Role of telemedical technologies at all stages of treatment of nephrological patients
Authors: Dorofeeva Ekaterina G. 
Published: July 2023

BACKGROUND: Patients who, due to great distance or for other reasons, are unable to visit the medical center, must be provided with high quality and accessible medical care. Quality assurance and improvement of two-way communication between the patient and the medical staff must be ensured. The work is conducted at https://nefrocentr.ru.
AIM: The study aims at improving the efficiency and quality of medical care for patients of nephrological profile, i.e. patients with chronic kidney disease (CKD) of grade IIIbV (pre-dialysis stages), patients undergoing renal replacement therapy (hemodialysis and peritoneal dialysis), and renal transplant recipients to reduce emergency hospitalizations and mortality and improve overall survival, as well as developing and implementing telerehabilitation and improving quality of life.
METHODS: The Telenephrocenter platform was created with the support of the Moscow Health Department, the Moscow Center for Innovative Technologies, and the Moscow Social Development Complex (Grant project No. 25-12-1/22 for the creation of a digital ecosystem for the Moscow Nephrology Cluster to promote alternative models of home nephrology care for patients with grades IIIb-IV-V CKD and kidney donor recipients).

Application and improvement of existing online platforms for remote monitoring: video consultations, use of questionnaires and health assessment scales, therapy correction, dialysis program, and group telerehabilitation.
Creation of educational video tutorials for patients to improve literacy with the further formation of a library of knowledge to teach the rules of life, nutrition, self-control, physical activity, hygiene, therapy, and peritoneal dialysis procedures.
Telepatronage and follow-up of patients on peritoneal dialysis.

RESULTS: The system is a multidimensional information base that allows collecting data on the patients health status outside of the medical facility. Over 150 patients after autologous kidney transplantation, 80 patients on peritoneal dialysis, 25 patients on hemodialysis, and 23 patients on pre-dialysis CKD stages are under remote monitoring. The system enables the doctor to adjust the prescription of drugs, provide an urgent response to patients problems, and select the correct algorithm for behavior in a critical situation. Monitoring is based on questionnaires to which the patient answers according to a schedule set by the doctor. The questionnaire contains a set of symptoms that the patient chooses based on the intensity of the color. The aggregate of the responses forms a heat map of health status, which, when viewed remotely, allows the doctor to determine whether the patient has a problem and what kind of problem he or she has. Thus, the doctor makes informed decisions about further treatment. The resource allows patients to review a wide range of information material. Online consultations for patients, i.e. tele-educational activities for groups of nephrological patients depending on the type of pathology with the development of video tutorials from doctors on major problems and side-effects, are conducted. The effectiveness of the ongoing therapy (drug therapy and renal replacement therapy) is assessed remotely to adjust, cancel, and select the drug therapy. Weekly classes on physical rehabilitation and dietary support and nutrition are offered in an online format.
CONCLUSIONS: The creation of the digital ecosystem of the Moscow nephrology cluster to provide telesupport to all nephrology patients plays an important role in everyday life. The ability to get quality timely care allows for quality control of patients. Questionnaires, including assessment of the psychological state of patients, provide early detection of complications after correction of immunosuppressive therapy and increase patients adherence to therapy. Conducting online patient schools on dietary and physical activity modification helps to reduce anxiety and improve mood, increase physical activity, form good eating habits, and adjust dietary intake. These conclusions are based on weekly monitoring of patient diaries.