Table 1

Domains of telehealth and specific applications in kidney care delivery

DomainDefinitionRelevant applicationsAdvantagesDisadvantages
A. Synchronous domains
- Interactive videoconferencingUse of real time video and audio for communicating (consulting, teaching, discussing treatment)- Group clinic sessions to improve compliance
- Training of nephrologists/nurses in LMICs
- Promoting appropriate CKD management
- Events take place in‘real time’
- Questions and answers will reflect real time discussions and can instantly be revisited
- Requires a good Internet and other equipment (TV monitor, computer screen, cables)
- May not be effective for practical hands-on demonstrations (eg, renal biopsy, urine microscopy)
- Phone (Mobile Health; mHealth)Telephone call- Patient referral
- Consultation
- Audio discussions take place in ‘real time’- Cost of long-distance calling
B. Asynchronous domains
- Store-and-forwardTransmission via email of medical or laboratory data and images to an expert for remote review- Consultations and referral
- Screening/prevention programmes
- Training of nephrologists/nurses in LIC and LMICs
- Improving compliance and appropriate CKD management
- Large data (image) can be sent- Information sent may be too bulky to read in a short time
- Needs capacity for storage of data sent
- Lack of personal voice interaction
- Phone (mHealth)Use of SMS or other methods of mobile text messaging for communication- Screening/prevention programmes
- Reminders to attend clinics
- Promoting appropriate CKD management
- No need for hospitalisation
- Opportunity to provide individualised care
- Self-monitoring and managementInvolves one or more types of sensors deployed in, on, or around a human body to collect physiological signals- Management of patients in remote areas
- Promoting appropriate CKD management
- No need for hospitalisation
- Allows for long-term and continuous monitoring / tracking of health status
- Opportunity to provide individualised care
- Need to always carry (wear) a sensing device
- Inconvenience of frequent buzzing / beeping sounds
- False alarms may be sent due to malfunctioning of device
  • CKD, chronic kidney disease; LIC, low income countries; LMIC, low  middle-income countries; mHealth, Mobile Health.