Telenephrology: Providing Healthcare to Remotely Located Patients with Chronic Kidney Disease

Abstract

Background: Chronic kidney disease (CKD) patients who live far (>30 miles) from their nephrologist experience lower rates of clinic visit adherence, limited access to treatment, and higher rates of hospitalization and mortality than patients who live in close proximity to their nephrologist. Strategies to minimize disparities between urban and remotely located CKD patients are needed. The purpose of this study was to determine whether adherence to clinic visits and clinical outcomes in the remote management of CKD via telenephrology is comparable to in-person conventional care. Methods: Renal clinic adherence and composite outcomes of death, end-stage renal disease (ESRD), or doubling of serum creatinine (Cr) were measured in geographically remote Hudson Valley VA Medical Center (HVVAMC) CKD patients enrolled in telenephrology (n = 112) and CKD patients enrolled in the Bronx VAMC renal clinic (n = 116). Results: Prior to implementing the telenephrology service, 53.1% of scheduled visits of rural HVVAMC patients to the Bronx VAMC renal clinic were either cancelled or were “no-shows.” This was reduced by nearly half (28.5%) after instituting telenephrology (p < 0.001). Moreover, the frequency of attending appointments was greater in the telenephrology (71.9%) vs. in-person Bronx VA cohort (61.0%). The incidence of the composite outcome of death, ESRD, or doubling of Cr was similar between both groups (p = 0.96) over 2 years of follow-up. Conclusions: Remote CKD care delivered through telenephrology improves renal clinic visit adherence while delivering comparable renal outcomes. Application of this technology is a promising method to provide access to care to rural CKD patients and to minimize the disparity between urban/rural patients.

Telehealth during the coronavirus disease 2019 pandemic: Rapid expansion of telehealth outpatient use during a pandemic is possible if the programme is previously established

“…29 A study of renal patients managed using telehealth identified similar outcomes to on-site management, and patients also had higher rates of clinical attendance. 18 Studies of diabetic foot management have, however, been variable, with studies showing better outcomes with telehealth, but one study showing higher mortality in the telehealth group, without a clear reason being identified. 30,31 With new technology, unintended consequences can occur, and the long-term impact of telehealth on doctor-patient relationships remains uncertain.…”

Telehealth for Home Dialysis in COVID-19 and Beyond: A Perspective From the American Society of Nephrology COVID-19 Home Dialysis Subcommittee

“…Telehealth has been used to manage patients with chronic kidney disease (CKD) and demonstrated equal outcomes in CKD care by either in-person or virtual visits. [16,17] Although the opportunities for the application of technology to the betterment of the lives and care of our patients exist, implementation of these strategies continues to remain challenging. Here, members of the American Society of Nephrology COVID-19 Home Dialysis Committee review regulatory changes, use-cases, implementation, and provider and patient perspectives on telehealth for home dialysis during the COVID-19 public health emergency.…”

Patients’ and caregivers’ perspectives on access to kidney replacement therapy in rural communities: systematic review of qualitative studies

“…[42][43][44][45] Telehealth or eHealth has been shown to benefit rural patients and their caregivers in other chronic diseases as well as various stages of CKD, with regard to management and provision of education, and have helped to reduce the burden of travel and cost on these patients. [46][47][48][49][50] Interventions that improve uptake of home-based therapies are suggested to minimise travel and the need for patients to relocate away from community and home. 51 52 However, as shown in this review, there is some reticence for patients to commence this, often because of lack of exposure to, and education about these options.…”