The PERMIT Project (Personalised Renal Monitoring via Information Technology) 

Medical technology in the form of wearables and wireless devices are becoming more commonplace in medical care. We would like to get opinions on your preferences for these to help create a device that will help heart failure patients look after their health.

The Personalised Renal Monitoring via Information Technology (or PERMIT project), managed at the University of Liverpool , is conducting a research questionnaire to find out preferences for medical technology to monitor heart failure from home. This study is open to anyone diagnosed with heart failure worldwide.

The study is led by Dr Ahmed Al-Naher, a clinician and researcher, and is funded by the National Institute of Health Research (CLAHRC NWC).

The findings from this research will go directly towards designing new types of medical technology that could improve the lives of anyone suffering from heart failure. If you are keen to help advance the research of heart failure, please take part in the survey and help us share it to other heart failure communities to get as many views as possible.

You can take part in the survey here. 

Many thanks in advance for providing this important feedback.

Dr. Ahmed Al-Naher

Academic Clinical Fellow

University of Liverpool, UK

aalnaher@liverpool.ac.uk

ahmed.al-naher@nhs.net

  

There are clear guidelines for the treatment of heart failure, which include the use of diuretics at some point during the treatment pathway. However, these guidelines do not cover when and how frequently patients with heart failure should have their renal function monitored largely because there is no good evidence to indicate optimum frequency in given circumstances.  

A study published in the BMJ in 2004 prospectively analysed 18,820 individuals admitted to hospital in a six month period. Overall, 6.5% presented with adverse drug reactions (ADR). Next to NSAIDs, diuretics were the second commonest cause of drug-induced hospital admissions, with most patients presenting with renal impairment.

These findings reflect a lack of guidance on when and how frequently renal function should be monitored. If evidence-based guidance on this was available, potentially this could be a method to prevent unnecessary diuretic-related hospital admissions. The aim of this project is to develop this guidance by using electronic health records and using novel analytical methodologies to define decision rules for individualised renal function monitoring.  

Our Solution – Personalised Renal Monitoring Guidance

We aim to develop personalised kidney function monitoring guidelines based on the characteristics of individual patients (for example: severity of heart failure, drugs being taken and other diseases that they might have). The availability of such monitoring protocols would change clinical care pathways, and potentially reduce hospital admissions, reduce cost and improve patient quality of life. 

To generate this personalised guidance system, electronic health care databases will be used to identify heart failure patients on diuretics. Patient data will be examined to evaluate how often renal function monitoring was done over the course of their heart failure diagnosis and how many of the patients were reported to develop renal impairment. Along with personal characteristics (for example gender, age, ethnicity) these data will be collated and examined in detail to provide indicators of how often monitoring would need to be done based on individual patient characteristics. 

Once a personalised guidance system has been developed, we aim to pilot the system out in primary care practices across the UK, using feedback from patients and clinicians in order to improve the design. This system is anticipated to set a precedent in machine learning based guidelines for the use of personalised medicine within the UK.

The Future – Remote Monitoring

This system will rely heavily on biochemical markers for renal function in order to generate personalised renal guidance. It is expected that in the near future, these markers will become easier for the patient to monitor on their own such as via point-of-care devices used in the patient’s home. To this end, our personalised guidance system will be designed to harness these future technologies in order to increase its predictive accuracy to improve the guidance it provides. Remote care will allow patients to be monitored closely even when they cannot travel to primary care practices, and allow clinicians to make changes to prescribed diuretics remotely in response. 

This will help pave the way to a future of personalised dynamic healthcare, where remote care technologies combine with personalised guidance, allowing patients to get the right drug at the right dose every time.

Affiliates and Funding

This research is being carried out at the University of Liverpool at the Institute of Translational Medicine, and has been funded by the National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC). 

Matched funding has also been provided in partnership with: