{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:31:56Z","timestamp":1786480316359,"version":"build-2736575974"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2024,11,22]],"date-time":"2024-11-22T00:00:00Z","timestamp":1732233600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2025,1]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Primary use of telenephrology in a hybrid system was associated with similar CKD progression outcomes as those seen primarily in-person.<\/jats:p>\n <\/jats:list-item>\n \n A hybrid system incorporating predominant use of telenephrology may be noninferior to standard in-person care with regard to multiple CKD outcomes.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Nephrology has seen an uptake in transition to remote care delivery. The effect of telenephrology care on CKD progression is not well defined.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We analyzed data from patients naturally selected for telenephrology versus standard in-person visits. Patients were seen across 4230 visits over a 2-year period at a nephrology clinic within the Veterans Affairs (VA) health system. Baseline characteristics and health profile data were assessed on the basis of grouping of individuals to the telenephrology group (>50% virtual visits) or in-person group (\u226450% virtual visits). The slope of eGFR change over time was estimated for each patient using a random effects regression model and compared across groups using weighted linear regression models.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 1098 patients comprised the final analysis. The groups were similar across baseline demographics and health profiles, although more cardiovascular disease, congestive heart failure, and diabetes mellitus were present in the in-person group. There was no significant difference in eGFR decline between groups, although those in telenephrology group trended toward less steep decline compared with those seen predominately in-person (telenephrology slope versus in-person slope; difference=0.81 ml\/min per 1.73 m\n 2<\/jats:sup>\n ; 95% confidence interval, \u22120.447 to 2.08;\n P<\/jats:italic>\n = 0.21). Those seen primarily in-person had a similar degree of proteinuria compared with those in telenephrology (\n P<\/jats:italic>\n = 0.12). All-cause mortality and incidence of outpatient RRT initiation was similar. Telenephrology patients had an average of 1.3 fewer emergency department visits per individual compared with their in-person counterpart (2.17 versus 3.44,\n P<\/jats:italic>\n < 0.001), as well as fewer hospital admissions (1.59 versus 2.08,\n P<\/jats:italic>\n = 0.02). Those in the in-person group were more often prescribed sodium glucose cotransporter 2 inhibitors, statins, nonsteroidal anti-inflammatory drugs, and potassium supplements.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Data from this observational study within a VA health care system suggest that medically complex patients with multimorbid CKD can expect a similar rate of eGFR decline when care is delivered through a hybrid system that includes a majority of telenephrology when compared with those managed in face-to-face visits. Further studies are needed to corroborate findings and ensure generalizability outside of this VA system.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000000641","type":"journal-article","created":{"date-parts":[[2024,11,22]],"date-time":"2024-11-22T12:01:02Z","timestamp":1732276862000},"page":"69-75","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["CKD Management in the Age of Telenephrology"],"prefix":"10.34067","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4966-2556","authenticated-orcid":false,"given":"Zachary Albert","family":"Scherzer","sequence":"first","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin"},{"name":"William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad C.","family":"Astor","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin"},{"name":"The Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dyan","family":"Lesnik","sequence":"additional","affiliation":[{"name":"William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Maursetter","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin"},{"name":"William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,11,22]]},"reference":[{"issue":"7","key":"B1-20250130","doi-asserted-by":"crossref","first-page":"e0158765","DOI":"10.1371\/journal.pone.0158765","article-title":"Global prevalence of chronic kidney disease - a systematic review and meta-analysis","volume":"11","author":"Hill","year":"2016","journal-title":"PLoS One."},{"issue":"2","key":"B3-20250130","first-page":"e57","article-title":"Predialysis nephrology care among older veterans using Department of Veterans Affairs or Medicare-covered services","volume":"16","author":"Fischer","year":"2010","journal-title":"Am J Manag Care."},{"issue":"3","key":"B6-20250130","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1159\/000488004","article-title":"Telenephrology: providing healthcare to remotely located patients with chronic kidney disease","volume":"47","author":"Tan","year":"2018","journal-title":"Am J Nephrol."},{"issue":"8","key":"B7-20250130","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1089\/tmj.2015.0197","article-title":"Tele-nephrology: a feasible way to improve access to care for patients with kidney disease who reside in underserved areas","volume":"22","author":"Ladino","year":"2016","journal-title":"Telemed J E Health."},{"issue":"1","key":"B8-20250130","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1053\/j.ajkd.2016.01.018","article-title":"Telehealth by an interprofessional team in patients with CKD: a randomized controlled trial","volume":"68","author":"Ishani","year":"2016","journal-title":"Am J Kidney Dis."},{"issue":"11","key":"B9-20250130","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.34067\/KID.0000802019","article-title":"The role of telenephrology in the management of CKD","volume":"1","author":"Belcher","year":"2020","journal-title":"Kidney360."},{"issue":"19","key":"B10-20250130","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C-based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med."},{"issue":"6","key":"B11-20250130","first-page":"e817","article-title":"Interdisciplinary telehealth team positively impacts difficult-to-control hypertension in CKD","volume":"4","author":"Dopp","year":"2023","journal-title":"Kidney360"},{"issue":"11","key":"B12-20250130","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1097\/MLR.0000000000001387","article-title":"Racial differences in the effectiveness of a multifactorial telehealth intervention to slow diabetic kidney disease","volume":"58","author":"Kobe","year":"2020","journal-title":"Med Care."}],"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000000641","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:03:15Z","timestamp":1786478595000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000000641"}},"subtitle":["An Observational Analysis of a Hybrid Telenephrology System within a Veteran's Affairs Medical Center"],"short-title":[],"issued":{"date-parts":[[2024,11,22]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.34067\/kid.0000000641","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,22]]},"assertion":[{"value":"2024-06-21","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-07","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}