registry in 2014 reported that in a period of less than 10 years, the number of new ESRD patients in Malaysia has increased at a rate of more than double, from 3,167 in 2005 to 7,055 in 2014.

Research has shown that the estimated incidence of new dialysis patients in 2020 and 2040 are 10,208 and 19,418 cases respectively. This is alarming and indicates a clear cause for concern as the need for dialysis and medical care increases, leading to a burden on our healthcare resources.

Exploring cloud-based remote monitoring

The introduction of cloud computing into the realm of healthcare services could be one of the steps that the medical community takes in face of the rising prevalence of patients with ESRD.

Ideal for ESRD patients who have already opted for the independence that PD provides them, cloud computing takes self-adherence and self-monitoring one step further.

Cloud computing holds inestimable value for providing high-quality and efficient care for PD patients – archiving patient records, improving efficiencies, streamlining the partnership between patient and doctor while removing logistical barriers of time and space.

Cloud computing and remote monitoring changes the way doctors and patients manage home dialysis care. Using a web-based connectivity platform, it bridges the gap between the clinic and home by allowing doctors to remotely monitor patients’ treatment data.

Providing comprehensive treatment reporting, it provides on demand access to data. This allows doctors to explore various opportunities in treating patients – further improving care by allowing doctors to intervene when necessary.

This would be helpful for patients who are staying far away from hospital, where remote monitoring also allows doctors to make adjustments to a patients’ treatment immediately through customised alerts, leading to a more timely therapy decisions that could possibly improve therapy outcome.

Patients on the other hand can be more connected with their renal care team, reducing missed dialysis sessions or incomplete treatment data record from their dialysis sessions.

This technology also ensures that nephrologists are receiving accurate data to guide their treatment decision and adjustment.

This would lessen the burden on our healthcare resources by reducing serious infections from occurring (namely peritonitis, i.e. peritoneal infections), and reducing hospitalisations.

Ultimately, this ensures treatment adherence and successful therapy, thereby enhancing a patient’s ability to improve self-care.

While Malaysia is still in the infancy stages of adopting cloud computing technologies into our healthcare, it is undeniable that this technology holds a lot of potential for ESRD patients in our country.

There might be challenges in addressing various issues that come with cloud-based remote monitoring – patient data confidentiality, the need for patient education, the additional effort for doctors to constantly monitor data.

However it is clear that the benefits outweigh these issues. What we can work towards is a community of patients and doctors who are fully informed of the new technology that is available to them, allowing doctors to provide better care regardless of distance and time and building a partnership that empowers patients to be an active participant in their PD treatment.

Slowly but surely, we will be able to reap the benefits of cloud computing for ESRD patients in Malaysia.