Supplementary Material for: Patient Adherence and the Serum Phosphate, Calcium, and Intact Parathyroid Hormone Control in Peritoneal Dialysis Patients: Effectiveness of Smart PD Care Program

Introduction: Patient adherence is important for long-term outcomes of peritoneal dialysis (PD). Artificial intelligence is a good tool to manage patients. However, limited data regarding on its impact on the patient adherence, and the effect of patient adherence on serum phosphate, calcium, and intact parathyroid hormone (iPTH) control in PD patients. Methods: This was a single-center, prospective cohort study included PD patients in Guangdong Provincial People's Hospital. Adult patients (age ≥ 18 years) who included in the smart PD care program from September 1, 2020 to April 31, 2023 were enrolled. Patient adherence was accessed using the patient reported daily PD prescription data and calculated as the total days with PD ultrafiltration reported divided by the total days of follow-up. Good adherence was defined as the reporting rate ≥ 80%. The primary outcome was serum phosphate, calcium, and iPTH values achieved the treatment targets at 12-month follow-up. Unadjusted and adjusted generalized estimating equations (GEE) were used to evaluate the association of patient adherence with the serum phosphorus, serum calcium, and iPTH control. Results: A total of 267 patients were included in this study. The mean age of the whole cohort was 43.3 ± 12.8 years, 130 (48.7%) were females, and 52 (19.5%) had diabetes. Patient adherence improved after included in the smart PD care program and the overall patient adherence during 12 months follow-up was 77.1% ± 26.4%, 93.0% ± 7.4% and 50.9% ± 25.6% for the entire cohort, patient with good adherence and poor adherence, respectively. Compared to patients with poor adherence, those with good adherence were associated with a better serum calcium (adjusted OR, 3.76; 95% CI, 2.67-5.30; p<0.001) and iPTH control (adjusted OR, 2.20; 95% CI, 1.56-3.11); p<0.001), but not for serum phosphorus control (adjusted OR, 1.31; 95% CI, 0.89-1.91; p=0.17) after adjusted for potential confounders. Results were similar when assessing the relationship between patient adherence and the longitudinal changes of serum calcium, iPTH and phosphorus during follow-up. Conclusions: Patients adherence improved after included in the smart PD care program. Good patient adherence was associated with better serum calcium and iPTH control, but not for phosphorus control in PD patients. Further studies should be done to evaluate the effect of the smart PD care program on long-term patient outcomes.