POS-339 IMPACT OF HOME TELEMONITORING AND MANAGEMENT SUPPORT ON BLOOD PRESSURE CONTROL IN NON-DIALYSIS CKD: A SYSTEMATIC REVIEW AND META-ANALYSIS

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Hypertension is a major cause of cardiovascular disease, chronic kidney disease (CKD), and death. Several studies have demonstrated the efficacy of using home blood pressure telemonitoring (HBPT) for BP control and outcomes, but the effects of this intervention remain unclear in patients with CKD. We searched MEDLINE, Embase, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Web of Science, and Dissertations and Theses for studies in non-dialysis CKD using HBPT for BP control as well as evaluation of other outcomes. We analyzed systolic blood pressure (SBP), diastolic blood pressure (DBP), estimated glomerular filtration rate (eGFR), and change in number of anti-hypertensives using a random effects model. We selected seven studies from 1,669 articles that were initially identified. Four studies were included in meta analysis for BP (Figure 1). Overall, pooled estimates in the mean difference (MD) for SBP and DBP was -8.8 mmHg; 95% CI: -16.2, -1.4; P=0.02 and -2.4 mmHg; 95% CI: -3.8, -1.0; P<0.001, respectively. For studies comparing intervention with usual care (UC), pooled estimates in MD for SBP was -7.9 mmHg; P=0.02) with no significant reduction for DBP (-2.6 mmHg; P=0.18). For studies without a UC arm, both SBP and DBP were not significantly reduced (p>0.05) (Figure 2). Two studies with a UC arm and baseline eGFR values that were not significantly different evaluated changes of eGFR after 6 months of follow-up in 79 participants. The pooled results showed a significant difference (MD: 5.35 mL/min/1.73m2; 95% CI: 2.49 to 8.21; I2= 0.0%; P<0.001) (Figure 3). However, sensitivity analysis using the follow-up measurements showed a non-significant difference (MD: 5.66 mL/min/1.73m2; 95% CI: − 1.51 to 12.83; I2= 0.0%; P=0.12) (Figure 2). Only one study reported the changes in number of hypertensive medications after 6 months of follow-up (MD: 2.63; 95% CI: − 6.52 to 1.26; I2= 0.0%). Figure 1: PRIMSA flow chart of study selection and inclusion Figure 2: Forest plot and meta-analysis for the effect of HBPT on SBP, DBP, and eGFR using 6-month follow-up mean values (sensitivity analysis). Figure 3: Forest plot and meta-analysis for the effect of HBPT on SBP, DBP, and eGFR after 6 months of follow-up. Our study shows that HBPT is associated with significant reduction of SBP and a significant improvement of kidney function, likely modulated by HBPT effects on BP. However, larger studies with improved designs and prolonged intervention periods are still needed to assess the effects of HBPT on patients’ outcomes including BP, kidney function and non-fatal and fatal CV events in patients with CKD.