POS-746 ROLE OF TELENEPHROLOGY IN THE MANAGEMENT OF CKD STAGES 4-5 (NO DIALYSIS) PATIENTS DURING THE COVID-19 PANDEMIC

Abstract

The Covid-19 sanitary crisis has restricted the management of patients with chronic kidney diseases (CKD). The telenephrology (TN), have enabled the virtual control and monitoring of transplanted or dialysis patients. This is a report regarding the use of TN to manage patients with advanced CKD, stage 4 (S4) and no dialysis stage 5 (S5/Nodial), during the COVID-19 pandemic. This descriptive study was performed between March 2020 and March 2021 in the Renal Transition Clinic (RTC) of Hospital Las Higueras, Talcahuano, Chile. Due to the sanitary crisis to maintain the continuity of care for CKD ambulatory patients, two kinds of attention were established according to the individual clinical condition: 1) Only telenephrology (video consultations); 2) Mixed, alternating face-to-face (FF) and TN attention (FF/TN). Both kinds had at least once a month phone control. Biodemographic variables, laboratory exams, initiation of dialysis, COVID-19 infections and mortality were evaluated. A questionnaire determined the degree of satisfaction with TN. Results are expressed as mean ± SD and percentages. One hundred and eighty eight of 203 active patients enrolled in the RTC were contacted (93%); of them 54.8% were women and their mean age was 70 ± 13 years. Most patients (54.3%) had CKD S5/Nodial. One hundred and fifty one patients were followed only by TN (80.3%) and they did not require FF consultation; 55% were women and 51.7% had CKD S5/Nodial. The hybrid FF/TN mode included 37 patients (19.7%); 54% were women and the most of them (78.4%) had CKD S5/Nodial. The mean age in TN group was 69.1 years and the hybrid group was 62.6 years (p = 0.007).. Patients treated for FF / TN were 35% more likely to require extra annual care than those in the TN group (p = 0.038). No differences for comorbidities were observed between both groups. Of the attentions, 2570 were phone consultations, 699 were video consultations and 329 were FF medical consultations. The relationship of phone consultations/patient/year was 13.6; that of TN video consultations/patient/year was 4.6. The lethality and initiation of dialysis between 2019 and 2020 decreased from 17.8 to 13.4% (p<0,05) and 31.8 to 22.9 % (p<0,05) respectively. Only 8 patients acquired Covid-19 (4.3%), similar to the Chilean general population (4.5%) and much lesser than patients on dilysisis (16.8%). There were no deaths from Covid-19. A 90.9% of the 66 patients that answered the questionnaire were very satisfied with the TN attentions and 77.3% approved this mode to continue their medical controls. TN permitted the monitorization and continuity of renal care in elderly patients with advanced CKD stages S4 and S5/Nodial during the pandemic. Moreover, unnecessary transfers and FF consultations were avoided, nephrologic controls were adapted to confinements, and lastly the incidence of COVID-19 infection was decreased in regard to subjects in hemodialysis and was similar to that of the Chilean general population.Periodic phone and video consultations by the integrated renal team permitted timely references to FF evaluations and contrary to expectations the TN group had lower lethality and income dialysis than the pre-pandemic year.After COVID-19 pandemic end the hybrid FF/TN mode should be evaluated as a new option for the ambulatory continues in subjects with advanced CKD.