Impact of telemedicine on metabolic control and hospitalization of peritoneal dialysis patients during the COVID-19 pandemic: a national multicentric cohort study

Abstract

Introduction: The coronavirus-19 pandemic threatens the lives of all people, but results in higher mortality rates for patients with end-stage kidney disease (ESKD) including those on peritoneal dialysis (PD). Telemedicine was the main alternative to reduce exposure to the virus, but it was introduced in the Brazil without proper training. Objective: To investigate the impact of telemedicine on metabolic control, peritonitis rates, and hospitalization in PD patients during the pandemic. Methods: This was a retrospective multicenter cohort study. We included all adult patients on chronic PD from 9 clinics selected by convenience during the pandemic. The outcomes of interest were measured and compared between before and after switching to telemedicine using repeated measure analysis and multilevel Poisson regression. Results: The study included 747 patients with a mean age of 59.7±16.6 years, of whom 53.7% were male and 40.8% had diabetes. Biochemical parameters including hemoglobin, potassium, phosphate, calcium, and urea serum levels did not change significantly after transition to telemedicine. There was no association between telemedicine and peritonitis rates. In contrast, hospitalization rates increased significantly in the telemedicine period. The incidence rate ratio (IRR) for hospitalization in the telemedicine period was 1.54 (95%CI 1.10-2.17; p 0.012) and 1.57 (95%CI 1.12-2.21; p 0.009) in the mixed-effects Poisson regression before and after adjustment for the presence of confounders. Admissions for hypervolemia and infections not related to PD doubled after transition to telemedicine. Conclusion: The implementation of telemedicine without proper training may lead to an increase in adverse events in PD patients.

Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: A Scoping Review

“…However, a study 100 (n=143) that used telephone calls and text messages to send blood glucose values, check insulin doses, and periodically monitor for acute complications in patients with type 1 diabetes observed worsening of HbA1c in 46% of patients. A Brazilian center 101 (n=747) assessed a telemedicine program without specific training and found hospitalization rates increased by ∼50%. In contrast, a pre-post study from the Dominican Republic 102 used WhatsApp and telephone calls to monitor 946 dialysis patients and observed decreased hospitalization and a 2% COVID-19 diagnosis rate over a 3-month follow-up period.…”

The impact of partial and complete lockdown during the COVID-19 pandemic on acute surgical services: a retrospective cohort study

“…The noted increase in dialysis patients needing admission is also consistent with findings in the literature. A Brazilian multicenter cohort study of 747 dialysis patients found that with the implementation of telemedicine during the pandemic, which was designed to provide patient care without the need for hospital visits, hospitalization rates among dialysis patients actually increased, and the incidence of infections was found to be significantly higher as well [ 17 ]. Note that their study looked at all dialysis patients’ admissions, not only surgical ones.…”

Telemedicina e diálise peritoneal: o futuro é hoje

“…A pandemia de covid-19 mostrou que a telemedicina pode ser um importante ato complementar à assistência médica, permitindo o acesso a milhares de pacientes. Em estudo publicado nesta edição por Tabuti et al 4 , "Impacto da telemedicina no controle metabólico e hospitalização de pacientes em diálise peritoneal durante a pandemia de covid-19: um estudo de coorte multicêntrico nacional", os autores investigam o impacto da telemedicina nos desfechos metabólicos e hospitalizações, em nove clínicas, totalizando 747 pacientes. Trata-se de um importante estudo, pois a prática da telemedicina está definitivamente incorporada à medicina, devendo, inclusive, ser abordada na formação educacional nas escolas de saúde.…”

“…Ronco et al publicaram, em 2020 6 , também no início da pandemia, recomendações de que o uso de ferramentas de telemedicina e o gerenciamento remoto certamente permitiram continuar um ótimo atendimento aos pacientes em DP sem aumento significativo de complicações ou falha técnica, e apoiaram o esforço para prescrever DP direcionado a metas de alta qualidade. Wang, em estudo recentemente publicado (2022) 7 , com objetivos similares aos do estudo de Tabuti et al 4 , apresentou resultados diferentes deste, mostrando diminuição da taxa de peritonites e de hospitalização em um período de dois anos, com 1.161 pacientes. Essa diferença pode ser devido ao tempo de acompanhamento, que foi maior no estudo chinês.…”