The year 2020 brought a pandemic that prompted the kidney community to modify daily clinical practice to avoid severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in our patients with advanced chronic kidney disease (CKD). Advanced CKD and solid organ transplantation have been identified as risk factors for mortality in patients with coronavirus infectious disease 2019 (COVID-19) (1). Moreover, patients with end-stage kidney disease (ESKD) were also identified to be at high risk of mortality compared to the general population (2).
Amid the pandemic, how do we communicate with our high-risk patients? How do we take care of patients with ESKD and patients with kidney transplants in a safe manner? New technologies have come out and developments have occurred in the field of telemedicine. For these reasons, European nephrologists modified their clinical practice in two ways: 1) increased the use of home-based dialysis modalities, and 2) implemented telemedicine in outpatient nephrology care. Similar processes were employed in other parts of the world (3, 4).
In my opinion, 2021 is a year of positive changes, and I foresee many modifications in the treatment and follow-up of patients with kidney diseases. In the past, most patients in Europe who needed kidney replacement therapy were treated in a dialysis facility either outside of or inside the hospital. Home-based dialysis modalities were mainly reserved for patients in rural areas with remote access to referral hospitals. In 2021, it is expected that home-based dialysis—namely, home hemodialysis and peritoneal dialysis—will sharply increase.
In addition, in 2021, the types of telemedicine currently implemented in non-nephrology specialties, such as critical care, neurology, and cardiology, will be expanded to nephrology. Patients with CKD will have the possibility to be in a tele-nephrology program for follow-up visits, including blood pressure, weight, and edema, among others. Mobile device-based applications will continue to be developed in nephrology, and our patients will only need a smartphone with an application as easy as “WhatsApp” to contact their nephrology team.
It is expected that the aforementioned changes, such as implementation of tele-nephrology programs, nephrology follow-up applications, and an increase in the use of home-based dialysis modalities in nephrology, will be implemented and will see expanded use in 2021 (Table 1). These developments may help patients avoid unneeded visits to medical centers.
Nephrology care in the pre- and post-COVID-19 pandemic era
|• Majority of ESKD patients in hospital or center-based dialysis||• Increase in home-based dialysis modalities|
|• Few home-based dialysis modalities||• Development of tele-nephrology|
|• Multiple outpatient clinic visits||• Follow-up via apps’ development and implementation|
|• Decrease in outpatient clinic visits|
Gansevoort RT, Hilbrands LB. CKD is a key risk factor for COVID-19 mortality. Nat Rev Nephrol 2020; 16:705–706. doi: 10.1038/s41581-020-00349-4
Ng JH, et al.. Outcomes of patients with end-stage kidney disease hospitalized with COVID-19 [published online ahead of print August 15, 2020]. Kidney Int doi: 10.1016/j.kint.2020.07.030; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428720/
Cozzolino M, et al.. The COVID-19 infection in dialysis: are home-based renal replacement therapies a way to improve patient management? J Nephrol 2020; 33:629–631. doi: 10.1007/s40620-020-00784-3
Soler MJ, et al.. Impact of the COVID-19 pandemic on Spanish nephrology services. Nefrologia 2020; 40:579–584. doi: 10.1016/j.nefro.2020.08.002