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Kidney Week

Abstract: PO0574

Telenephrology Care for Veterans in the COVID-19 Pandemic

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Salcedo Betancourt, Juan David, University of Miami School of Medicine, Miami, Florida, United States
  • Torres, Carlos Andres, University of Miami School of Medicine, Miami, Florida, United States
  • Olivera Arencibia, Yanetsy, University of Miami School of Medicine, Miami, Florida, United States
  • Venkat, Vasuki N., University of Miami School of Medicine, Miami, Florida, United States
  • Soberon, Daniel J., University of Miami School of Medicine, Miami, Florida, United States
  • LadinoAvellaneda, Marco A., University of Miami School of Medicine, Miami, Florida, United States
Background

Chronic kidney disease (CKD) affects 37 million adults in the United States. Since 2013 our Nephrology section has carried out a telenephrology clinic and implemented electronic consults (E-consults). During the COVID-19 pandemic, we implemented changes to evaluate patients with kidney disease. The aim of this study is to report our experience.

Methods

This is a single-center, retrospective chart review study, which evaluated the effect of our telenephrology clinic (video-on-demand and telemedicine clinic visits), as well as E-consults. Between January 2013 and 2020, 410 patients were seen at telemedicine clinic visits, and 1020 E-consults were evaluated. During the COVID-19 pandemic, between March 2020 and May 2020, 40 patients were assessed through video-on-demand.

Results

For telemedicine, a total of 169 patients were included, 99.4% were males, and 87% were white. The mean age was 66 ± 10 years, 92% had hypertension, and 41% diabetes mellitus. The baseline eGFR was 45 ± 14 ml/min/1.73m2. A one-way analysis of variance was conducted showing a statistically significant reduction on the systolic (SBP) and diastolic (DBP) blood pressure (p-value = 0.000), and improvement in potassium and bicarbonate levels (p-value = 0.000). Phosphorus levels did not show a significant difference (p-value 0.37). There was a significant association between attendance to >3 telenephrology visits and SBP control (p-value=0.027), DBP control (p-value=0.002) and potassium improvement (p-value=0.013). The overall decrease in GFR was 1.2 ± 11.1 ml/min/1.73 m2 (95% CI -0.41 to 2.95), lower than the reported natural progression of CKD (1.03 ml/min/1.73 m2/year). A survey for the video-on-demand patients showed 100% satisfaction, reflecting that patients felt their renal care needs were fulfilled. E-consults were answered in less than 24 hours, with 100% satisfaction from primary care physicians.

Conclusion

This is the first study evaluating the use of telenephrology in patients with kidney disease during the COVID-19 pandemic. In our cohort, telenephrology interventions improved SBP, DBP, bicarbonate, and potassium control. All three options improved health outcomes and guaranteed safety during the COVID-19 pandemic, at a reduced cost for the patient and the institution.