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Bringing Dialysis Home with Virtual Care

Nephrology, like many other medical specialties, is facing a critical shortage of providers. The ongoing COVID-19 pandemic has only increased this burden as kidney injury from COVID-19 occurs in as many as 43% of patients in some hospitals, and is associated with significant morbidity and mortality rates. The resulting demand increase for dialysis has pushed providers and staff to their limits, in a medical specialty that already experiences high turnover rates.

Dialysis specialists need extensive training and technical skills that can take months to learn. They need to know how to operate and troubleshoot the machinery, teach patients how to use at-home machines, manage vascular access, and be able to recognize and respond to incremental changes in patients’ clinical status.

Additionally, nephrologists and nurse kidney specialists are increasingly located in urban areas, compounding access issues for those in more rural settings, a population that already experiences a higher prevalence of chronic kidney disease. Patients who live farther from their provider are less likely to adhere to their kidney treatments compared with those living in closer proximity to care. This contributes to higher mortality rates in rural areas from kidney disease. There is a large need for healthcare delivery platforms to bridge this care gap.

Increasing need for dialysis treatment

With the growing need for dialysis with COVID-19 infections, Health and Human Services and Medicare began working to increase the number of patients using home dialysis. There are two main types of dialysis treatment, hemodialysis and peritoneal dialysis. Hemodialysis uses an external artificial kidney to remove waste and extra bodily fluid; it can be performed in the clinic or, in some cases, at home. Peritoneal dialysis, during which dialysate is infused into the abdominal cavity allowing the peritoneum to filter out excess fluid and waste, is the more common choice for home-based treatment. The use of home dialysis has increased from 11.6% in 2016 to 14.5% in 2021.

Studies have shown that when given the choice, patients prefer home dialysis. This preference is perhaps not surprising as it gives patients greater autonomy over their care, more flexibility in their lifestyle and diet, and can even result in longer kidney function.

Telenephrology is an emerging platform for patient care delivery

Home dialysis lends itself naturally to the use of virtual care, sometimes referred to as telenephrology. Patients on home dialysis do not require as much oversight or clinical manpower. While the upfront training time may be more extensive, it decreases the overall cost of care, cuts the time needed from providers in half, and allows provider resources to be utilized by more patients.

Training and proctoring costs can also be mitigated with Hippo’s® Virtual Proctoring™ platform. Using a voice activated head-mounted tablet, proctors can train, mentor, and guide providers on proper techniques for patient assessment and operating medical devices. The headset provides a clear view of the patient and allows for real-time collaboration and direct instruction. All without added travel costs, allowing one proctor to train more providers in less time.

By incorporating virtual care, patients in rural areas and others living far from nephrology providers can more easily access the care they need. It also allows patients with end-stage renal disease to conserve their energy and focus on healing rather than scrambling to get to doctor appointments.

In 2021, the American Society of Nephrology officially supported the use of virtual care to complement in-person visits and increase patient oversight and care.

Telenephrology can also be expanded by the incorporation of Clinician Extenders. Part of this system is already in place, with home-based nurses instructing patients on how to perform peritoneal and hemodialysis at home. By integrating Hippo’s hands-free, voice-activated, wearable computing solutions, Clinician Extenders can help nephrologists communicate with and examine patients virtually, in real time, giving them the same access as if they were physically in the room with the patient. The virtual care headset removes barriers to care by virtually connecting clinician extenders with specialists for guidance and better decision making, which can be critical in cases of end-stage renal disease. Hippo’s platform can also connect at-home nurses with technical specialists if they encounter issues with the dialysis devices.

Hippo is bringing a new dimension to telenephrology, allowing complex care to reach patients around the country from the comfort of their homes by extending the reach of available providers. By combining specialists’ expertise with the utility of virtual care, we can help bring exceptional care to the hundreds of thousands of patients receiving dialysis.

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