Telehealth by an Interprofessional Team in Patients With CKD: A Randomized Controlled Trial.

BACKGROUND: Telehealth and interprofessional case management are newer strategies of care within chronic disease management. We investigated whether an interprofessional team using telehealth was a feasible care delivery strategy and whether this strategy could affect health outcomes in patients with chronic kidney disease (CKD). STUDY DESIGN: Randomized clinical trial. SETTING & PARTICIPANTS: Minneapolis Veterans Affairs Health Care System (VAHCS), St. Cloud VAHCS, and affiliated clinics March 2012 to November 2013 in patients with CKD (estimated glomerular filtration rate < 60mL/min/1.73m(2)). INTERVENTIONS: Patients were randomly assigned to receive an intervention (n=451) consisting of care by an interprofessional team (nephrologist, nurse practitioner, nurses, clinical pharmacy specialist, psychologist, social worker, and dietician) using a telehealth device (touch screen computer with peripherals) or to usual care (n=150). OUTCOMES: The primary end point was a composite of death, hospitalization, emergency department visits, or admission to skilled nursing facilities, compared to usual care. RESULTS: Baseline characteristics of the overall study group: mean age, 75.1±8.1 (SD) years; men, 98.5%; white, 97.3%; and mean estimated glomerular filtration rate, 37±9mL/min/1.73m(2). Telehealth and interprofessional care were successfully implemented with meaningful engagement with the care system. One year after randomization, 208 (46.2%) patients in the intervention group versus 70 (46.7%) in the usual-care group had the primary composite outcome (HR, 0.98; 95% CI, 0.75-1.29; P=0.9). There was no difference between groups for any component of the primary outcome: all-cause mortality (HR, 1.46; 95% CI, 0.42-5.11), hospitalization (HR, 1.15; 95% CI, 0.80-1.63), emergency department visits (HR, 0.92; 95% CI, 0.68-1.24), or nursing home admission (HR, 3.07; 95% CI, 0.71-13.24). LIMITATIONS: Older population, mostly men, potentially underpowered/wide CIs. CONCLUSIONS: Telehealth by an interprofessional team is a feasible care delivery strategy in patients with CKD. There was no statistically significant evidence of superiority of this intervention on health outcomes compared to usual care.

Monitoring changes in fluid status with a wireless multisensor monitor: results from the Fluid Removal During Adherent Renal Monitoring (FARM) study.

Body fluid assessment is important for managing chronic kidney disease (CKD) and heart failure (HF). However, accurate detection of fluid retention remains elusive. The Fluid Removal During Adherent Renal Monitoring (FARM) study is a prospective, nonrandomized trial examining the performance of a wireless, noninvasive, multisensor fluid monitoring system, applied to the chest, to determine its performance and reliability during hemodialysis. Patients undergoing regular hemodialysis (n=25) were monitored continuously for 2 consecutive dialysis sessions and the interdialysis period. Physiologic variables, including tissue impedance, were recorded. The volume of fluid removed and weight change during dialysis were measured. An average of 3.4±1.2 L of fluid was removed during dialysis, which was associated with an increase in bioimpedance of 11.3±7.2 Ω. Change in bioimpedance was highly correlated with the amount of fluid removed but less so with weight loss. Normalized bioimpedance change (21.0%±12.1% increase from baseline, P<001) was larger than the normalized weight change (3.6%±1.1%, P<.01), suggesting a higher sensitivity and dynamic range than weight change for detecting fluid removal. The fluid monitoring system accurately tracked fluid and weight loss in patients during hemodialysis, supporting its use as a tool for the management of patient fluid status in disease states.