Teledialysis in Community Settings: Evaluation of Feasibility, Safety and Effectiveness

The number of patients with end-stage kidney disease requiring haemodialysis (HD) is increasing worldwide, placing substantial pressure on healthcare systems. In Central Queensland, Australia, many patients, including Indigenous Australians, live far from major centres providing HD services. Teledialysis (Tele-D), involving virtual nephrologist-led ward rounds, can improve access to specialist care while supporting community-based dialysis. This study evaluated the feasibility, safety and effectiveness of Tele-D for satellite HD units in Central Queensland. This retrospective cohort study compared patients receiving in-centre HD at Rockhampton Hospital (hospital group) with those receiving community HD (Tele-D group), where dialysis nurses delivered routine care under a nephrologist-led telehealth model comprising weekly virtual reviews via the Queensland Telehealth Portal and additional telephone or email support as required over a 2-year period. Both groups received routine monthly pathology review and face-to-face outpatient review every 3 months. Clinical and biochemical outcomes, including haemoglobin, urea reduction ratio, albumin, calcium, phosphate and parathyroid hormone, showed no significant differences in longitudinal trajectories between groups. Haemoglobin levels in the Tele-D group converged towards the recommended target range. Emergency department presentations, hospital length of stay and all-cause mortality were lower in the Tele-D group. However, after adjustment for age, sex, diabetes and modified Charlson comorbidity index (mCCI), the hazard ratio for mortality had a confidence interval crossing 1.0, indicating noninferiority rather than superiority. In this regional retrospective cohort, Tele-D was feasible, with clinical, biochemical and survival outcomes comparable with conventional hospital-based HD. Because patients in the Tele-D group were younger, had fewer comorbidities and exclusively used arteriovenous fistulas for vascular access, causal inference cannot be made. These findings support the Tele-D model of care and warrant further evaluation in larger prospective studies.