NE PHROLOGY
Remote monitoring of chronic kidney disease
Dr. Robert Lewis, a consultant nephrologist, from Wessex Kidney Centre Portsmouth, argues that patients are keen to embrace web-based remote monitoring, to support self-management of chronic kidney disease. Despite the benefits, some clinicians have been hesitant to adopt the technology. He calls for a change in attitude and shares his insights into the implementation of virtual consultations.
In 2019, the NHS plan set the ambition for greater adoption of remote monitoring and virtual consultations in order to achieve a 33% reduction in outpatient attendance over five years.1
The authors of the NHS
plan could not have foreseen the COVID-19 pandemic, which prompted an abrupt, unplanned reduction in clinic attendance driven by the need to reduce the risk to patients of COVID-19 exposure. Routine face-to-face consultations were largely replaced by telephone or video consultations scheduled at a given date and time using traditional clinic templates. This approach caused minimal disruption to existing administrative processes or staff working practices and thus provided a tolerable quick-fix to meet the needs of an emergency. Prior to the pandemic, there had been growing interest in the application of digital technologies to the management of chronic kidney disease (CKD). These systems have
been shown to be useful for the remote transfer of data from patient to clinician2,3
or
as a means of providing patient education.4 Computer-based software designed for remote management of CKD has been described,5
but
its value in clinical practice remains unclear. The adoption of such technology into routine clinical practice has therefore been slow. The changes in practice forced upon us by the pandemic have shown us that traditional clinics are not the only (or even the best) way to monitor patients with chronic disease. We now have an opportunity to establish the optimal relationship between healthcare users and providers in the digital age. We need to ask if digital technologies can be used to enhance patient involvement and if clinicians need to overhaul their traditional working practices to incorporate these technologies in order to reduce the burden of disease on patients and improve the efficiency of healthcare. This article describes our experience with
a novel web-based application designed to monitor people with CKD remotely while introducing a degree of self-management. It was developed by Ardia Health Care in collaboration with the Wessex Kidney Centre, which provides specialist nephrology, dialysis and renal transplant services to a catchment population of about two million in the central south coast region of England. Although this account relates solely to renal disease, the principles underlying the technology and the way it has been applied in practice could readily be adapted to the management of a wide range of chronic conditions.
Why consider remote monitoring? Many people with a kidney transplant or with stable CKD enjoy a full social and family life and can work full-time. Medical oversight should therefore be delivered in a way that is safe and yet makes the slightest possible intrusion into the ability of these
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