Table 2

Utilisation and impact of telenephrology from selected studies

Country (author)Telehealth platform*CKD population covered†Setting‡Number of patientsDesignImpact§Identified loopholes and limitations (if any)
Jordan (AlAzab et al)11 Electronic consults (e-Consult)Non-dialysis CKDRegional hospital in remote location64Prospective cohort- Improved access
- ↓ cost to patients
- Improved patient quality of life
- Small sample (78 patients)
- Short follow-up (1 year)
- Non-randomised
USA (Ishani et al)12 Android/iPad, emailsNon-dialysis CKDRegional care centres, aged patients600Randomised clinical trial- No difference in composite outcomes (death, hospitalisation, emergency department visits) compared with usual care- Short follow-up period
- Small sample size
Spain (Gomez-Martino et al)13 e-Consult and video conferenceNon-dialysis CKDRegional centre105Retrospective descriptive study- ↓ hospital visits- Small sample (107 patients)
- Short follow-up (27 months)
Netherlands (Scherpbier-de Haan et al)4 e-ConsultationNon-dialysis CKDRegional care centres122Prospective observational study- ↓ patient referral to tertiary hospital
- ↓ time per consultation
- Short study time
- No analysis of actual referrals
UK (Stoves et al)14 e-ConsultNon-dialysis CKDGeneral practices and a secondary referral hospital466Prospective observational study- ↓ of paper consults
- ↑ satisfaction by GPs
- ↑ Clinical Empowerment of GPs
- Short study time
- No analysis of actual referrals
USA (Diamantidis et al)43 SMS
Non dialysis CKDRegional hospital20Randomised parallel study- Improved medication safety in CKD- Small sample size
Russia (Braverman et al)15 e–ConsultNon-dialysis Paediatric CKDOpen to public (parents of paediatric patients with CKD provided with e-Consult)141Retrospective descriptive study- ↑ patient satisfaction- None
USA (Berman et al)16 Teleconference (video)HaemodialysisSingle hospital, high-risk patients (multiple comorbidities)44Prospective observational study- ↓ hospitalisation and hospital stay
- ↓ overall care cost
- ↑ quality of life
- Single hospital
- Small sample (44 patients)
USA (Bellazi et al)TeleconferenceHaemodialysisRegional hospital117Retrospective descriptive study-↓ patient visit to main hospital
-↓ reduced need for doctor travel to satellite unit
- Short study time
Canada (Berstein et al)TeleconferenceHaemodialysisReferral hospitals linked to remote dialysis units (First nations, aborigines)2663Retrospective descriptive study- ↑ 2 and 5 year survival on dialysis- Socioeconomic status not considered
- Comorbidity scare not considered
Spain (Gallar et al)18 TeleconferencePeritoneal dialysisSingle centre57Prospective non- randomised study- ↓ patient cost of care
- ↓ hospitalisation
- Single centre
- Small sample (57 patients)
Canada (Alison et al)TeleconferencePeritoneal dialysisSingle centre8Randomised parallel design- ↑ patient satisfaction- Small sample size
Canada (Sicotte et al)19 TeleconferenceHaemodialysis2 remote haemodialysis centres serving first nations19Prospective observational study- No difference between virtual patient rounds and telecase reviews with multidisciplinary teams- Non randomised
USA (Thompson et al)20 TeleconferencePost -transplant follow-upSingle centre138Prospective randomised study- No difference in usual care regarding post-transplant depression prevalence- Single centre
- Short follow-up
UK (Connor et al)TelephonePost-transplantSingle centre30Prospective observational study-Improved post-transplant access to care
-↓ visit to hospital by patient
-↑ cost effectiveness
- Small sample size
USA (Thompson et al)20 TeleconferencePost -transplantSingle centre138Prospective randomised study-No difference in usual care regarding post-transplant depression prevalence- Single centre
- Short follow-up
  • *Telephone, video, SMS, Android/iPad technology, email communications, electronic consults (e-Consult), other (outside any of the above platforms).

  • Non-dialysis CKD, haemodialysis population, peritoneal dialysis population, transplant population.

  • Single hospital, regional, national, special populations (remote communities, disadvantaged group, etc).

  • § Accessibility (reduction in wait times), efficiency (time savings for providers and/or patients, cost savings, etc), satisfaction (providers and/or patients).

  • CKD, chronic kidney disease; GP, general practitioner; PDA, personal digital assistant; SMS, short message service.