title: Tele-Nephrology: A Feasible Way to Improve Access to Care for Patients with Kidney Disease Who Reside in Underserved Areas.
abstract: The Miami VA Healthcare System serves veterans in three South Florida counties: Miami-Dade, Broward, and Monroe, with an estimated veteran population of 175,000. To overcome geographical barriers and facilitate the access to nephrology clinics, we implemented provider-patient tele-nephrology using secured videoconferencing.
  
  
  
  A retrospective and descriptive study design was used to evaluate the effect of the tele-nephrology clinic intervention. Multiple clinical indicators were included in the analysis: blood pressure (BP) control, stabilization of the renal function, and electrolyte/metabolic control. One hundred one patients who were evaluated in the clinic between 2013 and 2015 were included in the analysis, and the indicators were collected retrospectively.
  
  
  
  One hundred one patients were included in the analysis, with 95% of patients being male (n = 96) and 5% female (n = 5). The mean age was 65.5 years. Fifty patients had chronic kidney disease (CKD) stage III (49.5%), 14 patients had CKD stage IV (13%), and 8 patients had CKD stage II (7.9%). A one-way analysis of variance between subjects was conducted and showed that the effect of the tele-nephrology clinic intervention on reducing BP was statistically significant (systolic BP less than 140 p value <0.0001). Renal function stabilized but the creatinine changes over time were not statistically significant (p value: 0.50). Potassium showed a significant improvement in this sample (p value: 0.0076). Phosphorous and bicarbonate did not show a statistically significant improvement (p value 0.79 and 0.91, respectively).
  
  
  
  With the tele-nephrology clinic intervention, we were able to effectively improve BP and stabilize renal function in patients with kidney disease who reside in underserved areas.
authors.affiliation: Department of Medicine, Division of Nephrology, Miami VAMC/University of Miami , Miami, Florida.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Ladino
authors.affiliation: Department of Medicine, Division of Nephrology, Miami VAMC/University of Miami , Miami, Florida.
authors.forename: Joslyn
authors.initials: J
authors.lastname: Wiley
authors.affiliation: Department of Medicine, Division of Nephrology, Miami VAMC/University of Miami , Miami, Florida.
authors.forename: Ivonne Hernandez
authors.initials: IH
authors.lastname: Schulman
authors.affiliation: Department of Medicine, Division of Nephrology, Miami VAMC/University of Miami , Miami, Florida.
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Sabucedo
authors.affiliation: Department of Medicine, Division of Nephrology, Miami VAMC/University of Miami , Miami, Florida.
authors.forename: Desiree
authors.initials: D
authors.lastname: Garcia
authors.affiliation: Department of Medicine, Division of Nephrology, Miami VAMC/University of Miami , Miami, Florida.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Cardona
authors.affiliation: Department of Medicine, Division of Nephrology, Miami VAMC/University of Miami , Miami, Florida.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Valdes
authors.affiliation: Department of Medicine, Division of Nephrology, Miami VAMC/University of Miami , Miami, Florida.
authors.forename: Fernando
authors.initials: F
authors.lastname: Pedraza
authors.affiliation: Department of Medicine, Division of Nephrology, Miami VAMC/University of Miami , Miami, Florida.
authors.forename: Roberto J
authors.initials: RJ
authors.lastname: Echeverri
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D005260:Female; D005431:Florida; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000458:organization & administration*; D019114:Remote Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D049269:Videoconferencing; D014882:Water-Electrolyte Balance
chemical_list: D003404:Creatinine
keywords: CKD; care; electrolytes; hypertension; tele-nephrology