Use of Telemedicine and Surrogate Health Outcomes in In-Center Hemodialysis

In March 2020, responding to the COVID-19 pandemic, US public health emergency waivers enabled kidney care providers (nephrologists and advanced practice providers) to substitute face-to-face in-center hemodialysis visits with telemedicine encounters.

We merged an electronic health records database from dialysis patients at clinics owned by DaVita Inc. with Medicare claims-based records. We identified dialysis patients in the first six months of the pandemic. Kidney care providers were divided into those who used telemedicine frequently (above median) versus less frequently (below median) during the first three months of the pandemic. In multivariable regression models controlling for patient, kidney care provider, dialysis facility, and geographic characteristics, and the value of each outcome prior to the pandemic, we examined associations among telemedicine use by kidney care providers and hemodialysis-related surrogate health outcomes.

We identified 782 kidney care providers who saw patients at DaVita facilities from 4/2020-9/2020. Higher intensity (vis-à-vis telemedicine) kidney care providers documented the use of telemedicine in 86% (Standard Deviation (SD) 16%) of patients in the first three months of the pandemic, while lower intensity providers documented its use in 15% (SD 13%) of patients. Higher telemedicine use was associated with a 0.7% (95% confidence interval (CI), 0.1%-1%) reduction in the absolute probability of having a serum albumin <3.5 g/dl and a 1% (CI 0.2%-3%) reduction in the absolute probability of having a serum phosphate >5.5 mg/dl. Telemedicine use was not significantly associated with outcomes related to anemia management targets, blood pressure, dialysis efficiency, interdialytic weight gain, and dialysis prescription changes.

Patients of providers who used telemedicine more frequently had slightly better surrogate outcomes in nutritional parameters, but not in other dialysis-related health outcomes. These findings suggest that telemedicine can be employed for in-center hemodialysis visits without compromising conventional metrics of the quality of hemodialysis care.