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Safety and timeliness of telemedicine initiation of continuous kidney replacement therapy

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Abstract

Background

During the COVID-19 pandemic, some continuous kidney replacement therapy (CKRT) initiations were transitioned to telemedicine to improve the timeliness of initiation, and minimize COVID-19 transmission. While telemedicine would appear acceptable for many clinical settings, safety and timeliness of telemedicine CKRT initiation is undescribed.

Methods

We conducted a single-center retrospective cohort study of pediatric patients on CKRT from January 2021–September 2022. Information on patient characteristics and CKRT therapy was extracted from the electronic health record. Multidisciplinary team provider attitudes and perspectives were assessed using survey.

Results

During the study period, there were 101 CKRT circuit initiations in patients not previously receiving CKRT, with 33% (33/101) initiated by telemedicine. There were no differences in patient characteristics, including age, weight at initiation, severity of illness, nor degree of fluid overload between the in-person and telemedicine initiation cohorts. CKRT telemedicine initiations were timelier, occurring on average 3.0 h after decision to initiate therapy compared to 5.8 h for all in-person CKRT starts (p < 0.001) and 5.5 h for night and weekend in-person starts (p < 0.001). Complications did not differ between telemedicine and in-person starts (15% vs. 15%, p = 0.99) and initial circuit life was similar. There were no differences in likelihood of death or duration of CKRT therapy. Telemedicine initiations were widely acceptable to multidisciplinary providers.

Conclusion

In appropriately selected patients, telemedicine initiation of CKRT is a timely and safe option. Further standardization of telemedicine initiation of CKRT should be considered to improve the timely delivery of CKRT and may improve nephrology workforce wellness.

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Data availability

De‐identified individual participant data will be made available to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal. The data is de‐identified and a limited access data is available through a request from the corresponding author. Data dictionaries, study protocol, and statistical analysis plan are available upon request.

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Funding

This work was supported in part by the Indiana University School of Medicine Physician Scientist Initiative. Study data were collected and managed using REDCap electronic data capture tools hosted at the Indiana Clinical and Translational Sciences Institute (Indiana CTSI) funded, in part by Grant Numbers UL1TR001108, KL2TR001106, or TL1TR001107 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award and at the Indiana University Pervasive Technology Institute (https://pti.iu.edu/) which supports REDCap with IT infrastructure and consulting resources.

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    Michelle C. Starr, Kathleen Altemose, David S. Hains & Danielle E. Soranno

  2. Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th Street, Suite 2000A, Indianapolis, IN, 46202, USA

    Michelle C. Starr

  3. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    Jessalynn Parsley & Daniel T. Cater

  4. Department of Bioengineering, Purdue University, West Lafayette, IN, USA

    Danielle E. Soranno

Authors
  1. Michelle C. Starr
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  2. Kathleen Altemose
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  3. Jessalynn Parsley
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  4. Daniel T. Cater
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  5. David S. Hains
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  6. Danielle E. Soranno
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Corresponding author

Correspondence to Michelle C. Starr.

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Prior presentation of study data

Elements of this research project were presented at the International Symposium on AKI in Children, Cincinnati, OH, October 1, 2022 and at the Pediatric Academic Societies and American Society of Pediatric Nephrology Annual Meeting, Washington, DC; April 30, 2023.

Competing interests

All authors report no real or perceived conflicts of interest that could affect the study design, collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the manuscript for publication. For full disclosure, we provide the additional list of authors’ other funding not directly related to this study. M.S. is supported in part by the Indiana University School of Medicine Physician Scientist Initiative. No other disclosures were reported. Funding sources for this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

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Starr, M.C., Altemose, K., Parsley, J. et al. Safety and timeliness of telemedicine initiation of continuous kidney replacement therapy. Pediatr Nephrol 39, 325–329 (2024). https://doi.org/10.1007/s00467-023-06036-3

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  • DOI: https://doi.org/10.1007/s00467-023-06036-3

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