About Remote Blood Pressure Monitoring for Chronic Kidney Disease Patients

The Remote Chronic Kidney Disease (CKD) Management System aims to  empower chronic kidney disease patients to better manage their blood pressure (BP) and reduce medication discrepancies. With regular home-based monitoring and timely feedback, it allows prompt optimisation of BP to slow down CKD progression.


The system allows the healthcare team to:  

  • Monitor patient’s BP in a regular and timely manner 
  • Assess and manage patients’ medication management issues 
  • Assess and manage patients’ CKD-related symptoms 

In addition to routine clinical care, this system could transform the CKD chronic care model as it promotes self-care, supplements clinical information provided to the healthcare team, and enhances the delivery of safe and effective care. 

Allows regular assessment and review of medication management 

Empowers patients to manage their CKD condition 

Offers convenience of remote BP monitoring via telehealth


Remote Blood Pressure Monitoring for Chronic Kidney Disease Patients at a glance


As CKD progresses, multiple classes of anti-hypertensives may be required to optimise BP control, placing the patients at a higher risk of polypharmacy and medication non-adherence. There is a need for the healthcare team to have better insight of their patients’ BP control and CKD-related symptoms promptly and to be able to detect medication non-adherence or intolerance and intervene without delay.


With the Remote CKD Management System, patients can monitor and manage their condition from home, with timely advice from the health care team. Medications can be promptly adjusted instead of waiting until the next scheduled clinic visit.

Eligible patients will enrol in the programme for six months, with:

  • Remote BP monitoring via Health Discovery+ Programme
  • Monthly surveys on medication management and symptoms related to kidney disease
  • Surveys on medication adherence


Optimised BP management in CKD patients can help to prevent the progressive decline in renal function. 

The Remote CKD Management System: 

  • Allows the healthcare team to review patients’ home BP readings, make adjustments to medication and provide medical advice promptly 
  • Encourages patients to be engaged and involved in their CKD management
  • Upskills pharmacists to lead the titration of BP medications and CKD management

Future Outlook

There is potential to extend this model of care to other patient populations, such as patients with kidney disease who are discharged from hospitals and patients on dialysis. 


Frequently Asked Question

  • Do I still have to physically see the doctor at the clinic? 
    Yes. Telehealth used in the Remote CKD Management System does not replace routine medical care. You are still required to attend your scheduled medical or laboratory test appointments. Telehealth provides early intervention to optimise your blood pressure and improve disease control.
  • Do I need to pay for this Remote CKD Management System if I agree to participate? 
    There is no additional fee if you agree to participate in this project, which is funded by the Tan Tock Seng Hospital (TTSH) Centre for Allied Health & Pharmacy Excellence (CAPE) Fund. You will need to continue to pay for your usual clinic consultations, medications and lab test costs, as there is no change to your routine medical care.
  • Is this Remote CKD Management System available 24 hours, 7 days a week?
    The healthcare team will be available from Monday-Friday, 9am-5pm, and responses will be during working days for any medication-related issues or CKD symptoms.
  • Can I drop out of the Remote CKD Management System halfway?
    You can drop out of this project at any point of time if you wish to do so. You will continue to receive routine medical care if you no longer want to participate in this project. We strongly encourage you to remain on the Remote CKD Management System to better manage your blood pressure and CKD condition.


The project is funded by the TTSH Centre for Allied Health & Pharmacy Excellence (CAPE) Fund. It is a collaboration between the Division of Pharmacy and the Department of Renal Medicine, TTSH.


“I feel more confident towards titration patients’ anti-hypertensives with the Remote CKD Management System. There is increased job satisfaction for me as their nephrologist.” 


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