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Early referring saved lives in kidney transplant recipients with COVID-19: a beneficial role of telemedicine

INTRODUCTION: There is a strong impetus for the use of telemedicine for boosting early detection rates and enabling early treatment and remote monitoring of COVID-19 cases, particularly in chronically ill patients such as kidney transplant recipients (KTRs). However, data regarding the effectiveness...

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Autores principales: Zahradka, Ivan, Petr, Vojtech, Jakubov, Katarina, Modos, Istvan, Hruby, Filip, Viklicky, Ondrej
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546052/
https://www.ncbi.nlm.nih.gov/pubmed/37795416
http://dx.doi.org/10.3389/fmed.2023.1252822
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author Zahradka, Ivan
Petr, Vojtech
Jakubov, Katarina
Modos, Istvan
Hruby, Filip
Viklicky, Ondrej
author_facet Zahradka, Ivan
Petr, Vojtech
Jakubov, Katarina
Modos, Istvan
Hruby, Filip
Viklicky, Ondrej
author_sort Zahradka, Ivan
collection PubMed
description INTRODUCTION: There is a strong impetus for the use of telemedicine for boosting early detection rates and enabling early treatment and remote monitoring of COVID-19 cases, particularly in chronically ill patients such as kidney transplant recipients (KTRs). However, data regarding the effectiveness of this practice are lacking. METHODS: In this retrospective, observational study with prospective data gathering we analyzed the outcomes of all confirmed COVID-19 cases (n = 955) in KTRs followed at our center between March 1, 2020, and April 30, 2022. Risk factors of COVID-19 related mortality were analyzed with focus on the role of early referral to the transplant center, which enabled early initiation of treatment and remote outpatient management. This proactive approach was dependent on the establishment and use of a telemedicine system, which facilitated patient-physician communication and expedited diagnostics and treatment. The main exposure evaluated was early referral of KTRs to the transplantation center after confirmed or suspected COVID-19 infection. The primary outcome was the association of early referral to the transplantation center with the risk of death within 30 days following a COVID-19 diagnosis, evaluated by logistic regression. RESULTS: We found that KTRs who referred their illness to the transplant center late had a higher 30-day mortality (4.5 vs. 13.6%, p < 0.001). Thirty days mortality after the diagnosis of COVID-19 was independently associated with late referral to the transplant center (OR 2.08, 95% CI 1.08–3.98, p = 0.027), higher age (OR 1.09, 95% CI 1.05–1.13, p < 0.001), higher body mass index (OR 1.06, 95% CI 1.01–1.12, p = 0.03), and lower eGFR (OR 0.96, 95% CI 0.94–0.98, p < 0.001) in multivariable logistic regression. Furthermore, KTRs who contacted the transplant center late were older, had longer time from transplantation, lived farther from the center and presented with higher Charlson comorbidity index. DISCUSSION: A well-organized telemedicine program can help to protect KTRs during an infectious disease outbreak by facilitating pro-active management and close surveillance. Furthermore, these results can be likely extrapolated to other vulnerable populations, such as patients with chronic kidney disease, diabetes or autoimmune diseases requiring the use of immunosuppression.
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spelling pubmed-105460522023-10-04 Early referring saved lives in kidney transplant recipients with COVID-19: a beneficial role of telemedicine Zahradka, Ivan Petr, Vojtech Jakubov, Katarina Modos, Istvan Hruby, Filip Viklicky, Ondrej Front Med (Lausanne) Medicine INTRODUCTION: There is a strong impetus for the use of telemedicine for boosting early detection rates and enabling early treatment and remote monitoring of COVID-19 cases, particularly in chronically ill patients such as kidney transplant recipients (KTRs). However, data regarding the effectiveness of this practice are lacking. METHODS: In this retrospective, observational study with prospective data gathering we analyzed the outcomes of all confirmed COVID-19 cases (n = 955) in KTRs followed at our center between March 1, 2020, and April 30, 2022. Risk factors of COVID-19 related mortality were analyzed with focus on the role of early referral to the transplant center, which enabled early initiation of treatment and remote outpatient management. This proactive approach was dependent on the establishment and use of a telemedicine system, which facilitated patient-physician communication and expedited diagnostics and treatment. The main exposure evaluated was early referral of KTRs to the transplantation center after confirmed or suspected COVID-19 infection. The primary outcome was the association of early referral to the transplantation center with the risk of death within 30 days following a COVID-19 diagnosis, evaluated by logistic regression. RESULTS: We found that KTRs who referred their illness to the transplant center late had a higher 30-day mortality (4.5 vs. 13.6%, p < 0.001). Thirty days mortality after the diagnosis of COVID-19 was independently associated with late referral to the transplant center (OR 2.08, 95% CI 1.08–3.98, p = 0.027), higher age (OR 1.09, 95% CI 1.05–1.13, p < 0.001), higher body mass index (OR 1.06, 95% CI 1.01–1.12, p = 0.03), and lower eGFR (OR 0.96, 95% CI 0.94–0.98, p < 0.001) in multivariable logistic regression. Furthermore, KTRs who contacted the transplant center late were older, had longer time from transplantation, lived farther from the center and presented with higher Charlson comorbidity index. DISCUSSION: A well-organized telemedicine program can help to protect KTRs during an infectious disease outbreak by facilitating pro-active management and close surveillance. Furthermore, these results can be likely extrapolated to other vulnerable populations, such as patients with chronic kidney disease, diabetes or autoimmune diseases requiring the use of immunosuppression. Frontiers Media S.A. 2023-09-19 /pmc/articles/PMC10546052/ /pubmed/37795416 http://dx.doi.org/10.3389/fmed.2023.1252822 Text en Copyright © 2023 Zahradka, Petr, Jakubov, Modos, Hruby and Viklicky. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Zahradka, Ivan
Petr, Vojtech
Jakubov, Katarina
Modos, Istvan
Hruby, Filip
Viklicky, Ondrej
Early referring saved lives in kidney transplant recipients with COVID-19: a beneficial role of telemedicine
title Early referring saved lives in kidney transplant recipients with COVID-19: a beneficial role of telemedicine
title_full Early referring saved lives in kidney transplant recipients with COVID-19: a beneficial role of telemedicine
title_fullStr Early referring saved lives in kidney transplant recipients with COVID-19: a beneficial role of telemedicine
title_full_unstemmed Early referring saved lives in kidney transplant recipients with COVID-19: a beneficial role of telemedicine
title_short Early referring saved lives in kidney transplant recipients with COVID-19: a beneficial role of telemedicine
title_sort early referring saved lives in kidney transplant recipients with covid-19: a beneficial role of telemedicine
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546052/
https://www.ncbi.nlm.nih.gov/pubmed/37795416
http://dx.doi.org/10.3389/fmed.2023.1252822
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