Advertisment

Indian Journal of Nephrology About us |  Subscription |  e-Alerts  | Feedback | Login   
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Home | Current Issue | Archives| Ahead of print | Search |Instructions |  Editorial Board  

Users Online:1454

Official publication of the Indian Society of Nephrology
  Search
 
  
 ~  Similar in PUBMED
 ~  Search Pubmed for
 ~  Search in Google Scholar for
 ~  Article in PDF (973 KB)
 ~  Citation Manager
 ~  Access Statistics
 ~  Reader Comments
 ~  Email Alert *
 ~  Add to My List *
* Registration required (free)  

 
   References
   Article Figures

 Article Access Statistics
    Viewed654    
    Printed37    
    Emailed0    
    PDF Downloaded44    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 32  |  Issue : 5  |  Page : 519-520
 

A structured telemedicine model in the management of COVID-19 infected kidney transplant patients in a tertiary care center in India


Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission19-Sep-2021
Date of Acceptance25-Oct-2021
Date of Web Publication11-May-2022

Correspondence Address:
Harbir S Kohli
Department of Nephrology, PGIMER, Chandigarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijn.IJN_398_21

Rights and Permissions



How to cite this article:
Kakkanattu T, Bharati J, Ramachandran R, Kohli HS. A structured telemedicine model in the management of COVID-19 infected kidney transplant patients in a tertiary care center in India. Indian J Nephrol 2022;32:519-20

How to cite this URL:
Kakkanattu T, Bharati J, Ramachandran R, Kohli HS. A structured telemedicine model in the management of COVID-19 infected kidney transplant patients in a tertiary care center in India. Indian J Nephrol [serial online] 2022 [cited 2022 Dec 10];32:519-20. Available from: https://www.indianjnephrol.org/text.asp?2022/32/5/519/345113


Sir,

The coronavirus disease 2019 (COVID-19) pandemic brought many complexities for kidney transplant recipients (KTRs) as travel restrictions and economic slowdown hampered healthcare access. Even though 65% of India's population dwell in rural areas far-flung from a tertiary healthcare facility, the country ranks second in active internet users with a cyberspace penetration rate of 50%.[1],[2] We exploited the aforementioned and formulated a telemedicine-based, triage-coded management of COVID-19 positive KTRs from our center (as a pivot) to address the challenges of poor accessibility to local healthcare resources.

During the second wave of the COVID-19 pandemic between April 1 and May 31 2021, we managed 49 KTRs with COVID-19 infection from different states, as far as 2,500 km from the pivot centre using telemedicine. We established a 24/7 telephone line for COVID-positive KTRs and disseminated the number through the patient support groups (mainly through WhatsApp). After the initial contact, including a video consultation, patients were evaluated and partook immunosuppression adjustments framed by an expert panel: Nephrologists and Infectious disease physicians of our hospital [Figure 1]. The patients were colour triaged with red and yellow, denoting severe and moderate disease, respectively, requiring hospitalization. Domiciliary-care KTRs with mild disease, asymptomatic infection, and recovering patients (restarted on immunosuppression) were coded as green and were managed at home. The consults were done daily and if the clinical profile required, even more frequently. Patients who did not have a referral COVID center nearby, who were elderly, and whose clinical evaluation suggested a poor outcome were called up for admission even with the slightest deterioration. Twenty-nine (59. 18%) patients were managed entirely on domiciliary care and seven (14. 30%) patients with a deteriorating clinical state underwent treatment in our center. In five (10. 20%) patients admitted elsewhere in a local COVID-care center, we supervised the clinical care distantly using telemedicine. While there were four deaths (8.16%), 44 (89·79%) patients improved on follow-up.
Figure 1: Protocol for management of COVID positive-renal transplant recipients. Abbreviations- Respiratory rate, MMF: Mycophenolate Mofetil, CNI: Calcineurin inhibitor, CBC: Complete blood count, RFT: Renal function test, LFT: Liver function test, CRP: C-reactive protein, LDH: Lactate dehydrogenase, oxygen saturation level (SpO2)

Click here to view


Using the telemedicine-based triage-coded model, we provided remote healthcare access to COVID-19 positive KTRs, addressing the challenges of distant travel and hospital visits and provided value-based clinical care. The video consults provided a decorous platform to watch the patient (and circumambience), understand their body language, and facilitate a well-informed clinical impression in contrast to a simple telephonic audio consult.[3] Video consults covered other aspects such as patient reassurance, mitigation of undue fear, dissuasion from unproven remedies, diet, and hydration during this illness. Consequent to the COVID-19 pandemic, telemedicine is successfully used to manage KTRs globally and holds promise in resource-limited settings.[4],[5] We acknowledge that optimal utilization of telemedicine in managing sicker patients obligates the engagement of local healthcare personnel. We currently use the same framework to deal with vaccine scepticism in our KTRs. With many kidney patients in India travelling over 1,000 km to receive kidney transplantation and post-transplant care, the current model makes a compelling and convincing argument favouring telemedicine in dispensing routine clinical care of KTRs in resource-limited nations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rural population (% of total population)-India | Data. Available from: https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS? locations=IN. [Last accessed on 2021 Jun 28].  Back to cited text no. 1
    
2.
India: Internet penetration rate 2021 [Internet]. Statista. Available from: https://www.statista.com/statistics/792074/india-internet-penetration-rate/. [Last accessed on 2021 Jun 28].  Back to cited text no. 2
    
3.
Car J, Koh GC-H, Foong PS, Wang CJ. Video consultations in primary and specialist care during the covid-19 pandemic and beyond. BMJ 2020;371:m3945.  Back to cited text no. 3
    
4.
Jain G, Ahmad M, Wallace EL. Technology, telehealth, and nephrology: The time is now. Kidney360 2020;1:834-6.  Back to cited text no. 4
    
5.
Abuzeineh M, Muzaale AD, Crews DC, Avery RK, Brotman DJ, Brennan DC, et al. Telemedicine in the care of kidney transplant recipients with coronavirus disease 2019: Case reports. Transplant Proc 2020;52:2620-5.  Back to cited text no. 5
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
 

    

Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07