BOSTON — Has providing access to nephrology specialists improved care for veterans with chronic kidney disease (CKD) in remote areas?
A new study involved CKD patients managed by primary care providers because they lived near a lower-complexity VA. Researchers from the VA Boston Healthcare System and Boston University recounted how, to improve access to nephrology for rural veterans, a hub-and-spoke network used telemedicine to connect nephrologists to veterans at VA facilities lacking nephrology services (spokes).
Defined as eligible were veterans with CKD, refractory hypertension and electrolyte disorders cared for at spoke sites, while patients requiring dialysis or hospital management were excluded. The study team compared demographics, clinical characteristics, prescription rates and mortality of the veterans cared for by telenephrologists (Telenephrology+) with those cared for by primary providers (Telenephrology-).
The Telenephrology+ group consisted of 2,147 eligible veterans who had telenephrology visits during the study period (2021-2024). The Telenephrology control group consisted of 9,678 telenephrology eligible veterans who were managed by primary providers. At baseline, Telenephrology+ veterans were younger (69+/-12 vs 74+/-10 years, p<0.001), but had more advanced CKD (eGFR 47+/-21 vs 55+/-16 ml/min/1.73m2, p<0.001) than Telenephrology- veterans. Co-morbidities such as hypertension, diabetes mellitus and heart disease were common in both groups.
Results published in the Clinical Journal of the American Society of Nephrologists indicated that over the study period, more of the patients in the Telenephrology+ group were started on guideline directed therapies (p<0.001). In addition, survival analysis showed that the Telenephrology+ group had a significantly lower mortality compared to the Telenephrology-group (hazard ratio (HR) 0.62, CI 0.55-0.71, p<0.001).1
“Mortality in the Telenephrology+ veterans remained lower (HR 0.85, CI 0.74-0.98, p=0.02) after adjustment for confounders and medication use,” the authors advised. “In addition to telenephrology visits, major factors influencing mortality were rurality (HR 1.52 CI 1.39-1.67, p<0.001), heart disease (HR1.95, CI 1.76-2.17, p<0.001) and prescription of sodium glucose transporter 2 inhibitors (SGLT2i) during the study period (HR 0.50, CI 0.44-0.57, p<0.001).”
The researchers concluded that Telenephrology was associated with higher prescription rates of guideline directed therapies and longer survival in veterans with CKD.
- Bonegio R, Wallace KF, Kroll-Desrosiers A, Androsenko M, Lew RA, Crowley S, Rifkin I, Moore DT, Mattocks KM; Telenephrology EWI Working Group. Characteristics of Veterans with Chronic Kidney Disease Utilizing a Telenephrology Program in the Veterans Health Administration. Clin J Am Soc Nephrol. 2026 Feb 10. doi: 10.2215/CJN.0000000977. Epub ahead of print. PMID: 41665941.