Technology, Telehealth, and Nephrology: The Time Is Now.

Abstract

The global health emergency of coronavirus disease 2019 (COVID-19) has brought telemedicine to the forefront of the US health system and transformed the way health care is delivered. Although the need for telehealth to improve social distancing, and protect both patients and providers, was first and foremost in this transition, it has provided a great opportunity to rethink the future of health care with telehealth fully integrated as an option for patients. Some of the known benefits of telehealth include improved access to care, decreased travel time, and cost savings (1), and as we have clearly understood with COVID-19, provision of care during an infectious disease epidemic/pandemic. Patients with CKD and ESKD have a high disease burden, limited resources, and require care in different settings from multiple health care providers, thus contributing to their burden of disease; this may be an ideal patient population to benefit from telemedicine. Technology-based strategies to improve care such as remote patient monitoring, synchronous telehealth visits for both CKD patients and dialysis rounds, and asynchronous dialysis education platforms can be applied to nephrology care to great effect (2,3). Here, we discuss some such strategies that have been used successfully to improve nephrology care and have come to the forefront during this current pandemic. Remote monitoring of treatment adherence has been shown to achieve better BP readings in hypertensives and glycemic control in diabetics, both leading causes of CKD (4). A smartphone-based system to enhance self-care was successfully promoted in advanced CKD patients; prebuilt algorithms provided real-time feedback to patients and alerts to providers when treatment thresholds were exceeded or critical changes occurred (5). Telemedicine, with remote synchronous video visits, has demonstrated equivalent outcomes and reductions in cancelled or “no show” visits in two separate studies conducted at Veteran Affairs health systems (3). The …