Clinical Topics

Telenephrology Brings Better Care to VA CKD Patients in Remote Areas

by Brenda Mooney

April 22, 2018

BRONX, NY — For patients with chronic kidney disease (CKD), living more than 30 miles from their nephrologist is associated with many unfavorable outcomes. They have lower rates of clinic visit adherence, more limited access to treatment and higher rates of hospitalization and mortality, compared to those who live closer by.

A report in the American Journal of Nephrology recently stated that “strategies to minimize disparities between urban and remotely located CKD patients are needed.”1

As part of that, a study team led by researchers from the Mayo Clinic in Rochester, NY, the Icahn School of Medicine at Mount Sinai in New York and area VAMCs examined whether adherence to clinic visits and clinical outcomes in the remote management of CKD using telenephrology is as valuable as in-person conventional care.

To do that, the researchers measured renal clinic adherence and composite outcomes of death, end-stage renal disease (ESRD), or doubling of serum creatinine (Cr) in the geographically remote Hudson Valley VAMC. Those 112 patients enrolled in telenephrology were compared to 116 patients enrolled in the Bronx VAMC renal clinic.

The study noted that, before the telenephrology service was implemented, 53.1% of scheduled visits of rural HVVAMC patients to the Bronx VAMC renal clinic were either cancelled or were “no-shows.”

Results indicated that was reduced by nearly half (28.5%) after instituting telenephrology. In fact, adherence to appointments was greater in the telenephrology (71.9%) vs. the in-person Bronx VA cohort (61.0%).

Over two years of follow-up, the incidence of the composite outcome of death, ESRD, or doubling of Cr was similar between both groups (p = 0.96), the researchers reported.

“Remote CKD care delivered through telenephrology improves renal clinic visit adherence while delivering comparable renal outcomes,” study authors concluded. “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.”

1Tan J, Mehrotra A, Nadkarni GN, He JC, Langhoff E, Post J, Galvao-Sobrinho C, Thode HC Jr, Rohatgi R. Telenephrology: Providing Healthcare to Remotely Located Patients with Chronic Kidney Disease. Am J Nephrol. 2018 Mar 20;47(3):200-207. doi: 10.1159/000488004. [Epub ahead of print] PubMed PMID: 29558745.

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