Session SB1.1

Utilisation of Telemedicine to Assess Energy Expenditure and Stability in Older People with Chronic Kidney Disease

SG John*, PJ Owen, CW McIntyre

Derby City General Hospital
Derby, UK

Chronic Kidney Disease (CKD) is common in older people. Falls are a major public health issue in this patient group. Whilst aggressive blood pressure (BP) control forms the mainstay of CKD treatment, its cardiovascular and functional consequences are unknown, particularly in the more vulnerable older age group. We are currently undertaking a study to investigate the effects in the elderly of aggressive antihypertensive medication titration to recommended targets of BP control. Objective assessment of stability, falls and energy expenditure in a home setting is challenging. Overall energy expenditure as an integrated measure of physical capability and psychological volition appears an excellent potential objective measure of quality of life. As part of this study we have been evaluating a new technology capable of providing high resolution, convenient assessment in a patient's home environment.
5 patients from the initial recruitment cohort were given a portable energy/falls monitor (TriAx, Telemedcare Ltd, Lincoln, UK) to wear during the day whilst under going antihypertensive withdrawal and subsequent monitored reintroduction. This small pager-like device, worn on the waist, contains two accelerometers allowing measurement of orientation, force and direction of movement. Data are wirelessly transmitted to a small portal connected to a telephone line in the patient's home. Data are transmitted to a central server daily to provide information on stability, fall related events and an area under the curve assessment of total daily physical activity. The TriAx contains adequate memory to allow wear outside the home.
All patients reported no significant problems with the system and found it minimally intrusive to their usual lifestyle. All patients succeeded in installing the portal within their home. Data were successfully collected for 263 of 296 days (89%). Missing data were due to system errors (20 days) and patient concordance (13 days), frequently due to patients not wishing to take the device on holiday. Average mean energy expenditure (AMEE) appears to be lower during antihypertensive reintroduction, than after withdrawal of previous antihypertensive medication (405+/-79 c.f. 446+/-77M/s; p=0.079). 710 TriAx events relating to stability were recorded, with marked variability between patients (mean 2.7; range 1.4-4.3/day).
We have demonstrated that the use of the TriAx system can provide high resolution data on both energy and stability, and is well tolerated in this cohort of older people with CKD. Although not reaching statistical significance in this small initial cohort, the reduction in AMEE with the reintroduction of antihypertensives may relate to changes in patients overall well being, and requires further investigation. The large number of events recorded indicates the high sensitivity of this system, further work is ongoing to evaluate their relevance.

(Abstract Control Number: 339)