Telemedicine for Chronic Kidney Disease – A Digital Division of Benefits and Drawbacks

A medical review published by Medscape states that patients with Chronic Kidney Disease (CKD) who choose the virtual treatment line, generally report higher efficiencies compared to the patients who choose in-person consultation and treatment. The cost-effective grounds include better clinical outcomes, fewer visits to the emergency rooms and hospitalization, and an acceptable upper hand compared to those who are treated in person.

“The nature of CKD care makes it particularly amenable to virtual care given that relevant history, review of laboratory investigations, and counseling can all be conducted via virtual platforms,” added Ann Young, University Health Network, Toronto, Ontario, Canada, said in a statement issued by the American Society of Nephrology.

Before diving deep into the study and apprehending the conclusions, let’s understand what is Chronic Kidney Disease?

In the simplest terms, chronic kidney disease means the kidneys are damaged and can no longer filter blood the way they should. The loss of kidney function is a gradual process, hence the name chronic. CKD can lead to waste build-up in the body and cause other health problems. “With the rising cases of diabetes in India, the prevalence of CKD is expected to rise,” states a report by NCBI.

Key highlights of the prevalence of chronic kidney disease in India:

• The number of Indians that suffer from chronic kidney ailments has doubled between 2008-and 2018.
• 8 to 10 percent of the adult population suffers from some or the other form of kidney disease.
• In India, CKD is more prevalent among males than females.
• The CKD Registry body registered 63,538 cases of chronic kidney diseases in 2011.
• The number of people with diabetes in India has increased from 26 million in 1990 to 65 million in 2016. 
• 1 in every 3 persons with diabetes in India reports chronic kidney disease.
• The most common cause of CKD in India is diabetic nephropathy responsible for approximately 41 percent of cases.

Telemedicine and kidney stones – What are the benefits?

Chronic illness is the leading cause of death and disability worldwide, accounting for major healthcare expenditure. Patients with chronic kidney disease often remain asymptomatic at the early stages of the disease leading to suboptimal care. In such cases, telemonitoring comes as a highly efficient solution where optimum patient care is the central component. Medical reports state that telemonitoring improves patient autonomy in the system by helping patients have better control and understanding of their chronic disease and the symptoms related to the disease, which is an important incentive for treatment.

“These are the times when telemedicine is incredibly helpful. Patients living in rural communities who have to deal with mobility issues can also benefit from virtual consultations. Telemedicine eliminates the stress of visiting a physician’s office and can act as a boon during tough times. Video-based telemedicine provides an alternative health care delivery model for patients with CKD”: Milind Joshi, General Surgeon, Pristyn Care

Telemedicine has the potential to attenuate and gradually eliminate the disparities that come from in-person consultations.  

Drawbacks of the digital divide 

Like any other treatment, there are cautions of the ‘digital divide’ when telemedicine is being assessed.

A statement from the American Society of Nephrology says, “The results of telemedicine for kidney stones are encouraging but as the latest technologies are streamlined into routine healthcare, the ‘digital divide’ will become more pronounced, negatively impacting those without access to broadband internet connections, video-capable devices, and those with limited technology literacy.”

“There are times when it becomes crucial for the patient to visit the doctor’s office or undergo an imaging treatment at the clinic. But that does not overshadow the significance of the quality of care in the virtual context as it is in the case of the care one gets at the doctor’s office. Virtual visits save time, energy, and money. But the benefits of in-person consultation have their own upper hand that vanishes in the virtual scenario. It is clearly a matter of benefits and drawbacks, a game of boon and bane,” says Rohit Kaushal, Urologist, Pristyn Care.

Telemedicine vs in-person consultation – What do studies say?

24 studies published between 1997 and 2020, conducted across 10 countries primarily reported the use of institution-specific technologies from hospital sites to remote healthcare locations. The subject matters of the studies included patients with CKD, dialysis, and recipients of kidney transplants.

The studies conducted on telemedicine for patients with CKD reported different clinical outcomes, altered kidney function, and blood pressure, and other biochemical markers relative to in-person care.

“Visits to emergency rooms and hospitalizations were the same, if not lesser, in the case of the telemedicine group compared to in-person care. The studies, however, reported improved efficiencies with telemedicine, a significant cut down in the waiting time to consult a specialist, fewer clinical appointment cancellations, and reduction in travel time to the clinic,” the investigators of the above-mentioned studies unanimously found.

More than 95 percent of subjects involved in the studies had expressed high levels of satisfaction in terms of telemedicine for CKD. Most of the patients reported the same level of care as they received in a personal consultation. The studies further stated that the clinical endpoints among recipients of kidney transplants were equal in the case of those availing telemedicine and the ones receiving personal care. 

What do medical experts think of telemedicine for chronic kidney disease care?

Medical practitioners are of the strong opinion that innovative modalities are on the verge to revolutionize the way CKD care is delivered. Based on the current trend, medical scientists and doctors are of the view that telemedicine is the way forward; treatment shall no longer involve traveling to clinics or leaving their homes. The potential benefits of virtual care would encompass efficiency, quality, and immense access to care at the same time. Challenges shall remain, but adapting to modern multifaceted care, especially during this extraordinarily challenging time of covid pandemic is going to change the care structure significantly.