Telemedicine for Outpatient Care of Kidney Transplant and CKD Patients

Abstract

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.

Perceptions of Telehealth vs In-Person Visits Among Older Adults With Advanced Kidney Disease, Care Partners, and Clinicians

“… 13 , 14 Surveys suggest that many patients with chronic conditions are satisfied with telehealth care, 14 , 15 , 16 and telehealth has been successfully used for CKD disease management. 9 , 17 …”

Software-based Detection of Acute Rejection Changes in Face Transplant

“…If implemented correctly, there would be a positive clinical impact to patients with FT as its use could potentially mitigate unnecessary hospital trips and promote communication with the transplant center, as has been shown in kidney transplantation. 35 Its use could potentially lead to earlier treatment of CLR when paired with remote monitoring, 36 however, a prospective validating study is necessary for conclusive results.…”

Challenges of Antimicrobial Resistance and Stewardship in Solid Organ Transplant Patients

“…SOT candidates and recipients have been affected by the direct risks of COVID-19 infection, as well as the secondary effects from the pandemic. Overall decrease in resources available at hospitals has led to reduction in non-urgent surgery and outpatient care, potentially adding to the negative impact on the mental status of SOT patients, contributing to decreased adherence to medical appointments [ 93 – 95 ]. Another potential impact has been a decrease in living and deceased organ donation worldwide, and its deleterious effect on transplant candidates’ waitlist on morbidity and mortality [ 96 – 98 ].…”