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Kidney Week

Abstract: PO0575

Telenephrology: A Feasible Option for Inmates

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Butler, Maxwell, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Maursetter, Laura J., University of Wisconsin-Madison, Madison, Wisconsin, United States
Background

Socioeconomic and racial disparities are factors that contribute to the disproportionately high burden of chronic disease amongst the incarcerated population in the United States. Access to care can be compromised because of the burden of cost to a facility, lack of staff to transport patients and physical distance from specialists. Telenephrology has been shown to be a feasible option in the correctional setting for specialties such as mental health, infectious disease, cardiology, and primary care, but has not been studied in nephrology. In this quality improvement study, we showed telenephrology is a feasible option that can be implemented for CKD and hypertension management.

Methods

Using quality improvement methodology, data was collected from the electronic medical record for all telenephrology appointments from January 2015 to June 2019. Demographic data, comorbidities, appointment compliance, and clinical data including eGFR and blood pressure were tracked for analysis. Data for patients seen over a period of at least 3 years were included in the CKD progression portion and those seen at least 4 times for the blood pressure management.

Results

There were 871 appointments schedule over the 4.5 year period with 86% completed. Technology limited 3.5% of the cancelled appointments. The population was predominantly men (96%) of black race (51.9%) with hypertension (78%) and CKD (75.2%) being the most common comorbidities. There were 214 patients included in the analysis for management of CKD that showed an average annual change in eGFR of -1.57 mL/min/1.73 m2 (95% CI: -2.87 to -0.27). There were 79 included in the hypertension analysis with 19.0% achieving a goal BP of ≤130/80 mm Hg and 63.3% achieving a BP of ≤140/90 mm Hg.

Conclusion

Telenephrology can be successfully carried out in the correctional facility population with a low number of cancellations due to technology. The study sample showed mild-to-moderate CKD progression consistent with previously reported population rates of eGFR decline suggesting comparable management. The smaller subset in hypertension showed control that was less than the rates achieved in a nationally representative sample of CKD patients (52% and 75%). This marks an area that requires improvement. Continued rising referrals to telenephrology suggest provider acceptance but it is important to study and adjust management to provide at least equal care as in person visits.