May 1, 2020 / 11:11 PM / a month ago

Home dialysis monitored via telemedicine may help protect patients from SARS-CoV-2

(Reuters Health) - In the era of COVID-19, the best way to protect kidney failure patients may be home dialysis with monitoring through telemedicine, a new report suggests.

In the American Journal of Nephrology, specialists from several centers describe a program in which patients have been taught to dialyze at home, with monthly checkups via telemedicine and blood draws done by a phlebotomist who travels to patients’ homes.

Keeping patients in their homes as much as possible will lower their risk of developing severe symptoms of COVID-19, said the study’s lead author, Dr. Osama El Shamy, a nephrology fellow specializing in home dialysis at the Icahn School of Medicine at Mount Sinai in New York City. “We have tried our best at Mount Sinai and other locations to provide these home dialysis patients with the telemedicine option so they do not need to come to dialysis units where they could be exposed to the virus.”

Of the 80 peritoneal dialysis patients at Mount Sinai, more than 80% utilize Sharesource, a cloud-based connectivity platform that shares information from the patients’ dialysis cycler and allows nephrologists and other staff to monitor each cycle’s information: fill volume and time, dwell time, drain volume and time and ultrafiltration volume.

More than 90% of Mount Sinai’s home dialysis patients are having their monthly visits conducted through telehealth, which means they have not needed to come to the center for any of their needs, El Shamy said.

Along with contracting with a lab that sends a phlebotomist, “we’ve contracted with a courier service that sends someone to Mount Sinai to pick up medications and deliver them to patients,” El Shamy said.

Dr. Hamid Rabb welcomed the new article.

“It’s a very nice paper,” said Rabb, medical director of the Johns Hopkins Kidney Transplant Program and a professor of medicine in the department of nephrology at Johns Hopkins University, in Baltimore. “I liked it because it lists what many of us are trying to do, planning to do and are doing.”

The paper addresses the vulnerability of dialysis patients to the SARS-CoV-2 virus, Rabb said. “People with kidney failure are particularly vulnerable to COVID-19 because their immune systems are dampened,” he added. “Moreover, comorbidities such as diabetes, hypertension, and cardiovascular disease are more common in this population. And many are older. For many reasons this population is at increased risk.”

“What this group has done, and what many are moving toward, is working together with nursing staff and remote technology,” Rabb said. “And it’s going well so far. The patients are happy. The care they are getting is reasonable. And the healthcare system is being protected in terms of not having to use as much of the personal protective equipment, which means that resource can be saved for use with sicker patients.”

While the method seems to be working well in the era of COVID, Rabb wonders about a time when the pandemic has passed. It’s true that a lot can be gleaned from the video images, but there’s no substitute for a sense of touch, Rabb said. In person a doctor could tell whether there was any swelling or heat, he added.

“We’ll have to see how this affects long term outcomes,” he said.

SOURCE: American Journal of Nephrology, online April 28, 2020.

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