Telenephrology: current perspectives and future directions

Kidney Int. 2017 Dec;92(6):1328-1333. doi: 10.1016/j.kint.2017.06.032. Epub 2017 Oct 12.


There is increasing interest in telemedicine among physicians and patients; however, the evidence regarding the quality of care delivered by telemedicine, and telenephrology in particular, compared with in-person care is limited. In this review, different electronic modalities used to deliver nephrology care are reviewed and critiqued, with a focused analysis from the Australian and United States perspectives. Both countries are geographically expansive with significant rural populations where access to nephrology care is limited. However, their health care systems are organized differently. The Australian health care system is a mostly nonprofit, single-payer system, whereas the United States system is more fractured with a greater proportion of patients covered by for-profit private insurance or no insurance coverage. Videoconferencing is widely used in Australia to manage kidney disease including chronic kidney disease, dialysis, pediatric nephrology, and post-kidney transplantation care. In contrast, the United States telenephrology experience is limited, with most reports originating from the Veterans Health Administration, a single-payer system providing care for nearly 9 million veterans, ∼3 million of whom reside in rural communities. Preliminary reports from the Veterans Health Administration suggest that that delivery of nephrology care via videoconferencing results in clinical outcomes that are at least equivalent to in-person care and improved patient adherence to scheduled appointments. Nevertheless, large, adequately controlled studies are needed to identify patient populations that are most likely to benefit from telenephrology and to determine the optimal systems for the delivery of telenephrology care.

Keywords: chronic kidney disease; hemodialysis; telehealth.

Publication types

  • Review

MeSH terms

  • Australia
  • Delivery of Health Care / methods*
  • Delivery of Health Care / statistics & numerical data
  • Delivery of Health Care / trends
  • Humans
  • Kidney Diseases / therapy*
  • Nephrology / methods*
  • Nephrology / statistics & numerical data
  • Nephrology / trends
  • Quality of Health Care*
  • Telemedicine / methods*
  • Telemedicine / statistics & numerical data
  • Telemedicine / trends
  • United States
  • United States Department of Veterans Affairs / organization & administration
  • United States Department of Veterans Affairs / statistics & numerical data
  • Videoconferencing / statistics & numerical data
  • Videoconferencing / trends