Use of Telemedicine by Kidney Care Providers for Patients on Hemodialysis

Background: The federal emergency waivers in March 2020 in the United States (US) enabled kidney care providers to substitute face-to-face in-center hemodialysis (HD) visits with telemedicine encounters. While the use of telemedicine facilitated maintaining of visit frequency of providers during the COVID-19 pandemic, how it affected the HD-related outcomes of patients was unknown. Methods: We used national Medicare claims data to identify US patients receiving in-center HD at DaVita, one of the large facility chains, during the first 6 months of the pandemic, from 4/1/2020-9/30/2020. We focused on patients of providers who demonstrated knowledge of how to bill for telemedicine visits, i.e., making at least one telemedicine bill in the first 3 months of the period. We compared HD-related outcomes among patients of providers with high-level vs. low-level use of telemedicine. Multivariable regression models adjusted for Covid-19 rate, patient, physician, geographic and dialysis facility characteristics along with the HD-related outcome level before the pandemic. Results: Among the 13,108 in-center HD patients identified, 35% were from providers with higher-level telemedicine. In fully adjusted models, the higher telemedicine group had 0.7% lower absolute probability of serum albumin < 3.5 g/dL (95% CI: -1.3%, -0.1%, p=0.02) and 1.4% lower probability of serum phosphate >5.5 mg/dL (95% CI: -2.5%, -0.2%, p=0.02). No significant difference between the two groups was observed on average mean blood pressure between dialysis, inter-HD weight gain, and other dichotomous outcomes and count measure (Figure 1). Conclusion: Higher use of telemedicine among in-center HD patients did not affect most HD-related outcomes, and was related to a slightly lower chance of low albumin and high phosphate. Funding: NIDDK Support