Contributors: A Bansal (U of Pennsylvania) | P Dedhia (U of Cincinnati) | A Elebiary (Lahey Clinic) | X Vela (U of El Salvador) | D Thomson (ECU) | P Jawa (ECU)

Courtesy: D. Divakaran | mostphotos.com/ 1987407/ human- kidney

ISSN 2372- 0824 (Print) | 2372- 0832 (Electronic)

Kidney
Konnection
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TELENEPHROLOGY: M ORE THAN CALLING IN

YOUR DIALYSIS ORDERS
(by X avier Vela: @xaviervel)

Chronic illnesses are the leading cause of morbidity, disability and

mortality in America and for many underdeveloped countries as
well. Let?s face it: our society is getting older and the number of
people with chronic diseases is increasing. It's well known that the
costs of caring for patients with chronic kidney disease (CKD) and
end- stage renal disease (ESRD) are increasing and represent a big
burden for any government. Several efforts encourage coordination
between primary care providers and nephrologists to reduce
healthcare costs but improve healthcare outcomes. One of these
efforts is the application of something relatively new: telemedicine
and, as it is applied to nephrology, telenephrology. According to the
American Telemedicine Association (yes...this organization does
actually exist) telemedicine is ?the use of medical information
exchanged from one site to another via electronic communications
to improve health status?. For kidney patients, telenephrology
would facilitate cohesive and coordinated care between primary care
providers and nephrologists for patients with CKD, especially those
who live in rural communities where there is a lack of healthcare
coverage.

Author's vision of what telemedicine can become

Step outside of America for a moment and analyze the situation in

Central America. In the last decade there has been an alarming
increase in the number of CKD patients. Countries like N icaragua
and El Salvador are so afflicted by CKD, that it is now the #1 cause
of death in man (more than heart disease or cancer). Unfortunately
these patients can?t afford specialized consultations with
nephrologists and other critically essential providers such as
nutritionists, internists, urologists and more. And the scarcity of
healthcare providers in this region is only matched by the
tremendous burden of CKD; making telenephrology all the more
necessary to implement.

From https: / / twitter.com/ EricTopol/ status/ 548849301527355394

It allows for real- time consultations between experts; like

remote monitoring of clinical examinations, surveillance of
home- based dialysis therapies (e.g., peritoneal dialysis), and
transmitting radiographic and laboratory data. Using
telenephrology would allow kidney patients to "visit" a
nephrologist much sooner than they do currently. In places
like N icaragua and El Salvador, where many people die of
kidney disease having never seen a kidney doctor, "much
sooner", however vague that may be, is still better than
"never".

Telenephrology is a lot more than just a fancy phone connected to

the Internet. At its heart it provides the primary care provider with
a set of tools that enhance his/ her ability to provide nephrology care
to patients.

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TELENEPHROLOGY

(continued)

Lets review some of the technologies that can be incorporated into a future telenephrology program:
1.

E- consultation: Imagine you?re a rural physician that needs a consultation on a patient with CKD. Turn on your telenephrology
device (web cam, wearable camera, Google Glass...if it still exists) and stream into your exam room a nephrologist who can discuss
your patient with you in real- time. Sounds cool, but how does this exactly help? First, you've established a new provider- patient
interaction (the nephrologist & your patient) that benefits your patient and a new provider- provider interaction (between you and the
nephrologist) that benefits you! These types of high- yield, real- time interactions have the potential to reduce patient costs, expedite
changes in treatment plans, reduce the # of hospital admissions or transfers, & perhaps improve patient outcomes.

2.

Real time clinical monitoring: Today, there are many devices & / or apps that track personal health metrics, from how long you walked
to how well you slept last night. Admittedly, those are simple uses of telemedicine; imagine monitoring something more complex, like
a patient?s kT/ V while s/ he's on a home- based renal replacement therapy. Researchers from the University of H eidelberg (Germany)
are developing a cost- effective polyurethane circuit board, that, when worn by a patient, starts a complex set of procedures to
"examine" the patient. The researchers claims that this method can reduce the cost by 60% compared to more traditional methods of
monitoring home- based patients and clinical trials are already in the works.

3.

Clinical research: The N ational Institute of H ealth of El Salvador are running a pilot CKD research program using cellular- connected
tablets. The tablets will display survey questions and transmit the answers in real- time to a central location where researchers can
analyze the data and establish trends in disease patterns.

And telenephrology isn't just for physicians and patients. In the future nutritionists, social workers, and health educators can all use a
telenephrology service to expeditiously care for patients.
The sky's the limit for telenephrology. M ore than just calling in your orders, this new technology has a real potential to change (for the
better) the speed and accuracy with which any provider cares for a kidney disease patient. Stay tuned as telenephrology comes to a device
near you!

I THINK THEREFORE I KNOW

A 70 year- old patient with acute kidney injury is
sent to you by an M D/ DO from Somewhere,
USA. Because telenephrology hasn't been
implemented where you work (yet), the patient
has waited 1 week to see you. When s/ he arrives,
the patient voices non- specific complaints. Your
history and examination are unrevealing but you
check a urine just for the "fun" of it. You see this:

After consultation, you send off a bunch of viral serologies and immunologic markers
which will, undoubtedly, take > a week to return. So in the interim, you decide to
biopsy this patient (who by now, because of your excellent bedside manner, thinks
you're the best physician on the planet!)
- What do these images
show?
- What do you think the
diagnosis is?
- H ow would you treat?

Image A
Send us your answers:
Twitter: @nephondemand
Email:
myFellowship@ecu.edu

Image B

Answers will be posted in a

Images courtesy of Dr. Jordan Weinstein (@UKidney)

future issue.
2