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REMOTE MONITORING OF CHRONIC KIDNEY DISEASE: A NOVEL MODEL OF
RENAL SERVICE DELIVERY
Elsayed, I¹, Khwaja, A¹, Siddall, S¹, Mortimer, F²
¹Sheffield Teaching Hospitals, ²Centre for Sustainable Healthcare
INTRODUCTION:
Chronic kidney disease (CKD) is common affecting 5-10% of UK population with its frequency
increasing with age. With an ageing population, the burden of CKD on the NHS budget,is increasing
and therefore new sustainable service models are required to enable delivery of good quality care to
CKD.
AIM:
Evaluate the impact of a remote, community-based disease management program (DMP) for patients
with advanced CKD on disease progression, patient satisfaction and environmental outcomes.
METHODS:
A pilot program was initiated our teaching hospital and our local Central Consortium of GP practices.
All patients with CKD managed in secondary care were selected for the remote management program
except i) those on immunosuppressive drugs and ii) those who were likely to need renal replacement
therapy within the next 12 months. Patients had an individualized care plan generated by a consultant
nephrologist specifying frequency of laboratory (lab) and blood pressure (BP) monitoring, thresholds
for escalation of care with appropriate management plan. Laboratory and BP monitoring were
performed at the local GP practice. Laboratory data was automatically uploaded to renal IT system
whilst BP and clinical data were sent manually to secondary care. The nephrology outpatient
consultation was replaced with a telephone consultation with a nurse specialist based at SKI. Clinical
data was collated over 2 years before and 12 months after implementation of the DMP along with a
patient satisfaction survey and travel data.
RESULTS:
There are 77 patients under remote management. There was no significant difference between the
patients’ eGFR over 2 years before and 12 months after implementation of DMP, with their mean
28.7(95%CI, 28.27-29.14) & 28.5(95%CI, 28.14-28.86), respectively. The difference between BP
before and after implementation of DMP was not significant. 90% of our survey respondents said they
preferred receiving their kidney care in the community and felt more empowered about managing
their CKD. The median distance travelled by patients to hospital was 5.4 miles whilst only 0.6 miles
to their GP surgery, generating an annual carbon saving of 507 kg CO2 equivalent.
CONCLUSION:
NHS Kidney Care estimates expenditure on CKD to be £1.45 billion per annum. Our pilot data
suggests that remote monitoring of CKD is deliverable, clinically safe in selected patients, improves
patient satisfaction and empowerment whilst delivering significant carbon savings. With prevalence
of CKD increasing with an ageing population, remote monitoring of CKD may be a more sustainable
model of delivery of CKD care.