Chronic Kidney Disease, Queensland (CKD.QLD) Registry: Management of CKD With Telenephrology

Venuthurupalli, S. K.; Rolfe, A.; Fanning, John; Cameron, A.; Hoy, Wendy E.

doi:10.1016/j.ekir.2018.07.013

Cited by 14 publications

(19 citation statements)

References 11 publications

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“…Our findings among the CKD population are similar to those of previous studies. 16 , 17 Interestingly, Ladino et al. found improved outcomes for blood pressure, although this was among an underserviced population compared with our study population, who were already accessing care.…”

Section: Discussioncontrasting

confidence: 62%

“…12 However, the uptake of TVC for management of kidney transplant recipients (KTRs) has been lagging, 13 and reports of outcomes of care are limited. 14 , 15 Telehealth videoconferencing has been more widely reported among the CKD population, including in observational studies 16 , 17 , 18 and a randomized controlled trial, 19 all suggesting improved patient access and clinical outcomes comparable to those of standard care. A systematic review of telemedicine for blood pressure control in nondialysis CKD found only 3 studies with no difference compared to standard care.…”

mentioning

confidence: 99%

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Telemedicine for Outpatient Care of Kidney Transplant and CKD Patients

Lambooy

Krishnasamy

Pollock

et al. 2021

Kidney International Reports

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Introduction: Telehealth videoconferencing (TVC) may improve access in rural areas, but reported uptake and outcomes among kidney transplant recipients (KTRs) and chronic kidney disease (CKD) patients are limited. This study aimed to assess the feasibility, sustainability, and clinical outcomes of TVC for this patient population.Methods: A total of 64 participants were recruited in this single-center, prospective, 2-year longitudinal, case-control study. Inclusion criteria for the telemedicine group included travel of $15 km to the hospital, and the control group was matched for transplant or CKD status, age, and sex. The primary outcome was feasibility ($50% of consultations for each individual patient in the telemedicine group being conducted by TVC in year 1). Secondary outcomes were sustainability of telemedicine, change in blood pressure and creatinine, hospitalization, and travel distance.Results: There were 32 participants in both the telemedicine and control arms, with no baseline differences. The majority were male (65.6%) and the mean age was 63.9 years (SD ¼ 12.3 years). TVC uptake in year 1 in the telemedicine arm was 71% (interquartile range [IQR] ¼ 50.0À100.0) but reduced significantly in year 2 (50.0% [IQR ¼ 33.3À71.4], P < 0.01). No significant differences in creatinine or blood pressure were observed between groups, including in the KTRs and CKD subgroup analysis. Patient satisfaction remained high for both groups. Compared with travel distance required if TVC was unavailable, travel distance in the TVC group decreased by 48% (16,644 km) in year 1 and by 37.0% (8177 km) in year 2. Conclusion:TVC was feasible and sustainable, with outcomes comparable to those of standard care. Larger studies, especially among KTRs, are needed to confirm these findings.

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Section: Discussioncontrasting

confidence: 62%

mentioning

confidence: 99%

Telemedicine for Outpatient Care of Kidney Transplant and CKD Patients

Lambooy

Krishnasamy

Pollock

et al. 2021

Kidney International Reports

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“…The information from this data enabled us to develop alternate models of care for these elderly populations with multiple co-morbidities distributed over a vast geographical area with telenephrology service. 40 Comparisons of the Registry data across various health services and between urban and rural population may inform disease variance across Queensland.…”

Section: Discussionmentioning

confidence: 99%

Chronic kidney disease, Queensland: Profile of patients with chronic kidney disease from regional Queensland, Australia: A registry report

et al. 2019

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Background Chronic kidney disease, Queensland (CKD.QLD) is a multidisciplinary, collaborative research platform for CKD in Queensland. Most public renal services contribute towards the CKD Registry, including Toowoomba Hospital, which is a referral hospital for Darling Downs Health serving a largely regional population in Queensland. We aim to present the profile of the CKD cohort recruited to the CKD.QLD Registry from Toowoomba Hospital, the first comprehensive report on a pre‐dialysis population from regional Australia. Methods Study subjects were patients in the Darling Downs Health Service who consented to be included in the CKD.QLD registry from June 2011 to December 2016. Those who were on renal replacement therapy (RRT) were excluded. Patients were followed until date of RRT, death, discharge or loss to follow up or a censor date of 30th June 2017. Results Overall 1051 subjects, representing 13% of all CKD.QLD Registry patients gave consent of whom, 42.7% were ≥70 years of age. The mean age was 63.8 ± 15.1 years (median age 67 years) with male predominance (55.4%). The majority were born in Australia (86.4%). Aboriginal and Torre Strait Islanders (A&TSI) constituted 9.6% of the cohort. The predominant CKD stages were 3b (28.9%) and 4 (27.7%). Hypertension and diabetes were noted in 91% and 44% of subjects, respectively. Diabetic nephropathy was the leading cause of CKD (26.7%) followed by renovascular disease (17.3%) and glomerulonephritis (14.8%). In 12%, the diagnosis was uncertain. Major co‐morbidities included coronary artery disease (24.7%) chronic lung disease (14.8%), cerebrovascular disease (11.6%) and peripheral vascular disease (8.9%). Non‐vascular co‐morbidities included arthritis (24.6%), gout (23.6%) and gastro‐oesophageal reflux disease (19%). The multi‐morbidity profile was differed by gender, diabetic status and age. Over a follow‐up period upto 72 months, 93 (8.8%) started RRT and 175 (16.6%) died. Of those 82% died without RRT and 18% died after RRT. Conclusion This CKD Registry cohort from regional Queensland consisted mainly of older Caucasians with male predominance. A&TSI patients were overrepresented compared to the overall population. A significant proportion had cardio‐vascular disease and multiple co‐morbidities which differed by gender, diabetic status and age. This report provides valuable data for health services planning and delivery in regional Queensland.

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“…An observational study of nephrology clinics run via videoconference in Australia found these to be economical and have outcomes comparable to those obtained by standard care (renin-angiotensin system inhibitors [RASi] and lipid-lowering drug use, clinic attendance rate, hospital admissions, length of stay, KRT, and overall mortality). 3 Additionally, among geographically remote patients in the United States with CKD, a clinical video telehealth system was shown to improve adherence to clinic visits while delivering comparable clinical outcomes (doubling of serum creatinine, progression to end-stage renal disease [ESRD], death) over a 2-year follow-up period. 4,5 Communication with patients prior to telehealth visits with reminders to have blood work completed, medication list prepared and blood pressure and weights documented should improve both clinic efficiency and effectiveness.…”

Section: Suggestions 1 Adhere To Clinic Visit Schedulesmentioning

confidence: 99%

Management of Advanced Chronic Kidney Disease During the COVID-19 Pandemic: Suggestions From the Canadian Society of Nephrology COVID-19 Rapid Response Team

White

Kappel

Levin

et al. 2020

Can J Kidney Health Dis

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Purpose of program: To provide guidance on the management of patients with advanced chronic kidney disease (CKD) not requiring kidney replacement therapy during the COVID-19 pandemic. Sources of information: Program-specific documents, pre-existing, and related to COVID-19; documents from national and international kidney agencies; national and international webinars, including webinars that we hosted for input and feedback; with additional information from formal and informal review of published academic literature. Methods: Challenges in the care of patients with advanced CKD during the COVID-19 pandemic were highlighted within the Canadian Senior Renal Leaders Forum discussion group. The Canadian Society of Nephrology (CSN) developed the COVID-19 rapid response team (RRT) to address these challenges. They identified a lead with expertise in advanced CKD who identified further nephrologists and administrators to form the workgroup. A nation-wide survey of advanced CKD clinics was conducted. The initial guidance document was drafted and members of the workgroup reviewed and discussed all suggestions in detail via email and a virtual meeting. Disagreements were resolved by consensus. The document was reviewed by the CSN COVID-19 RRT, an ethicist and an infection control expert. The suggestions were presented at a CSN-sponsored interactive webinar, attended by 150 kidney health care professionals, for further peer input. The document was also sent for further feedback to experts who had participated in the initial survey. Final revisions were made based on feedback received until April 28, 2020. Canadian Journal of Kidney Health and Disease (CJKHD) editors reviewed the parallel process peer review and edited the manuscript for clarity. Key findings: We identified 11 broad areas of advanced CKD care management that may be affected by the COVID-19 pandemic: (1) clinic visit scheduling, (2) clinic visit type, (3) provision of multidisciplinary care, (4) bloodwork, (5) patient education/support, (6) home-based monitoring essentials, (7) new referrals to multidisciplinary care clinic, (8) kidney replacement therapy, (9) medications, (10) personal protective equipment, and (11) COVID-19 risk in CKD. We make specific suggestions for each of these areas. Limitations: The suggestions in this paper are expert opinion, and subject to the biases associated with this level of evidence. To expedite the publication of this work, a parallel review process was created that may not be as robust as standard arms’ length peer-review processes. Implications: These suggestions are intended to provide guidance for advanced CKD directors, clinicians, and administrators on how to provide the best care possible during a time of altered priorities and reduced resources.

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Chronic Kidney Disease, Queensland (CKD.QLD) Registry: Management of CKD With Telenephrology

Cited by 14 publications

References 11 publications

Telemedicine for Outpatient Care of Kidney Transplant and CKD Patients

Telemedicine for Outpatient Care of Kidney Transplant and CKD Patients

Chronic kidney disease, Queensland: Profile of patients with chronic kidney disease from regional Queensland, Australia: A registry report

Management of Advanced Chronic Kidney Disease During the COVID-19 Pandemic: Suggestions From the Canadian Society of Nephrology COVID-19 Rapid Response Team

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