Clinical Kidney Journal | 2021
Point-of-Care Testing Technologies for the Home in Chronic Kidney Disease: a Narrative Review
Abstract
Abstract Point of care testing (POCT) performed by the patient at home, paired with eHealth technologies, offers a wealth of opportunities to develop individualised, empowering clinical pathways. The non-dialysis dependent chronic kidney disease (NDD-CKD) patient who is at risk of, or may already be suffering from, a number of the associated complications of CKD, represents an ideal patient group for the development of such initiatives. The current COVID-19 pandemic, and drive towards shielding vulnerable individuals, has further highlighted the need for home testing pathways. In this narrative review we outline the evidence supporting remote patient management and the various technologies in use in the POCT setting. We then review the devices currently available for use in the home by patients in five key areas of renal medicine: anaemia, biochemical, blood pressure, anticoagulation and diabetes monitoring. Currently there are few devices and little evidence to support the use of home POCT in CKD; while home testing in blood pressure, anticoagulation and diabetes monitoring are relatively well developed, the fields of anaemia and biochemical POCT are still in their infancy. However, patients’ attitudes towards eHealth and home POCT are consistently positive and physicians also find this care highly acceptable. The regulatory and translational challenges involved in the development of new home based care pathways are significant. Pragmatic and adaptable trials of a hybrid effectiveness-implementation design, as well as continued technological POCT device advancement, are required to deliver these innovative new pathways that our patients desire and deserve.