Telemedicine versus Face-to-Face Follow-Up in Post-Acute Kidney Injury Survivors: A Pilot Randomized Controlled Trial

This is the first randomized controlled trial to evaluate the feasibility of telemedicine specifically in the follow-up care of post-AKI survivors. Telemedicine proved practical by reducing travel and waiting times while maintaining high patient satisfaction and clinical monitoring quality. Less frequent serum creatinine measurements in the telemedicine group highlight a potential feasibility limitation for virtual follow-up.

Regular postdischarge follow-up with a nephrologist is recommended for post-AKI survivors; however, accessibility barriers, particularly among patients with multiple comorbidities or those living in remote areas, often limit continuity of care. Telemedicine offers a potential solution, but evidence in post-AKI populations remains limited.

This single-center, open-label, randomized controlled trial was conducted at Thammasat University Hospital, Thailand. Adults who survived hospitalization with stages 2-3 AKI and lived ≥15 km from the hospital were randomly assigned to telemedicine follow-up using the secure Thammasat University Hospital Telemed application or conventional face-to-face follow-up for 6 months. The primary outcome was feasibility, assessed using three process indicators: ( 1 ) follow-up adherence, ( 2 ) serum creatinine measurement, and ( 3 ) BP measurement. Secondary outcomes included clinical (mortality, readmission, CKD progression, recurrent AKI, and BP control) and patient-centered outcomes (satisfaction, waiting time, travel time, and travel cost).

A total of 58 post-AKI patients were enrolled, with 29 assigned to the conventional face-to-face follow-up group and 29 to the telemedicine follow-up group. The mean age was 65.2±14.3 years, and 57% were male. At 6 months, follow-up adherence, the key feasibility indicator, was similar between the telemedicine and face-to-face groups (90% versus 90%, P = 1.00). BP measurement rates were also comparable (92% versus 100%, P = 0.15). However, serum creatinine measurement was significantly lower in the telemedicine group (58% versus 100%, P < 0.001). Patients in the telemedicine group had significantly lower travel costs, shorter travel time, and shorter waiting time. Patient satisfaction remained high in both groups (9.2±0.8 versus 9.1±0.7, P = 0.46).

Telemedicine follow-up for post-AKI survivors achieved follow-up adherence comparable with conventional face-to-face care, supporting its feasibility. However, lower rates of laboratory monitoring highlight an important implementation limitation of virtual follow-up. In addition, telemedicine reduced travel and waiting times while maintaining high patient satisfaction.

Thai Clinical Trials Registry, TCTR20240928002 .