Scherzer Zachary Albert, Astor Brad C, Lesnik Dyan, Maursetter Laura
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
Kidney360. 2025 Jan 1;6(1):69-75. doi: 10.34067/KID.0000000641. Epub 2024 Nov 22.
Primary use of telenephrology in a hybrid system was associated with similar CKD progression outcomes as those seen primarily in-person. A hybrid system incorporating predominant use of telenephrology may be noninferior to standard in-person care with regard to multiple CKD outcomes.
Nephrology has seen an uptake in transition to remote care delivery. The effect of telenephrology care on CKD progression is not well defined.
We analyzed data from patients naturally selected for telenephrology versus standard in-person visits. Patients were seen across 4230 visits over a 2-year period at a nephrology clinic within the Veterans Affairs (VA) health system. Baseline characteristics and health profile data were assessed on the basis of grouping of individuals to the telenephrology group (>50% virtual visits) or in-person group (≤50% virtual visits). The slope of eGFR change over time was estimated for each patient using a random effects regression model and compared across groups using weighted linear regression models.
A total of 1098 patients comprised the final analysis. The groups were similar across baseline demographics and health profiles, although more cardiovascular disease, congestive heart failure, and diabetes mellitus were present in the in-person group. There was no significant difference in eGFR decline between groups, although those in telenephrology group trended toward less steep decline compared with those seen predominately in-person (telenephrology slope versus in-person slope; difference=0.81 ml/min per 1.73 m; 95% confidence interval, −0.447 to 2.08; = 0.21). Those seen primarily in-person had a similar degree of proteinuria compared with those in telenephrology ( = 0.12). All-cause mortality and incidence of outpatient RRT initiation was similar. Telenephrology patients had an average of 1.3 fewer emergency department visits per individual compared with their in-person counterpart (2.17 versus 3.44, < 0.001), as well as fewer hospital admissions (1.59 versus 2.08, = 0.02). Those in the in-person group were more often prescribed sodium glucose cotransporter 2 inhibitors, statins, nonsteroidal anti-inflammatory drugs, and potassium supplements.
Data from this observational study within a VA health care system suggest that medically complex patients with multimorbid CKD can expect a similar rate of eGFR decline when care is delivered through a hybrid system that includes a majority of telenephrology when compared with those managed in face-to-face visits. Further studies are needed to corroborate findings and ensure generalizability outside of this VA system.
在混合系统中，远程肾脏病学的主要应用与主要面对面就诊时观察到的慢性肾脏病（CKD）进展结果相似。就多种CKD结局而言，主要采用远程肾脏病学的混合系统可能不劣于标准的面对面护理。
肾脏病学在向远程护理服务的转变中得到了应用。远程肾脏病学护理对CKD进展的影响尚不明确。
我们分析了自然选择接受远程肾脏病学治疗与标准面对面就诊患者的数据。在退伍军人事务部（VA）医疗系统的一家肾脏病诊所，对患者进行了为期2年的4230次就诊观察。根据个体分组为远程肾脏病学组（虚拟就诊>50%）或面对面组（虚拟就诊≤50%），评估基线特征和健康状况数据。使用随机效应回归模型估计每位患者随时间的估算肾小球滤过率（eGFR）变化斜率，并使用加权线性回归模型在各组之间进行比较。
共有1098名患者纳入最终分析。两组在基线人口统计学和健康状况方面相似，尽管面对面组中存在更多的心血管疾病、充血性心力衰竭和糖尿病。两组之间的eGFR下降没有显著差异，尽管远程肾脏病学组的患者与主要面对面就诊的患者相比，eGFR下降趋势较缓（远程肾脏病学斜率与面对面斜率；差异=0.81 ml/min per 1.73 m；95%置信区间，−0.447至2.08；P = 0.21）。与远程肾脏病学组相比，主要面对面就诊的患者蛋白尿程度相似（P = 0.12）。全因死亡率和门诊开始肾脏替代治疗的发生率相似。与面对面就诊的患者相比，远程肾脏病学组的患者每人平均急诊就诊次数少1.3次（2.17对3.44，P < 0.001），住院次数也较少（1.59对2.08，P = 0.02）。面对面组的患者更常被处方钠-葡萄糖协同转运蛋白2抑制剂、他汀类药物、非甾体抗炎药和钾补充剂。
来自VA医疗系统内这项观察性研究的数据表明，与面对面就诊管理的患者相比，患有多种合并症的复杂CKD患者通过包括大多数远程肾脏病学的混合系统接受护理时，eGFR下降率相似。需要进一步的研究来证实这些发现，并确保在该VA系统之外具有普遍性。
