ABSTRACT
Background: Telehealth utilization, including the use of telephone appointments (TAV) and video appointment visits (VAV), are a valuable alternative to in-person visits and were a crucial form of health delivery during the COVID-19 national emergency. Among chronic kidney disease (CKD) patients within an integrated healthcare system, we evaluated the rate of successfully completed telehealth visits and assess differences in adoption using an equity lens. Method(s): A retrospective cohort study was conducted among individuals (age>=18yrs) with CKD stage 3 and 4 receiving care at Kaiser Permanente Southern California (KPSC). We limited our sample to patients with at least one in-person visit within 12 months prior to Mar 1, 2020 and followed them for 1 year. A successfully completed telehealth visit was defined as a >=20 min completed appointment via TAV/VAV. Poisson regression with robust variance error was conducted to estimate the rate ratio for a successful telehealth visit. Result(s): Of 161,088 patients, 74% (N=118,456) had >= 1 successfully completed telehealth visit, 34% of which were VAVs. Younger age, female gender, white race, and English as spoken language were associated with the successful completion of a telehealth visit. Senior persons (85+) were less likely to have a successfully TAV/VAV compared to young adults (18-34 yrs) (RR:0.82;95% CI:0.79-0.86) (Figure). Those having a KPSC online account were more likely to have successful TAV/VAV (RR:1.11;95% CI:1.10-1.12). Medicaid patients had more successful telehealth visits while patients living in neighborhoods with less internet access were marginally less likely to have successful TAV/VAV (p=0.05). Conclusion(s): We observed disparities in adoption of telehealth care among CKD patients within an integrated health system. Our findings suggest that further studies and management strategies are needed to facilitate and improve equitable patient-centered care.
ABSTRACT
Background: Use of remdesivir in the treatment of dialysis patients with Coronavirus Disease 2019 (COVID-19) has been limited due to inconclusive data regarding safety outcomes among patients with severe renal impairment. For this reason, the FDA has not recommended remdesivir use in patients with eGFR < 30 ml/min per 1.73 m2. We sought to evaluate outcomes among dialysis patients with COVID-19 who received remdesivir in a real-world setting. Methods: We conducted a retrospective study of patients on hemodialysis or peritoneal dialysis hospitalized with COVID-19 between 5/1/2020 -1/31/2021 within the integrated health system of Kaiser Permanente Southern California. Patients with a COVID-19 International Classification of Diseases (ICD)-10 code: U07.1 and laboratory confirmed SARS-CoV-2 infection within 14 days prior to admission date to two days after admission date were included. The primary endpoint was 30-day all-cause mortality. Secondary endpoints were intensive care unit (ICU) stay, and evidence of acute liver injury defined as AST and/or ALT values >5x upper limit of normal. Results: A total of 486 patients (407 hemodialysis and 79 peritoneal dialysis) met inclusion criteria. Among those, 112 patients (23%) were treated with remdesivir, with median treatment time of 4 days (IQR: 2-5). Mean age was 63.8 years with 63.8% male and 63.0% Hispanic patients. There were 80.2% of patients who received treatment with steroids during hospitalization. Relative risk (RR) for all-cause 30-day mortality was 0.74 (95% CI: 0.52-1.05) in remdesivir treated patients compared to untreated patients. Acute liver injury occurred in 1.8% and 2.4% of remdesivir treated and untreated patients, respectively. ICU admissions occurred in 14.3% of remdesivir treated and 16% of untreated patients. Conclusions: Among dialysis patients hospitalized with COVID-19, treatment with remdesivir was not associated with worse outcomes in terms of liver injury or ICU admission, and demonstrated a trend (26% lower risk) toward decrease in 30-day mortality, though no statistical significance was found due to insufficient power.