Sugawara Yuka, Hirakawa Yosuke, Nangaku Masaomi
Division of Nephrology and Endocrinology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Clin Kidney J. 2024 Nov 22;17(Suppl 2):1-8. doi: 10.1093/ckj/sfae267. eCollection 2024 Dec.
Telemedicine is a medical practice that uses electronic information and communication technologies. It is not exclusive to face-to-face care but complements face-to-face care and other forms of medical care. It has advantages such as facilitating home therapy, reducing patient travel time and costs, and empowering patients. This makes equitable access to care feasible. Clinical studies have been conducted on telemedicine in nephrology outpatient care, inpatient consultations and hemodialysis, indicating that telemedicine can improve patient satisfaction, leading to enhanced treatment owing to increased adherence and frequency of visits. However, it has not been sufficiently used in the kidney field. The key to spreading "telenephrology" (telemedicine in nephrology) is how physical examinations and laboratory/imaging/physiological tests, currently challenging to perform without face-to-face contact, can be substituted with methods optimized for the telemedicine framework. This paper describes the current status of telemedicine and telenephrology, along with advanced methods for collecting data equivalent to laboratory, imaging and physiological tests outside of hospitals, including estimation of serum creatinine levels from saliva or tear fluid, estimation of blood hemoglobin levels by taking pictures of the eyelid conjunctiva or nails with a smartphone and ultrasound of the kidneys using motion capture technology. With an understanding of the strengths and weaknesses of current telemedicine, we should make full use of it for better treatment and patient care. However, further telenephrology research is required.
远程医疗是一种利用电子信息和通信技术的医疗实践。它并非面对面医疗所独有，而是对面对面医疗及其他形式的医疗起到补充作用。它具有诸多优势，比如便于居家治疗、减少患者的出行时间和费用以及增强患者的能力。这使得公平获得医疗服务成为可能。针对远程医疗在肾脏病门诊护理、住院会诊和血液透析方面已开展了临床研究，结果表明远程医疗能够提高患者满意度，由于就诊依从性和就诊频率的提高而带来更好的治疗效果。然而，它在肾脏领域尚未得到充分应用。推广“远程肾脏病学”（肾脏病领域的远程医疗）的关键在于，如何用针对远程医疗框架优化的方法来替代目前在无法进行面对面接触的情况下难以开展的体格检查以及实验室/影像/生理检查。本文介绍了远程医疗和远程肾脏病学的现状，以及在医院外收集等同于实验室、影像和生理检查数据的先进方法，包括通过唾液或泪液估算血清肌酐水平、用智能手机拍摄眼睑结膜或指甲照片估算血红蛋白水平以及利用动作捕捉技术进行肾脏超声检查。在了解当前远程医疗的优缺点之后，我们应充分利用它来实现更好的治疗和患者护理。然而，还需要进一步开展远程肾脏病学研究。
