POS-204 TELENEPHROLOGY IN MANAGING ACUTE KIDNEY INJURY IN RURAL RWANDA

Abstract

Telenephrology provides clinical nephrology support to overcome geographical barriers, connecting users who are not in the same physical location. Strategies to minimize access disparities between urban and remotely located Acute Kidney Injury (AKI) were used, telephone calls, and email-based consultation between the general practitioners and physicians of Gisenyi and Gihundwe district hospitals and the nephrologist based in the city of Kigali. The purpose of this study was to determine whether telenephrology can be implemented in remote areas to improve the clinical outcomes of patients with AKI. A retrospective study design was adopted to evaluate the effect of telenephrology on AKI patient care. We collected data on patients admitted in Gisenyi and Gihundwe district hospitals in western province, Rwanda between August 2019 to October 2020. The patient history was captured by a dialysis nurse or general practitioner using a pre-established patient follow up datasheet. The filled template was shared with the nephrologist remotely for more assessment and testing. The nephrologists advised the team on additional investigations and diagnosis. Urgent clarifications were done telephonically. Additionaly, a daily evening e-mail based clinical reporting system was completed by nurses to inform the whole team of nephrologists as a second check mechanism. Once a month visit was conducted by the nephrologist to each of the sites for follow-up of all patients. Clinical outcomes included renal functions and urinary output. All admitted patients with suspected AKI from two hospitals were enrolled in the telenephrology program (n = 105), Gisenyi hospital (n=64), and Gihundwe hospital (n=41) during the study period. The mean age of patients admitted with suspected AKI was 42.73 years, 55.55% (n=61) being male. The etiological breakup of AKI was sepsis 66.67% (n=70), malaria 31.4% (n=33), indigenous drug toxicity32%(n=33), and unknown causes in 1.8%(n=2). Hypertension (n=32) and diabetes (n=18) were co-morbidities found in 50 patients. The mean initial, and peak serum creatinine values were 739.2umols/l and 2578.6umols/l respectively. Hemodialysis (HD) was required in 53.7% (n=57) patients and the total HD and mean HD being 322 and 5.45 sessions, respectively. Of the patients admitted 74 (69.8%) recovered completely. Mortality occurred in 15 (14.2%) patients; two patients (1.8%) were referred out for further management at a higher center. Fifteen patients (14.2%) showed only partial recovery hence deemed to have Chronic Kidney Disease (CKD) and were enlisted for long-term follow-up. With the telenephrology-based patient consultation, the findings of this study evidenced the effective care of patients with AKI by local general physicians in patients who reside in underserved areas. This being an initial feasibility evaluation, a larger study is planned for further investigation of the impact of telenephrology based AKI management in these underserved areas to improve clinical outcomes.