Effect of telemedicine for patients with chronic kidney disease who perform dialysis at home: a systematic review

Abstract

Introduction and background: The world’s population is getting older, and the prevalence of chronic kidney disease (CKD) rises parallel with age. CKD is a major public health concern, characterised by poor health outcomes and a high economic burden for society as well as for the individual. With an aging population, there is an increasing need to organize healthcare services in alternative ways. There are two main types of dialysis, peritoneal dialysis (PD) and hemodialysis (HD), and both can be performed by the patient at home. Telemedicine (TM) gives the patient quick access to medical expertise independent of the distance to a treatment centre. The use of technology provides possibilities for thorough patient follow-up (FU), and at the same time, saving human resources. Objective: To systematically review the effectiveness of FU by TM compared to standard care for adult patients with dialysis-dependent CKD on home dialysis, including PD and HD. Methods: A systematic review that followed the Cochrane Handbook for Systematic Reviews of Interventions was conducted. Results: The findings suggested that TM FU was effective in reducing hospitalizations and technical failure as the cause for transfer to a different dialysis modality. The effects of TM FU on overall quality of life and infections were inconclusive. No studies included the outcome ‘time patients used for travel’. The certainty of evidence (GRADE) was rated as very low or low for all the outcomes, and the results must be interpreted with caution. Author’s conclusions: The evidence suggests that there may be positive effects and no harms regarding technical failure and hospitalizations from TM patient FU. However, there is a large research gap and further research in the form of primary studies with high methodological quality are needed to draw stronger conclusions.