TELEMEDICINE VERSUS FACE-TO-FACE FOLLOW-UP IN POST-ACUTE KIDNEY INJURY SURVIVORS: A RANDOMIZED CONTROLLED TRIAL

 

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https://storage.unitedwebnetwork.com/files/1099/e9a5acfdb5c13850308e80779c172569.pdf
TELEMEDICINE VERSUS FACE-TO-FACE FOLLOW-UP IN POST-ACUTE KIDNEY INJURY SURVIVORS: A RANDOMIZED CONTROLLED TRIAL

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Peerapat
Thanapongsatorn
Emwalee Piti ormmy.emwale@gmail.com Thammasat University Hospital Department of Medicine Pathum Thani Thailand -
Massupa Krisem massupa.k@hotmail.com Thammasat University Hospital Department of Radiology Pathum Thani Thailand -
Opas Traitanon ot2004@gmail.com Thammasat University Hospital Department of Medicine Pathum Thani Thailand -
Adis Tasanarong adis_tasanarong@hotmail.com Thammasat University Hospital Department of Medicine Pathum Thani Thailand -
Nattachai Srisawat drnattachai@yahoo.com Chulalongkorn University Department of Medicine Bangkok Thailand -
Peerapat Thanapongsatorn peerapat.manu@gmail.com Thammasat University Hospital Department of Medicine Pathum Thani Thailand *
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Regular post-discharge 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 stage 2–3 AKI and lived ≥15 km from the hospital were randomized to telemedicine follow-up using the secure “TUH Telemed” application or conventional face-to-face follow-up for six months. The primary outcome was feasibility, assessed using three process indicators: (i) follow-up adherence, (ii) serum creatinine measurement, and (iii) blood pressure (BP) measurement. Secondary outcomes included clinical (mortality, readmission, CKD progression, recurrent AKI, 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 conventional face-to-face follow-up group and 29 to telemedicine follow-up group. The mean age was 63.9 ± 13.8 years, and 57% were male. Baseline characteristics were comparable between groups. At six months, follow-up adherence and blood pressure measurement rates were similar between the telemedicine and face-to-face groups (89.6% vs. 93.1%, p = 0.70, and 92.3% vs. 100%, p = 0.15, respectively). However, serum creatinine measurement was significantly lower in the telemedicine group (57.7% vs. 100%, p < 0.001). There were no significant differences in mortality, CKD progression, recurrent AKI or BP control between groups, whereas hospital readmission occurred more frequently in the face-to-face group (20.7% vs. 3.4%, p = 0.044). 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 vs. 9.1 ± 0.7, p = 0.46).

Telemedicine follow-up for post-AKI patients was feasible and yielded clinical outcomes comparable to traditional face-to-face follow-up. It also significantly reduced travel and waiting times while maintaining high patient satisfaction. 

Kewords