Managing CKD by Telemedicine: The Zuni Telenephrology Clinic

Adv Chronic Kidney Dis. 2017 Jan;24(1):6-11. doi: 10.1053/j.ackd.2016.11.019.


Telemedicine has significant potential to extend nephrology consultation to rural and isolated communities. We describe a telenephrology clinic that has delivered ongoing consultative care from a nephrologist based at the National Institutes of Health in Bethesda, MD, to the Zuni Comprehensive Health Center in western New Mexico. Over the past 9 years, the clinic has conducted 1870 patient visits managing patients using a collaborative approach engaging a nurse case manager, nephrologist, primary clinicians, pharmacists, and community health nurses. A significant proportion of the care provided is directed toward patients with advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2). Although there are unique aspects to the Indian Health Service and to the Zuni community which is served by this clinic, this telemedicine clinic does serve as a demonstration that nephrologic consultative care can be delivered effectively and efficiently to rural high-risk communities using a collaborative and integrated model of care.

Keywords: Indian Health Service; Kidney disease; Nephrology consultation; Telehealth; Telemedicine.

Publication types

  • Review

MeSH terms

  • Ambulatory Care / organization & administration
  • Case Managers
  • Delivery of Health Care / organization & administration*
  • Diabetic Nephropathies / therapy*
  • Disease Management
  • Humans
  • National Institutes of Health (U.S.)
  • Nephrologists
  • Nephrology*
  • New Mexico
  • Nurses, Community Health
  • Renal Insufficiency, Chronic / therapy*
  • Severity of Illness Index
  • Telemedicine / organization & administration*
  • United States
  • United States Indian Health Service / organization & administration