Skip to main content
SpringerLink
Log in

Telenephrology: A Resource for Universalizing Access to Kidney Care, Perspectives from Latin America

  • Chapter
  • First Online:
Innovations in Nephrology

Abstract

Chronic kidney disease (CKD) is a public health problem that is increasing in prevalence and incidence and together with the shortage of nephrologists constitutes a major challenge for world public health. It is imperative to seek and apply innovative models to provide a timely response to these demands, especially with regard to the prevention of CKD. In this regard, this chapter presents a proposal in order to incorporate digital technology into a systemic approach strategy to address promotion, prevention, and clinic care work of CKD in a public health network. It considers the use of information and communication technologies (ICTs) in the renal health area as articulating instruments and supporting for the integration and coordination between primary health centers (PHCs) and the most renal specialized levels.

The proposal is based on telenephrology (TN) experiences reported in publications and in Latin American countries, some already consolidated and others under evaluation as public policies in renal health. During the COVID-19 pandemic, telemedical care allowed continuity of care, follow-up, and control of patients with chronic CKD, especially in geographically remote areas. The use of ICTs permitted the recording of data on infected CKD patients, education for confinement, instructions on vaccinations, and management of complications associated with COVID-19.

Additionally, this chapter reports the successful results of the strategic alliance between the Pan American Health Organization (PAHO) and the Latin American Society of Nephrology and Hypertension (SLANH) in the organization of nephrology education courses in telematic mode for health professionals from different Latin American countries.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. N Engl J Med. 2017;377(16):1585–92. https://doi.org/10.1056/NEJMsr1503323.

    Article  PubMed  Google Scholar 

  2. Weinstein RS, Krupinski EA, Doarn CR. Clinical examination component of telemedicine, telehealth, mHealth, and connected health medical practices. Med Clin North Am. 2018;102(3):533–44. https://doi.org/10.1016/j.mcna.2018.01.002.

    Article  PubMed  Google Scholar 

  3. Batsis JA, DiMilia PR, Seo LM, Fortuna KL, Kennedy MA, Blunt HB, et al. Effectiveness of ambulatory telemedicine care in older adults: A systematic review. J Am Geriatr Soc. 2019;67(8):1737–49. https://doi.org/10.1111/jgs.15959. Epub 2019 May 8

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lee SWH, Chan CKY, Chua SS, Chaiyakunapruk N. Comparative effectiveness of telemedicine strategies on type 2 diabetes management: a systematic review and network meta-analysis. Sci Rep. 2017;7(1):12680. https://doi.org/10.1038/s41598-017-12987-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Shah ND, Krupinski EA, Bernard J, Moyer MF. The evolution and utilization of telehealth in ambulatory nutrition practice. Nutr Clin Pract. 2021;36:739–49. https://doi.org/10.1002/ncp.10641. Epub 2021 Mar 18

    Article  PubMed  Google Scholar 

  6. Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2015;2015:CD002098. https://doi.org/10.1002/14651858.CD002098.pub2.

    Article  PubMed Central  Google Scholar 

  7. Zuniga C, Riquelme C, Muller H, Vergara G, Astorga C, Espinoza M. Using Telenephrology to improve access to nephrologist and global kidney management of CKD primary care patients. Kidney Int Rep. 2020;5(6):920–3. https://doi.org/10.1016/j.ekir.2020.03.002.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Salem R, El Zakhem A, Gharamti A, Tfayli A, Osman H. Palliative care via telemedicine: a qualitative study of caregiver and provider perceptions. J Palliat Med. 2020;23(12):1594–8. https://doi.org/10.1089/jpm.2020.0002. Epub 2020 Apr 23

    Article  PubMed  Google Scholar 

  9. Koraishy FM, Rohatgi R. Telenephrology: an emerging platform for delivering renal health care. Am J Kidney Dis. 2020;76(3):417–26. https://doi.org/10.1053/j.ajkd.2020.02.442. Epub 2020 Jun 2

    Article  PubMed  Google Scholar 

  10. Belcher JM. The Role of Telenephrology in the Management of CKD Kidney360 Nov 2020. 1(11):1310–5. https://doi.org/10.34067/KID.0000802019.

  11. El Shamy O, Tran H, Sharma S, Ronco C, Narayanan M, Uribarri J. Telenephrology with remote peritoneal dialysis monitoring during Coronavirus Disease 19. Am J Nephrol. 2020;51:480–2. https://doi.org/10.1159/000508023. Epub 2020 Apr 28

    Article  CAS  PubMed  Google Scholar 

  12. Roess A. The promise, growth, and reality of Mobile health—another data-free zone. N Engl J Med. 2017;377(21):2010–1. https://doi.org/10.1056/NEJMp1713180. Epub 2017 Nov 8

    Article  PubMed  Google Scholar 

  13. Thangada ND, Garg N, Pandey A, Kumar N. The emerging role of Mobile-health applications in the management of hypertension. Curr Cardiol Rep. 2018;20(9):78. https://doi.org/10.1007/s11886-018-1022-7.

    Article  PubMed  Google Scholar 

  14. Chen TK, Knicely DH, Grams ME. Chronic kidney Disease diagnosis and management: a review. JAMA. 2019;322(13):1294–304. https://doi.org/10.1001/jama.2019.14745.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Levin A, Tonelli M, Bonventre J, Coresh J, Donner JA, Fogo AB, et al. ISN global kidney health summit participants. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet. 2017;390(10105):1888–917. https://doi.org/10.1016/S0140-6736(17)30788-2. Epub 2017 Apr 20

    Article  PubMed  Google Scholar 

  16. Bello AK, Levin A, Tonelli M, Okpechi IG, Feehally J, Harris D, et al. Assessment of global kidney health care status. JAMA. 2017;317(18):1864–81. https://doi.org/10.1001/jama.2017.4046.

    Article  PubMed  PubMed Central  Google Scholar 

  17. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709–33. https://doi.org/10.1016/S0140-6736(20)30045-3. Epub 2020 Feb 13

    Article  Google Scholar 

  18. Ferreiro-Fuentes A. Nefrología en Latinoamérica post-COVID-19. Nefro Latinoam. 2021;18:89–94. https://doi.org/10.24875/NEFRO.21000051.

    Article  Google Scholar 

  19. Ministry of Health (Chile). Strategy for approaching of chronic kidney Disease in the health network. Accessed January 23 2022. https://redcronicas.minsal.cl/wp-content/uploads/2022/01/2022.01.03_ESTRATEGIA-PARA-EL-ABORDAJE-DE-LA-SALUD-RENAL-EN-LA-RED.pdf

  20. Margolis A, Gonzalez-Martinez F, Noboa O, Abbud-Filho M, Lorier L, Nin M, et al. Online continuing medical education for the Latin American nephrology community. Stud Health Technol Inform. 2015;216:372–5.

    PubMed  Google Scholar 

  21. Report of Renal Health Committee. Latin American Society of Nephrology and Hypertension. A survey to determine the level of use of telenephrology in the countries members of the SLANH. Accessed 23January 2022. https://slanh.net/

  22. Luyckx VA, Cherney DZI, Bello AK. Preventing CKD in developed countries. Kidney Int Rep. 2019;5(3):263–77. https://doi.org/10.1016/j.ekir.2019.12.003. Erratum in: Kidney Int Rep. 2020 May 04;5(5):758. PMID: 32154448; PMCID: PMC7056854

    Article  PubMed  PubMed Central  Google Scholar 

  23. NICE Guidance. Chronic kidney disease in adults: assessment and management. Published date: August 2021. Accessed January 23 2021. https://www.nice.org.uk/guidance/ng203

  24. Smart NA, Dieberg G, Ladhani M, Titus T. Early referral to specialist nephrology services for preventing the progression to end-stage kidney disease. Cochrane Database Syst Rev. 2014;6:CD007333. https://doi.org/10.1002/14651858.CD007333.pub2.

    Article  Google Scholar 

  25. Kidney Disease: Improving global outcomes (KDIGO) CKD Work Group KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.

    Google Scholar 

  26. Bhachu HK, Cockwell P, Subramanian A, Adderley NJ, Gokhale K, Fenton A, et al. Impact of using risk-based stratification on referral of patients with chronic kidney Disease from primary care to specialist Care in the United Kingdom. Kidney Int Rep. 2021;6(8):2189–99. https://doi.org/10.1016/j.ekir.2021.05.031.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Black C, Sharma P, Scotland G, McCullough K, McGurn D, Robertson L, et al. Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis. Health Technol Assess. 2010;14(21):1–184. https://doi.org/10.3310/hta14210.

    Article  CAS  PubMed  Google Scholar 

  28. Osman MA, Alrukhaimi M, Ashuntantang GE, Bellorin-Font E, Benghanem Gharbi M, Braam B, et al. Global nephrology workforce: gaps and opportunities toward a sustainable kidney care system. Kidney Int Suppl. 2018;8:52–63.

    Article  Google Scholar 

  29. Sharif MU, Elsayed ME, Stack AG. The global nephrology workforce: emerging threats and potential solutions! Clin Kidney J. 2016;9(1):11–22. https://doi.org/10.1093/ckj/sfv111. Epub 2015 Nov 14

    Article  PubMed  Google Scholar 

  30. Rosa-Diez G, González-Bedat MC, Luxardo R, Ceretta ML, Ferreiro-Fuentes A. Step-by-step guide to setting up a kidney replacement therapy registry: the challenge of a national kidney replacement therapy registry. Clin Kidney J. 2021;14(7):1731–7. https://doi.org/10.1093/ckj/sfab015.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 2019 Report. Latin American Registry of Dialysis and Renal Transplantation. [Internet]. Latin American Society of Nephrology and Hypertension. Accessed 23 January 2022. https://slanh.net/wp-content/uploads/2021/08/informe-2019-final.pdf

  32. Wainstein M, Bello AK, Jha V, Harris DCH, Levin A, Gonzalez-Bedat MC, et al. ISN Latin America Regional Board. International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Latin America. Kidney Int Suppl (2011). 2021;11(2):e35–46. https://doi.org/10.1016/j.kisu.2021.01.005. Epub 2021 Apr 12

    Article  Google Scholar 

  33. Dominguez-Alonso E. The burden of diabetes in Latin America and the Caribbean: analysis from the results of the 2015 Global Burden of Disease Study. Latin Am Diabetes Association J. 2018;8:81–94. Accessed 23 January 2022. Available at: http://www.revistaalad.com/frame_esp.php?id=375

    Google Scholar 

  34. Gonzalez-Bedat M, Rosa-Diez G, Pecoits-Filho R, Ferreiro A, García-García G, Cusumano A, et al. Burden of disease: prevalence and incidence of ESRD in Latin America. Clin Nephrol. 2015;83(7 Suppl 1):3–6. https://doi.org/10.5414/cnp83s003.

    Article  PubMed  Google Scholar 

  35. Kalantar-Zadeh K, Li PK. Strategies to prevent kidney disease and its progression. Nat Rev Nephrol. 2020;16(3):129–30. https://doi.org/10.1038/s41581-020-0253-1.

    Article  PubMed  Google Scholar 

  36. Li PK, Garcia-Garcia G, Lui SF, Andreoli S, Fung WW, Hradsky A. World Kidney Day Steering Committee, et al.; Members of the World Kidney Day Steering Committee. Kidney Health for Everyone Everywhere - From prevention to detection and equitable access to care. Nefrologia (Engl Ed). 2020 40(2):133–141. English, Spanish. doi: https://doi.org/10.1016/j.nefro.2019.11.001.

  37. Tuot DS, Boulware LE. Telehealth applications to enhance CKD knowledge and awareness among patients and providers. Adv Chronic Kidney Dis. 2017;24(1):39–45. https://doi.org/10.1053/j.ackd.2016.11.017.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kelly JT, Warner MM, Conley M, Reidlinger DP, Hoffmann T, Craig J, et al. Feasibility and acceptability of telehealth coaching to promote healthy eating in chronic kidney disease: a mixed-methods process evaluation. BMJ Open. 2019;9(1):e024551. https://doi.org/10.1136/bmjopen-2018-024551.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Osman MA, Okel J, Okpechi IG, Jindal K, Bello AK. Potential applications of telenephrology to enhance global kidney care. BMJ Glob Health. 2017;2(2):e000292. https://doi.org/10.1136/bmjgh-2017-000292.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Diamantidis CJ, Ginsberg JS, Yoffe M, Lucas L, Prakash D, Aggarwal S, et al. Remote usability testing and satisfaction with a mobile health medication inquiry system in CKD. Clin J Am Soc Nephrol. 2015;10(8):1364–70. https://doi.org/10.2215/CJN.12591214. Epub 2015 Jul 28

    Article  PubMed  PubMed Central  Google Scholar 

  41. Ong SW, Jassal SV, Porter EC, Min KK, Uddin A, Cafazzo JA, et al. Digital applications targeting medication safety in ambulatory high-risk ckd patients: randomized controlled clinical trial. Clin J Am Soc Nephrol. 2021;16(4):532–42. https://doi.org/10.2215/CJN.15020920. Epub 2021 Mar 18

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Chang AR, Bailey-Davis L, Hetherington V, Ziegler A, Yule C, Kwiecen S, et al. Remote dietary counseling using smartphone applications in patients with stages 1-3a chronic kidney disease: a mixed methods feasibility study. J Ren Nutr. 2020;30(1):53–60. https://doi.org/10.1053/j.jrn.2019.03.080. Epub 2019 May 8

    Article  PubMed  Google Scholar 

  43. Ong SW, Jassal SV, Miller JA, Porter EC, Cafazzo JA, Seto E, et al. Integrating a smartphone-based self-management system into usual care of advanced CKD. Clin J Am Soc Nephrol. 2016;11(6):1054–62. https://doi.org/10.2215/CJN.10681015. Epub 2016 May 12

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Silva Junior GB, Ferreiro Fuentes A, Nangaku M, Remuzzi G, Ronco C, Nephrology and Public Health Worldwide. Digital Health and Possible Solutions to Improve the Care in the Field of Nephrology Basel. Contrib Nephrol. 2021;199:307–21. https://doi.org/10.1159/000517709.

    Article  PubMed  Google Scholar 

  45. Stauss M, Floyd L, Becker S, Ponnusamy A, Woywodt A. Opportunities in the cloud or pie in the sky? Current status and future perspectives of telemedicine in nephrology. Clin Kidney J. 2020;14(2):492–506. https://doi.org/10.1093/ckj/sfaa103.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Zúñiga-SMC, Guerrero-GJL, Bezanilla CG, Arrese-JM, Reyes-BH. Telemedicine today and tomorrow. Boletín Academia Chilena de Medicina. 2021;LVIII:61–82. Accessed at: https://www.academiachilenademedicina.cl/wp-content/uploads/2022/05/boletin_academia-med-2021.pdf.

  47. Aungst LA. Can telemedicine improve triage and patient satisfaction in urgent care settings? J Am Assoc Nurse Pract. 2019;31:162–6. https://doi.org/10.1097/JXX.0000000000000117.

    Article  PubMed  Google Scholar 

  48. McHugh C, Krinsky R, Sharma R. Innovations in emergency nursing: Transforming emergency care through a novel nurse-driven ED Telehealth Express Care Service. J Emerg Nurs. 2018;44:472–7. https://doi.org/10.1016/j.jen.2018.03.001. Epub 2018 Apr 7

    Article  PubMed  Google Scholar 

  49. Ritchey KC, Foy A, McArdel E, Gruenewald DA. Reinventing palliative care delivery in the era of COVID-19: how telemedicine can support end of life care. Am J Hosp Palliat Care. 2020;37:992–7. https://doi.org/10.1177/1049909120948235.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Chaet D, Clearfield R, Sabin JE, Skimming K. Council on ethical and judicial affairs American Medical Association. Ethical practice in telehealth and telemedicine. J Gen Intern Med. 2017;32:1136–40. https://doi.org/10.1007/s11606-017-4082-2.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Daniel H, Sulmasy LS. Health and public policy Committee of the American College of physicians. Policy recommendations to guide the use of telemedicine in primary care settings: an American College of Physicians position paper. Ann Intern Med. 2015;163:787–9. https://doi.org/10.7326/M15-0498. Epub 2015 Sep 8

    Article  PubMed  Google Scholar 

  52. Sulmasy LS, Bledsoe TA. ACP Ethics, Professionalism and Human Rights Committee. American College of Physicians Ethics Manual: Seventh Edition. Ann Intern Med. 2019;170(2_Suppl):S1–S32. https://doi.org/10.7326/M18-2160.

    Article  PubMed  Google Scholar 

  53. American Medical Association. Principles of medical ethics. Accessed January 23 2022. https://www.ama-assn.org/about/publications-newsletters/ama-principles-medical-ethics

  54. Mesa M, Perez I. The medical act in the era of telemedicine. Rev Med Chile. 2020;148(6):852–7. https://doi.org/10.4067/S0034-98872020000600852.

    Article  PubMed  Google Scholar 

  55. Nongovernmental organizations in official relations with the Pan American Health Organization. The 156th session of the executive committee. June 25 2015. Accessed January 23 2022. https://www.paho.org/hq/dmdocuments/2015/CE156-R15-e.pdf

  56. Mehta RL, Cerdá J, Burdmann EA, Tonelli M, García-García G, Jha V, et al. International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet. 2015;385(9987):2616–43. https://doi.org/10.1016/S0140-6736(15)60126-X. Epub 2015 Mar 13

    Article  PubMed  Google Scholar 

  57. Lombardi R, Ferreiro A, Rosa-Diez G, Margolis Á, Yu L, Younes-Ibrahim M, et al. Raising awareness of acute kidney injury: a Latin American experience. Kidney Int Rep. 2018;3(6):1416–23. https://doi.org/10.1016/j.ekir.2018.08.003.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Telematic course on prevention and management of CKD for the first level of care in Latin America. PAHO/SLANH. Accessed January 23 2022. https://www3.paho.org/hq/index.php?option=com_content&view=article&id=12252:curso-virtual-de-prevencion-y-manejo-de-la-enfermedad-renal-cronica&Itemid=1969&lang=es

  59. Report of Renal Health Committee. Latin American Society of Nephrology and Hypertension. Telematic course on prevention and management of CKD for the first level of care in Latin America. PAHO/SLANH. Accessed January 23 2022. https://slanh.net/

  60. Di Bernardo JJ, García García G, Gonzalez-Martinez F, Di Rienzo P, Cortés Sanabria L, Cerdás Calderón M, Fernández CJ. Recommendations for the training of nephrologists in Latin America: specialty adult nephrology, version 2.0. Buenos Aires: Publicaciones Latinoamericanas SRL; 2015. p. 40. ISBN:978-987-33-9061-6

    Google Scholar 

  61. Hollander JE, Carr BG. Virtually perfect? Telemedicine for Covid-19. N Engl J Med. 2020;382(18):1679–81. https://doi.org/10.1056/NEJMp2003539. Epub 2020 Mar 11

    Article  CAS  PubMed  Google Scholar 

  62. Zuniga C, Friz P, Vivanco P, Urizar A, Briñon MA, Alvarado C, et al. Role of telenephrology in the management of CKD stages 4–5 (non dialysis) patients during the Covid-19 pandemic. Kidney Int Rep. 2022;7:S322.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Facultad de Medicina, Universidad Católica de la Santísima Concepción, Bío Bío, Chile

    Carlos Zúñiga-San Martín

  2. Facultad de Medicina, Universidad de Concepción, Bío Bío, Chile

    Carlos Zúñiga-San Martín

  3. Departamento Salud Digital, Ministerio de Salud, Santiago, Chile

    Carlos Zúñiga-San Martín

Authors
  1. Carlos Zúñiga-San Martín
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil

    Geraldo Bezerra da Silva Junior

  2. Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, Tokyo, Japan

    Masaomi Nangaku

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Martín, C.ZS. (2022). Telenephrology: A Resource for Universalizing Access to Kidney Care, Perspectives from Latin America. In: Bezerra da Silva Junior, G., Nangaku, M. (eds) Innovations in Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-031-11570-7_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-11570-7_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-11569-1

  • Online ISBN: 978-3-031-11570-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation