Telehealth strategies in the care of people with chronic kidney disease: integrative review

Almeida, Onislene Alves Evangelista de; Lima, Maria Eduarda Freitas de; Santos, Walterlânia Silva; Silva, Bárbara Louise Moreira

doi:10.1590/1518-8345.6824.4050

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Revista Latino-Americana de Enfermagem

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Review Article • Rev. Latino-Am. Enfermagem 31 • 2023 • https://doi.org/10.1590/1518-8345.6824.4050 copy

Telehealth strategies in the care of people with chronic kidney disease: integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to evaluate the evidence about telehealth strategies in caring for people with chronic kidney disease.

Method:

integrative literature review. The search for primary studies was carried out in six databases: PubMed/MEDLINE, Web of Science, EMBASE, CINAHL, LILACS, and Scopus. The sample consisted of 48 articles published between 2000 and 2021. The telehealth strategy was applied by a multidisciplinary team of doctors, nurses, pharmacists, nutritionis, and social workers. The type of study, country, strategy applied, setting, population, and professional were extracted from the articles. The studies were selected by reading the title and abstract (phase 1) and then reading them in full (phase 2), categorizing them by telehealth strategy. The results were summarized descriptively and the studies were classified according to their level of evidence.

Results:

the home was the most representative in dialysis and conservative treatment. Six categories of telehealth strategies were identified: remote monitoring devices, teleconsultation, digital platforms, apps, multimodality strategies, and telephone contact.

Conclusion:

using these strategies for the care of people with chronic kidney disease presents different forms and implementations, being feasible for the renal population at any stage of the disease and applicable by different health professionals with an emphasis on the home environment. The evidence shows that telehealth favors lower cost, accessibility to remote locations, and better monitoring of dialysis with positive resul in symptom control, risk reduction, and patient training.

Descriptors:
Chronic Kidney Disease; Dialysis; Peritoneal Dialysis; Kidney Transplant; Telenursing; Telehealth

Highlights:

(1) Telehealth in chronic kidney disease care is feasible and promising.

(2) Telehealth is feasible for people at all stages of CKD.

(3) Health promotion and monitoring were the most applied by telehealth.

(4) Remote care can reduce costs, emergencies, and contac with the clinic.

(5) Nurses mainly used telephone contact and teleconferencing.

Authors (year)/ Periodical/ Country	Delineation / Scenario/ Population	Objective	Strategies	Results / Level of Evidence
1. Remote Monitoring Devices
^{Li, et al., 2020}21. Li WY, Chiu FC, Zeng JK, Li YW, Huang SH, Yeh HC, et al. Mobile Health App With Social Media to Support Self-Management for Patients With Chronic Kidney Disease: Prospective Randomized Controlled Study. J Med Internet Res. 2020;22(12):e19452. https://doi.org/10.2196/19452 https://doi.org/10.2196/19452... / Journal of Medical Internet Research/ Taiwan	RCT ^* * ECA = Ensayo Clínico Aleatorizado; Home-based/CKD ^† † ERC = Enfermedad Renal Crónica stages 1 to 4	To evaluate the effectiveness of the health management and social media platform in improving self-management skills and delaying the progression of ^† † ERC = Enfermedad Renal Crónica CKD.	MR ^‡ ‡ MR = Monitoreo Remoto by device (wristwatch) and social media platform.	IG ^§ § GI = Grupo Intervención had higher scores for self-efficacy, self-management, quality of life, and increased number of steps per day, with a smaller decline in GFR ^\|\| \|\| TFG = Tasa de Filtración Glomerular ./ Level II
^{St-Jules, et al., 2020}18. St-Jules DE, Woolf K, Goldfarb DS, Pompeii ML, Li H, Wang C, et al. Feasibility and Acceptability of mHealth Interventions for Managing Hyperphosphatemia in Patients Undergoing Hemodialysis. J Ren Nutr. 2020;31(4):403-10. https://doi.org/10.1053/j.jrn.2020.07.009 https://doi.org/10.1053/j.jrn.2020.07.00... / Journal of Renal Nutrition/ United States	RTC ^* * ECA = Ensayo Clínico Aleatorizado; Home-based / HD ^¶ ¶ HD = Hemodiálisis with hyperphosphatemia	Examine the feasibility and acceptability of the self-directed mobile health program with education, self-monitoring, and behavioral counseling on phosphorus control.	Educational programs through videos and handou associated with self-monitoring with feedback by e-mail.	Nurse-supervised RM ^‡ ‡ MR = Monitoreo Remoto can improve health outcomes for patients with high-risk CKD ^† † ERC = Enfermedad Renal Crónica by reducing hospitalizations and emergency room visits./ Level II
^{McGillicuddy, et al., 2020}17. McGillicuddy JW, Chandler JL, Sox LR, Taber DJ. Exploratory Analysis of the Impact of an mHealth Medication Adherence Intervention on Tacrolimus Trough Concentration Variability: Post Hoc Results of a Randomized Controlled Trial. Ann Pharmacother. 2020;54(12):1185-93. https://doi.org/10.1177/1060028020931806 https://doi.org/10.1177/1060028020931806... / Annals of Pharmacotherapy/ United States	RTC ^* * ECA = Ensayo Clínico Aleatorizado; / Home-based/ Post-transplanted kidneys	To determine whether mHealth affects intra-patient variability in tracolimus adherence.	Electronic medicine tray integrated into the app Smartphone Medication Adherence Saves Kidneys (SMASK).	IG ^§ § GI = Grupo Intervención achieved a significant reduction in mean tacrolimus at 12 months (p = 0.046) and a significant improvement in the proportion achieving the low tacrolimus coefficient of variation (<40%; p = 0.001), compared to GC ^ GC = Grupo Control ./ Level II
^{Manani, et al., 2020}22. Manani SM, Baretta M, Giuliani A, Virzì GM, Martino F, Crepaldi C, et al. Remote monitoring in peritoneal dialysis: benefits on clinical outcomes and on quality of life. J Nephrol. 2020;10;1-8. https://doi.org/10.1007/s40620-020-00812-2 https://doi.org/10.1007/s40620-020-00812... / Journal of Nephrology/ Italy	Retrospective case-control/ Home-based / PD ^†† †† DP = Diálisis Peritoneal	To compare clinical outcomes and QoL ^‡‡ ‡‡ CV = Calidad de Vida between patients using or not using MR ^‡ ‡ MR = Monitoreo Remoto through PD ^†† †† DP = Diálisis Peritoneal machines.	Claria Cycling Machine ^®.	Statistically significant reduction in the number of hospitalizations for specific diseases, emergencies, and acute hypervolemia in the RM ^‡ ‡ MR = Monitoreo Remoto group. There were no differences between the two groups in terms of all-cause hospitalization, hypervolemia, and QoL ^‡‡ ‡‡ CV = Calidad de Vida ./ Level IV
^{Viglino, et al., 2019}31. Viglino G, Neri L, Barbieri S, Tortone C. Videodialysis: a pilot experience of telecare for assisted peritoneal dialysis. J Nephrol. 2020;33(1):177-82. https://doi.org/10.1007/s40620-019-00647-6 https://doi.org/10.1007/s40620-019-00647... / Journal of Nephrology/ Italy	Transverse/ Home-based / PD ^†† †† DP = Diálisis Peritoneal	Describe the telemedicine system created to overcome the physical, cognitive, and psychological barriers to PD ^†† †† DP = Diálisis Peritoneal .	The video dialysis system consists of a remote station in the patient’s home and a station in the Control Center equipped with a video camera, monitor, microphone, technological connectivity box, high-resolution computer, webcam, and speakerphone.	There were no differences related to peritonitis in the groups evaluated. Video-assisted PD ^†† †† DP = Diálisis Peritoneal proved to be highly reliable and easy to use for staff, patients, and caregivers, without requiring special technological skills.
^{Sanabria, et al., 2019}29. Sanabria M, Buitrago G, Lindholm B, Vesga J, Nilsson LG, Yang D, et al. Remote Patient Monitoring Program in Automated Peritoneal Dialysis: Impact on Hospitalizations. Perit Dial Int. 2019;39(5):472-8. https://doi.org/10.3747/pdi.2018.00287 https://doi.org/10.3747/pdi.2018.00287... / Peritoneal Dialysis International/ Colombia	Retrospective cohort/ Home-based/ PD ^†† †† DP = Diálisis Peritoneal	To evaluate the association between the use of RM ^‡ ‡ MR = Monitoreo Remoto , hospitalizations, and hospital days.	Claria Cycling Machine ^®.	Significant reduction in the hospitalization rate in the RM ^‡ ‡ MR = Monitoreo Remoto group compared to the non-monitored group./ Level IV
^{Ellis, et al., 2019}30. Ellis RJB, Hill JH, Kerley KD, Sinha A, Ganci A, Russell CL. The Feasibility of a Using a Smart Button Mobile Health System to Self-Track Medication Adherence and Deliver Tailored Short Message Service Text Message Feedback. JMIR Form Res. 2019;3(2):e13558. https://doi.org/10.2196/13558 https://doi.org/10.2196/13558... / JMIR Formative Research/ United States	Prospective cohort/ Home-based / CKD ^† † ERC = Enfermedad Renal Crónica stage 1 to 4	To evaluate the feasibility and acceptability of using the mobile health system for medication adherence.	mHealth system with a smart button device for tracking medication intake through the smartphone app and SMS ^§§ §§ SMS = Short Message Service; service.	Of the 260 expected data points, 36.5% were recorded with the smart button and 76.2% with electronic monitoring. Sending encouraging text messages and medication schedule reminders were suggested./ Level IV
^{Magnus, et al., 2017}40. Magnus M, Sikka N, Cherian T, Lew SQ. Satisfaction and Improvements in Peritoneal Dialysis Outcomes Associated with Telehealth. Appl Clin Inform. 2017;8(1):214-25. https://doi.org/10.4338/ACI-2016-09-RA-0154 https://doi.org/10.4338/ACI-2016-09-RA-0... / Applied Clinical Informatics/ United States	Transverse/ Home-based / PD ^†† †† DP = Diálisis Peritoneal	Describe satisfaction with the telehealth interface and health outcomes associated with the intervention.	Telehealth monitoring with RM ^‡ ‡ MR = Monitoreo Remoto for blood pressure, weight, and glucose, video chat, and access to online educational videos.	RM ^‡ ‡ MR = Monitoreo Remoto was associated with the perception of autonomy and confidence in health activities. There was a decrease in negative perceptions of PD ^†† †† DP = Diálisis Peritoneal and CKD ^† † ERC = Enfermedad Renal Crónica care. The majority of participants (80.1%) indicated high levels of satisfaction with the system./ Level VI
^{Lew, et al., 2017}39. Lew SQ, Sikka N, Thompson C, Cherian T, Magnus M. Adoption of telehealth: Remote biometric monitoring among peritoneal dialysis patients in the United States. Perit Dial Int. 2017;37(5):576-8. https://doi.org/10.3747/pdi.2016.00272 https://doi.org/10.3747/pdi.2016.00272... / Peritoneal Dialysis International/ United States	Transverse (descriptive)/ Home-based / PD ^†† †† DP = Diálisis Peritoneal	Examine the use of remote biometric monitoring devices.	Remote biometric monitoring and audio and video communication by the Internet.	The RM ^‡ ‡ MR = Monitoreo Remoto is viable and capable of optimizing adherence to treatment and communication between the patient and the clinical team./ Level VI
^{Ishani, et al., 2016}42. Ishani A, Christopher J, Palmer D, Otterness S, Clothier B, Nugent S, et al. Telehealth by an Interprofessional Team in Patients With CKD: A Randomized Controlled Trial. Am J kidney Dis Off J Natl Kidney Found. 2016;68(1):41-9. https://doi.org/10.1053/j.ajkd.2016.01.018 https://doi.org/10.1053/j.ajkd.2016.01.0... / American Journal of Kidney Diseases/ United States	RCT ^* * ECA = Ensayo Clínico Aleatorizado; Home-based / GFR ^\|\| \|\| TFG = Tasa de Filtración Glomerular < 60 mL/min/1.73 m ², non-dialysis	Evaluate the feasibility and impact on health outcomes of the interprofessional telehealth program.	LifeView device; AmericanTeleCare, with tools (blood pressure cuff, scale, glucometer, pulse oximeter, stethoscope, and web camera) and access to the clinical team.	There was no difference between the groups for any component of the primary outcome: all-cause mortality, hospitalization, emergency department visits, or ward admission./ Level II
^{Migliozzi, et al., 2015}43. Migliozzi DR, Zullo AR, Collins C, Elsaid KA. Achieving blood pressure control among renal transplant recipients by integrating electronic health technology and clinical pharmacy services. Am J Heal Pharm. 2015;72(22): 1987-92. https://doi.org/10.2146/ajhp140810 https://doi.org/10.2146/ajhp140810... / Blood Pressure Control/ United States	Prospective cohort/ Home-based / Kidney transplant patients	Describe the RM ^‡ ‡ MR = Monitoreo Remoto blood pressure and drug management program.	RM ^‡ ‡ MR = Monitoreo Remoto of blood pressure with pharmacist management of drug therapy.	Significant reductions in mean systolic and diastolic were observed at 30, 90, 180, and 360 days after initiation of the program (p <0.05)./ Level IV
^{Rifkin, et al., 2013}41. Rifkin DE, Abdelmalek JA, Miracle CM, Low C, Barsotti R, Rios P, et al. Linking clinic and home: a randomized, controlled clinical effectiveness trial of real-time, wireless blood pressure monitoring for older patients with kidney disease and hypertension. Blood Press Monit. 2013;18(1):8-15. https://doi.org/10.1097/MBP.0b013e32835d126c https://doi.org/10.1097/MBP.0b013e32835d... / Blood Pressure Monitoring/ United States	RCT ^* * ECA = Ensayo Clínico Aleatorizado; Home-based/ Elderly hypertensive patients, CKD ^† † ERC = Enfermedad Renal Crónica stage 3.	To evaluate the applicability of RM ^‡ ‡ MR = Monitoreo Remoto to blood pressure.	Automatic blood pressure measurement device with data transmission to the health center.	Both groups obtained a reduction in systolic levels, without statistical significance. The IG ^§ § GI = Grupo Intervención showed greater adherence to pressure checks./ Level II
^{Berman, et al., 2011}44. Berman SJ, Wada C, Minatodani D, Halliday T, Miyamoto R, Lindo J, et al. Home-based preventative care in high-risk dialysis patients: a pilot study. Telemed J E-health. 2011;17(4):283-7. https://doi.org/10.1089/tmj.2010.0169 https://doi.org/10.1089/tmj.2010.0169... / Telemedicine and e-Health/ Hawaii	RCT ^* * ECA = Ensayo Clínico Aleatorizado; Home-based/ HD ^¶ ¶ HD = Hemodiálisis	To determine whether home-based interventions using telehealth can optimize health outcomes and be economically sustainable.	Commercial Home Monitoring (VitelCare Turtle 500).	Nurse-supervised RM ^‡ ‡ MR = Monitoreo Remoto can improve health outcomes, with cost reductions, hospitalizations, and emergency room care./ Level II
2. Teleconsultation
^{Cheung, et al., 2020}19. Cheung KL, Tamura MK, Stapleton RD, Rabinowitz T, LaMantia MA, Gramling R. Feasibility and Acceptability of Telemedicine-Facilitated Palliative Care Consultations in Rural Dialysis Units. J Palliat Med. 2021;24(9):1307-13. https://doi.org/10.1089/jpm.2020.0647 https://doi.org/10.1089/jpm.2020.0647... / Journal of Palliative Medicine / United States	Transverse / Hemodialysis clinics/ HD ^¶ ¶ HD = Hemodiálisis	To determine the feasibility and acceptability of telepalliative care in rural dialysis unit.	Teleconsultation of Nursing in palliative care.	More than 80% of the participants reported that the teleconsultation was as good as the face-to-face one, and 41% found it better. In addition, 81% of the patients declared the teleconsultation relevant, 58% reported new learning about their condition and 27% revealed changes in their perception of dialysis./ Level VI
^{Kazawa, et al., 2020}16. Kazawa K, Osaki K, Rahman MM, Moriyama M. Evaluating the effectiveness and feasibility of nurse-led distant and face-to-face interviews programs for promoting behavioral change and disease management in patients with diabetic nephropathy: a triangulation approach. BMC Nurs. 2020;19(16). https://doi.org/10.1186/s12912-020-0409-0 https://doi.org/10.1186/s12912-020-0409-... / BMC Nursing/ Japan	RCT ^* * ECA = Ensayo Clínico Aleatorizado; Home-based/ Diabetics CKD ^† † ERC = Enfermedad Renal Crónica	To examine the effectiveness between nursing teleconsultations and face-to-face care in promoting behavioral changes.	Nursing teleconsultation and telephone follow-up.	Both groups showed similar behavioral changes. The IG ^§ § GI = Grupo Intervención showed a better understanding of the severity of their disease, the need for self-care, and trust in nurses. The GC ^ GC = Grupo Control showed a higher degree of behavioral change about self-monitoring./ Level II
^{Kaier, et al., 2017}45. Kaier K, Hils S, Fetzer S, Hehn P, Schmid A, Hauschke D, et al. Results of a randomized controlled trial analyzing telemedically supported case management in the first year after living donor kidney transplantation - a budget impact analysis from the healthcare perspective. Health Econ Rev. 2017;7(1). https://doi.org/10.1186/s13561-016-0141-3 https://doi.org/10.1186/s13561-016-0141-... / Health Economics Review/ Germany	RCT ^* * ECA = Ensayo Clínico Aleatorizado; Home-based/ Post-transplanted living donor kidneys	To analyze the costs and savings of the telemedicine case management program after kidney transplantation.	Post-renal transplant follow-up with case management by teleconference.	Participan assisted by telemedicine had lower costs and hospitalizations. The mean difference in costs was € 4,945.07 per patient, p <0.001. The economy was favorable when applied to 15 patients./ Level II
^{Alazab, et al., 2016}46. AlAzab R, Khader Y. Telenephrology application in rural and remote areas of Jordan: benefits and impact on quality of life. Rural Remote Health. 2016;16(1):3646. https://doi.org/10.22605/RRH3646 https://doi.org/10.22605/RRH3646... / Rural and Remote Health/ Jordan	Quasi-experimental/ Home-based (rural areas)/ Pre-dialysis patients	To evaluate the impact of telenephrology on diagnosis, disease management, quality of life, time savings, and costs.	Nephrology Teleconsultation.	The lowest costs and waiting time with telehealth were verified, impacting the improvement of QoL ^‡‡ ‡‡ CV = Calidad de Vida ./ Level III
^{Gallar, et al., 2007}47. Gallar P, Vigil A, Rodriguez I, Ortega O, Gutierrez M, Hurtado J, et al. Two-year experience with telemedicine in the follow-up of patients in home peritoneal dialysis. J Telemed Telecare. 2007;13(6):288-92. https://doi.org/10.1258/135763307781644906 https://doi.org/10.1258/1357633077816449... / Journal of Telemedicine and Telecare/ Spain	RCT ^* * ECA = Ensayo Clínico Aleatorizado; Home-based/ PD ^†† †† DP = Diálisis Peritoneal Home-based	To evaluate the use of telemedicine in the long-term management of stable patients with PD ^†† †† DP = Diálisis Peritoneal .	Nursing teleconsultation with a review of technique, catheter care, early detection, and prevention of peritonitis.	Telemedicine appears to be clinically useful in the long-term follow-up of PD ^†† †† DP = Diálisis Peritoneal patients, with encouraging costs and savings./ Level II
^{Prado, et al., 2006}49. Prado M, Roa LM, Reina-Tosina J. Viability study of a personalized and adaptive knowledge-generation telehealthcare system for nephrology (NEFROTEL). Int J Med Inform. 2006;75(9):646-57. https://doi.org/10.1016/j.ijmedinf.2006.03.005 https://doi.org/10.1016/j.ijmedinf.2006.... / International Journal of Medical Informatics/ Spain	Transverse/ Clinics/ HD ^¶ ¶ HD = Hemodiálisis	To present the feasibility of a personalized telehealth system in Nephrology (NEFROTEL).	Telehealth systems composed of Remote Access Units and Public Switched Telephone Networks.	The system was able to provide physiological knowledge, integrated and adapted to each patient. Demonstrated reliability in human motion monitor impact detection./ Level VI
^{Kariyawasam, 2005}50. Kariyawasam D. The use of telemedicine to assess and advise patients regarding dietary treatment of hyperphosphataemia. EDTNA/ERCA J Ren Care. 2005; 31(4):215-8. https://doi.org/10.1111/j.1755-6686.2005.tb00433.x https://doi.org/10.1111/j.1755-6686.2005... / EDTNA/ERCA Journal of Renal Care / United Kingdom	Prospective cohort/ Ambulatory/ HD ^¶ ¶ HD = Hemodiálisis with hyperphosphatemia	To verify the effectiveness of telemedicine in helping to control phosphorus levels and reduce consultation times with nutritionists.	Telemedicine unit with follow-up via nutritional teleconsultation.	There was a statistically significant reduction in phosphorus levels at 1, 3, and 6 months after nutritional counseling. Travel time was reduced and patients had the benefit of receiving the dietary information soon after the increased phosphate result. / Level IV
^{Michel, et al., 2000}48. Michel LM, Baroux N, Frimat L, Quirin N. Telenephrology and on-site nephrology: Comparable adequate dialysis care to patients living in remote Pacific Islands. J Telemed Telecare. 2021;27(9):562-71. https://doi.org/10.1177/1357633X19896680 https://doi.org/10.1177/1357633X19896680... / Journal of Telemedicine and Telecare/ France	Prospective cohort/ Clinics/ HD ^¶ ¶ HD = Hemodiálisis	To compare the quality of care between face-to-face and remote care.	Follow-up by telehealth, with monthly and quarterly face-to-face consultations.	There was no difference in survival rate, number of deaths, and transplants between the groups. The evaluation for transplantation was lower (p<0.042) in IG ^§ § GI = Grupo Intervención ./ Level IV
3. Digital platform
^{Easom, et al., 2020}20. Easom AM, Shukla AM, Rotaru D, Ounpraseuth S, Shah S V, Arthur JM, et al. Home run-results of a chronic kidney disease Telemedicine Patient Education Study. Clin Kidney J. 2020;13(5):867-72. https://doi.org/10.1093/ckj/sfz096 https://doi.org/10.1093/ckj/sfz096... / Clinical Kidney Journal/ United States	RCT ^* * ECA = Ensayo Clínico Aleatorizado; Ambulatory/ CKD ^† † ERC = Enfermedad Renal Crónica stage 4 and 5 with ^\|\| \|\| TFG = Tasa de Filtración Glomerular GFRof 30 mL/min/1.73 m ²	To evaluate the effectiveness of pre-dialysis education between the tele-education program and face-to-face care.	Online education platforms and face-to-face educational programs.	Reduced reports of lack of knowledge about RRT ^\|\|\|\| \|\|\|\| TRS = Terapia Renal Substitutiva after orientation sessions in both groups. Home modalities of RRT ^\|\|\|\| \|\|\|\| TRS = Terapia Renal Substitutiva were the favorites after the reorientations in both groups./ Level II
^{Cabacungan, et al., 2019}25. Cabacungan AN, Diamantidis CJ, Russell JSC, Strigo TS, Pounds I, Alkon A, et al. Development of a Telehealth Intervention to Improve Access to Live Donor Kidney Transplantation. Transplant Proc. 2019;51(3):665-75. https://doi.org/10.1016/j.transproceed.2018.12.032 https://doi.org/10.1016/j.transproceed.2... / Transplantation Proceedings/ United States	Transverse / Domiciliar/ Kidney donors and recipients	To test the usability and satisfaction of the app Talking About Live Kidney Donation Social Worker Intervention (TALK SWI).	Website and app with educational materials and behavioral intervention by social worker.	Most participants easily completed the technology tasks and preferred the educational app over traditional materials. There was high satisfaction with the intervention of counseling by a social worker./ Level VI
^{Weinhandl, et al., 2018}36. Weinhandl ED, Collins AJ. Relative risk of home hemodialysis attrition in patients using a telehealth platform. Hemodial Int. 2018;22(3):318-27. https://doi.org/10.1111/hdi.12621 https://doi.org/10.1111/hdi.12621... / Hemodialysis International/ United States	Prospective cohort/ Home-based / Home-based HD ^¶ ¶ HD = Hemodiálisis	To evaluate the association between the telehealth platform (Nx2me ) and the risk of changes during HD ^¶ ¶ HD = Hemodiálisis .	Telehealth Platform (Nx2me Connected Health).	IG ^§ § GI = Grupo Intervención was associated with a lower risk of alterations due to all causes studied./ Level IV
^{Kiberd, et al., 2018}34. Kiberd J, Khan U, Stockman C, Radhakrishnan A, Phillips M, Kiberd BA, et al. Effectiveness of a Web-Based eHealth Portal for Delivery of Care to Home Dialysis Patients: A Single-Arm Pilot Study. Can J Kidney Heal Dis. 2018;5. https://doi.org/10.1177/2054358118794415 https://doi.org/10.1177/2054358118794415... / Canadian Journal of Kidney Health and Disease/ Canada	Transverse/ Home-based / HHD ^¶¶ ¶¶ HHD = Hemodiálisis Domiciliaria and DP ^†† †† DP = Diálisis Peritoneal	To determine the efficiency of an eHealth portal in optimizing the patient experience in home dialysis care.	Portal online eHealth (McKesson Canada, RelayHealth ^®): sending text messages between patients and professionals, viewing message history, and accessing electronic medical records.	There were no differences in QoL ^‡‡ ‡‡ CV = Calidad de Vida and communication between the patient and the care team. Only 12 users answered the satisfaction questionnaire. Average monthly phone use decreased from 12.5 to 10 minutes after adopting the portal.
^{Barahimi, et al., 2017}53. Barahimi H, Zolfaghari M, Abolhassani F, Rahimi Foroushani A, Mohammadi A, Rajaee F. E-Learning Model in Chronic Kidney Disease Management: a Controlled Clinical Trial. Iran J Kidney Dis [Internet]. 2017 [cited 2023 May 08];11(4):280-5. Available from: https://pubmed.ncbi.nlm.nih.gov/28794290/ https://pubmed.ncbi.nlm.nih.gov/28794290... / Iranian Journal of Kidney Diseases/ Iran	CT ^* ***** EC = Ensayo Clínico not randomized/ Ambulatory/ CKD ^† † ERC = Enfermedad Renal Crónica GFR ^\|\| \|\| TFG = Tasa de Filtración Glomerular < 60 mL/min/1.73 m ²	To determine the effectiveness of virtual training in the impact of self-care.	Digital e-learning platform: http://barahimi.com/bmr.aspx	Both study groups showed statistically significant differences only in GFR ^\|\| \|\| TFG = Tasa de Filtración Glomerular , with improvement in IG ^§ § GI = Grupo Intervención ./ Level II
^{Gordon, et al., 2016}51. Gordon EJ, Feinglass J, Carney P, Vera K, Olivero M, Black A, et al. A Website Intervention to Increase Knowledge About Living Kidney Donation and Transplantation Among Hispanic/Latino Dialysis Patients. Prog Transplant. 2016;26(1):82-91. https://doi.org/10.1177/1526924816632124 https://doi.org/10.1177/1526924816632124... / Progress in Transplantation/ United States	Quasi-experimental/ Dialysis clinic / HD ^¶ ¶ HD = Hemodiálisis Hispanics	To evaluate the effectiveness of a website in promoting knowledge about kidney transplantation by living donors.	Website “Informate: Inform Yourself about Living Kidney Donation for Hispanics/Latinos”: treatment options; donation; benefits and risks; financial problems; immigrant issues; Cultural beliefs and myths.	There was a gain of knowledge in the two post-test tests, with statistical significance, especially in the sections on treatment and cultural beliefs./ Level III
^{Harrington, et al., 2014}52. Harrington DM, Myers L, Karen E, Bhise V, Nayak KS, Rosner MH. The use of a tablet computer platform to optimize the care of patients receiving peritoneal dialysis: A pilot study. Blood Purif. 2014;37(4):311-5. https://doi.org/10.1159/000365440 https://doi.org/10.1159/000365440... / Blood Purification / United States	Transverse / Home-based / PD ^†† †† DP = Diálisis Peritoneal Outpatient Domiciliary	To examine the effectiveness of using a tablet app for asynchronous, real-time monitoring.	PD ^†† †† DP = Diálisis Peritoneal Remote aims to remind patients of sterile techniques and bag change procedures. It allows users to record vital signs, exchange data (% dextrose, volume infused and drained), and review medications and laboratory findings.	A total of 1,172 exchanges were recorded in 251 days. Compliance with the app ranged from 51 to 92%, with no major adverse events. The overall impression of the interface was 5.2 out of 10. Participants stressed the need to adjust the app to the level of patient experience and to simplify and automate data entry. Level VI
4. Apps
^{Ong, et al., 2021}54. Ong SW, Jassal SV, Porter EC, Min KK, Uddin A, Cafazzo JA, et al. Digital Applications Targeting Medication Safety in Ambulatory High-Risk CKD Patients: Randomized Controlled Clinical Trial. Clin J Am Soc Nephrol. 2021;16(4):532-42. https://doi.org/10.2215/CJN.15020920 https://doi.org/10.2215/CJN.15020920... / Journal of the American Society of Nephrology/ Canada	RCT ^* * ECA = Ensayo Clínico Aleatorizado; Home-based / HD ^¶ ¶ HD = Hemodiálisis , PD ^†† †† DP = Diálisis Peritoneal and stage 3 to 5d	To compare the effectiveness of two digital apps in optimizing safety in drug therapy.	eKidneyCare app for medication management, blood pressure monitoring, symptom assessment, and laboratory testing screening for CKD ^† † ERC = Enfermedad Renal Crónica .	The eKidneyCare group had fewer total medication discrepancies compared to MyMedRec and also reduced the severity of clinically relevant medication discrepancies across all categories. Level II
^{Khoury, et al., 2020}15. Khoury CFE, Crutzen R, Schols JMGA, Halfens RJG, Karavetian M. A dietary mobile app for patients undergoing hemodialysis: Prospective pilot study to improve dietary intakes. J Med Internet Res. 2020;22(7). https://doi.org/10.2196/17817 https://doi.org/10.2196/17817... / Journal of Medical Internet Research/ United Arab Emirates	Quasi-experimental/ Home-based / HD ^¶ ¶ HD = Hemodiálisis	To estimate the effectiveness of dietary intervention with the smartphone app.	Diet diary app: Kidney Education for Lifestyle App (KELA.AE app).	There was an increase in average calorie intake and protein intake, with moderate to high effect size./ Level III
^{Ong, et al., 2016}58. Ong SW, Jassal SV, Miller JA, Porter EC, Cafazzo JA, Seto E, et al. Integrating a Smartphone-Based Self-Management System into Usual Care of Advanced CKD. Clin J Am Soc Nephrol. 2016;11(6):1054-62. https://doi.org/10.2215/CJN.10681015 https://doi.org/10.2215/CJN.10681015... / Journal of the American Society of Nephrology/ Canada	Quase-experimental/ Ambulatory/ CKD ^† † ERC = Enfermedad Renal Crónica stage 4 and 5	To determine the acceptability and clinical impact of the app for the self-care of patients with CKD ^† † ERC = Enfermedad Renal Crónica .	Mobile health app for smartphones.	There was 80% adherence to the app, with a statistically significant reduction in blood pressure. Report of more confidence in the control of clinical conditions./ Level III
^{Dey, et al., 2016}59. Dey V, Jones A, Spalding EM. Telehealth: Acceptability, clinical interventions and quality of life in peritoneal dialysis. SAGE Open Med. 2016;4:2050312116670188. https://doi.org/10.1177/2050312116670188 https://doi.org/10.1177/2050312116670188... / SAGE Open Medicine/ United Kingdom	Quasi-experimental/ Home-based / PD ^†† †† DP = Diálisis Peritoneal	To evaluate the acceptability of the technology by the patient and its effect on clinical interventions and QoL ^‡‡ ‡‡ CV = Calidad de Vida .	Interventions for self-management at home (Home PODs) with recognition of fluid problems, ability to change regimens, telephone dietary counseling, education via web resources, and access to clinical records.	There were no statistically significant differences between the start and end of follow-up. The high retention and satisfaction rates indicated high acceptability of the technology. Satisfaction was high, with no significant change in QoL ^‡‡ ‡‡ CV = Calidad de Vida score at the end of the program. The important characteristics of Home PODs for patients were ease of use, efficacy, and safety. Level III
^{Diamantidis, et al., 2015}55. Diamantidis CJ, Ginsberg JS, Yoffe M, Lucas L, Prakash D, Aggarwal S, et al. Remote Usability Testing and Satisfaction with a Mobile Health Medication Inquiry System in CKD. Clin J Am Soc Nephrol. 2015;10(8):1364-70. https://doi.org/10.2215/CJN.12591214 https://doi.org/10.2215/CJN.12591214... / Clinical Journal of the American Society of Nephrology/ United States	Transverse/ Home-based/ GFR ^\|\| \|\| TFG = Tasa de Filtración Glomerular < 60 mL/min/1.73 m ²	To examine the feasibility of the counseling mobile app on the safe use of medicines in CKD ^† † ERC = Enfermedad Renal Crónica .	Smartphone app for the consultation of medications with answers from the personal digital assistant, through images and alert text to emphasize the safety responses.	The high overall satisfaction with the app was verified, with emphasis on the digital assistant group compared to the short message service group. Only three errors were recorded among the 60 medication consultations./ Level VI
^{Doyle, et al., 2009}57. Doyle N, Murphy M, Brennan L, Waugh A, McCann M, Mellotte G. The “Mikidney” smartphone app pilot study: Empowering patients with Chronic Kidney Disease. J Ren Care. 2019;45(3):133-40. https://doi.org/10.1111/jorc.12294 https://doi.org/10.1111/jorc.12294... / Journal of Renal Care/ Ireland	Quasi-experimental/ Households/ CKD ^† † ERC = Enfermedad Renal Crónica stage 2 to 5	To develop and evaluate the app that stimulates the engagement of patien in the management of their clinical condition.	The smartphone app, MiKidney, with exercise tracker, daily record of exercises performed, reminder alerts, a notes section, a scoring scheme that provides feedback to users, and motivational messages.	There was a significant improvement in the walking test, total cholesterol, LDL ^††† ††† LDL = Low Density Lipoprotein , waist circumference, and body fat. The MiKidney app was considered easy to navigate and 3/4 of the participants felt comfortable with the technology./ Level III
5. Multimodalities
^{Polanco, et al., 2021}38. Polanco E, Aquey M, Collado J, Campos E, Guzman J, Cuevas-Budhart MA, et al. A COVID-19 pandemic-specific, structured care process for peritoneal dialysis patients facilitated by telemedicine: Therapy continuity, prevention, and complications management. Ther Apher Dial. 2021;25(6):970-8. https://doi.org/10.1111/1744-9987.13635 https://doi.org/10.1111/1744-9987.13635... / Therapeutic Apheresis and Dialysis/ Dominican Republic	Longitudinal transverse/ Dialysis clinic/ PD ^†† †† DP = Diálisis Peritoneal manual and automated.	Report on the telemedicine protocol of the PD ^†† †† DP = Diálisis Peritoneal program in the context of the COVID-19 pandemic.	Multi-professional teleconsultation by video calls, photos, and text messages.	There were no statistical differences in the rates of peritonitis, hospitalization, and transfer to HD ^¶ ¶ HD = Hemodiálisis compared to care absent from telemedicine./ Level IV
^{Amici, et al., 2021}60. Amici G, D’Angela D, Lo Cicero A, Romanini D, Martino FK, Spandonaro F. Pilot health technology assessment study: organizational and economic impact of remote monitoring system for home automated peritoneal dialysis. Int Urol Nephrol. 2021;53(9):1933-40. https://doi.org/10.1007/s11255-021-02816-8 https://doi.org/10.1007/s11255-021-02816... / International Urology and Nephrology/ Italy	Quasi-experimental/ Home-based / Automated PD ^†† †† DP = Diálisis Peritoneal	Determine the impact of telemedicine technology with RM ^‡ ‡ MR = Monitoreo Remoto compared to traditional technology on organizational, social, and economic aspects.	Automated PD ^†† †† DP = Diálisis Peritoneal RM ^‡ ‡ MR = Monitoreo Remoto and telephone follow-up.	There was early detection of clinical problems, reduction of unscheduled visits, hospitalization, and telephone contact between patients and caregivers with the clinic. The RM ^‡ ‡ MR = Monitoreo Remoto system led to the relevant savings of € 335 (average per patient/month)./ Level III
^{Bunch, et al., 2020}24. Bunch A, Ardila F, Castaño R, Quiñonez S, Corzo L. Through the Storm: Automated Peritoneal Dialysis with Remote Patient Monitoring during COVID-19 Pandemic. Blood Purif. 2021;50(3):279-82. https://doi.org/10.1159/000511407 https://doi.org/10.1159/000511407... / Blood Purification / Colombia	Prospective cohort / Clinics / PD ^†† †† DP = Diálisis Peritoneal	Describe the organization of care for PD ^†† †† DP = Diálisis Peritoneal patients in the face of the COVID-19 pandemic and the impact on adherence to treatment and other health outcomes.	Implementation of telehealth with teleconsultation, videos, text messages, and teletriage.	There were no statistically significant differences in peritonitis rates. There was an increase in interactions between the patient and the clinic, with a decrease in evaluations of the catheter exit site./ Level IV
^{Milan, et al., 2019}28. Manani SM, Rosner MH, Virzì GM, Giuliani A, Berti S, Crepaldi C, et al. Longitudinal Experience with Remote Monitoring for Automated Peritoneal Dialysis Patients. Nephron. 2019;142(1):1-9. https://doi.org/10.1159/000496182 https://doi.org/10.1159/000496182... / Nephron Clinical Practice/ Italy	Transverse/ Home-based/ Automated PD ^†† †† DP = Diálisis Peritoneal	Evaluate the usefulness of the automated ^†† †† DP = Diálisis Peritoneal PD RM ^‡ ‡ MR = Monitoreo Remoto system.	Automated PD ^†† †† DP = Diálisis Peritoneal RM ^‡ ‡ MR = Monitoreo Remoto and telephone follow-up.	The number of night alarms, visits to the clinic, time spent and distances traveled were significantly lower in IG ^§ § GI = Grupo Intervención . Patients reported ease of use of the RM ^‡ ‡ MR = Monitoreo Remoto system, and satisfaction with the level of interaction with the team and the timely resolution of technical problems. The intervention proved to be cost-effective./ Level VI
^{Kelly, et al., 2019}22. Manani SM, Baretta M, Giuliani A, Virzì GM, Martino F, Crepaldi C, et al. Remote monitoring in peritoneal dialysis: benefits on clinical outcomes and on quality of life. J Nephrol. 2020;10;1-8. https://doi.org/10.1007/s40620-020-00812-2 https://doi.org/10.1007/s40620-020-00812... / BMJ Open / Australia	RCT ^* * ECA = Ensayo Clínico Aleatorizado; Ambulatory/ CKD ^† † ERC = Enfermedad Renal Crónica stage 3 to 4	To evaluate the feasibility and acceptability of telehealth intervention in dietary self-management in CKD ^† † ERC = Enfermedad Renal Crónica .	RM ^‡ ‡ MR = Monitoreo Remoto by phone calls and text messages.	The program showed high acceptability and usability among the groups, with 96% of the interventions completed. There was satisfaction with the frequency of contacts and the model was seen as an acceptable and personalized alternative to face-to-face clinical consultations./ Level II
^{Warner, et al., 2018}35. Warner BE, Velardo C, Salvi D, Lafferty K, Crosbie S, Herrington WG, et al. Feasibility of Telemonitoring Blood Pressure in Patients With Kidney Disease (Oxford Heart and Renal Protection Study-1): Observational Study. JMIR Cardio. 2018;2(2):e11332. https://doi.org/10.2196/11332 https://doi.org/10.2196/11332... / JMIR Cardio/ United Kingdom	Transverse/ Home-based / CKD ^† † ERC = Enfermedad Renal Crónica	To evaluate the usability and acceptability of blood pressure telemonitoring technology.	Blood pressure monitor by bluetooth and smartphone app.	The usability of the monitoring system was high. Pressure variability was significant over 30 and 90 days, indicating that the greatest variation was short-term./ Level VI
^{Aberger, et al., 2014}61. Aberger EW, Migliozzi D, Follick MJ, Malick T, Ahern DK. Enhancing patient engagement and blood pressure management for renal transplant recipients via home electronic monitoring and web-enabled collaborative care. Telemed J E Health. 2014;20(9):850-4. https://doi.org/10.1089/tmj.2013.0317 https://doi.org/10.1089/tmj.2013.0317... / Telemedicine and e-Health/ Iceland	Transverse (descriptive)/ Home-based / Post-kidney transplant patients	To optimize blood pressure levels, involvement, and medication adherence.	Good Health Gateway digital portal and blood pressure check monitor (adherence feedback and pressure monitoring).	There was a statistically significant reduction in mean systolic and diastolic pressures of 6 mmHg and 3 mmHg, respectively./ Level VI
6. Telephone contact
^{Fallahpour, et al., 2020}23. Fallahpour S, Nasiri M, Fotokian Z, Alipoor ZJ, Hajiahmadi M. The effects of telephone-based telenursing on perceived stressors among older adults receiving hemodialysis. Nurs Midwifery Stud. 2020;9(4):201-7. https://doi.org/10.4103/nms.nms_111_19 https://doi.org/10.4103/nms.nms_111_19... / Nursing and Midwifery Studies/ Iran	RCT ^* * ECA = Ensayo Clínico Aleatorizado; Home-based / People over 60 in HD ^¶ ¶ HD = Hemodiálisis	To evaluate the effects of telephonic care on physiological and psychological stressors.	Telenursing by telephone monitoring, with face-to-face educational sessions.	The mean scores for physiological and psychosocial stressors were reduced in GI ^§ § GI = Grupo Intervención after follow-up, with no changes in GC**. There were differences between the groups in terms of the mean post-test scores and the mean pre- and post-test differences for both stressors: physiological and psychosocial./ Level II
^{Shahsavani, et al., 2019}27. Shahsavani A, Kiani F. Investigating the Effect of Telenursing on Health Promoting Behaviours of Haemodialysis Patients in Education Hospitals in Zahedan in 2017-2018. J Evol Med Dent Sci [Internet]. 2019 [cited 2023 May 08];8(44):3326-31. Available from: https://link.gale.com/apps/doc/A612928362/AONE?u=anon~144d9408&sid=googleScholar&xid=0f4a0687 https://link.gale.com/apps/doc/A61292836... / Journal of Evolution of Medical and Dental Sciences/ Iran	Quasi-experimental / Home-based / HD ^¶ ¶ HD = Hemodiálisis	To investigate the effect of telenursing on health promotion behaviors.	Telenursing care with follow-up via telephone contact.	The IG ^§ § GI = Grupo Intervención showed statistically significant differences in the dimensions of exercise, stress, responsibility, and interpersonal relationships. There were no differences in the nutrition and spirituality dimensions. / Level III
^{Tan, et al., 2018}37. Tan J, Mehrotra A, Nadkarni GN, He JC, Langhoff E, Post J, et al. Telenephrology: Providing Healthcare to Remotely Located Patients with Chronic Kidney Disease. Am J Nephrol. 2018;47(3):200-7. https://doi.org/10.1159/000488004 https://doi.org/10.1159/000488004... / AMJ Nephrology / United States	Prospective cohort/ Ambulatory/ CKD ^† † ERC = Enfermedad Renal Crónica stage 1 to 5	To determine whether adherence to visits and clinical outcomes in remote CKD ^† † ERC = Enfermedad Renal Crónica are comparable to conventional face-to-face care.	Telenephrology with follow-up via telephone calls.	Cancellation of appointments was reduced by half, with a higher frequency of attendance at telenephrology appointments. The incidence of death, CKD ^† † ERC = Enfermedad Renal Crónica dialysis, or creatinine doubling was similar in both groups./ Level IV
^{Cao, et al., 2018}32. Cao F, Li LF, Lin M, Lin QY, Ruan YP, Hong FY. Application of instant messaging software in the follow-up of patients using peritoneal dialysis, a randomised controlled trial. J Clin Nurs. 2018;27(15-16):3001-7. https://doi.org/10.1111/jocn.14487 https://doi.org/10.1111/jocn.14487... / Journal of Clinical Nursing/ China	CT ^* ***** EC = Ensayo Clínico not randomized/ Home-based/ PD ^†† †† DP = Diálisis Peritoneal	Investigating the effectiveness of instant messaging apps in monitoring PD ^†† †† DP = Diálisis Peritoneal patients.	Usual caution along with sending text messages.	IG ^§ § GI = Grupo Intervención had higher levels of serum albumin and hemoglobin, and lower levels of phosphorus, calcium-phosphorus product. There was a better level of satisfaction, with statistical significance, in all these variables. / Level II
^{Hung, et al., 2018}33. Hung CS, Lee J, Chen YH, Huang CC, Wu VC, Wu HW, et al. Effect of Contract Compliance Rate to a Fourth-Generation Telehealth Program on the Risk of Hospitalization in Patients With Chronic Kidney Disease: Retrospective Cohort Study. J Med Internet Res. 2018;20(1):e23. https://doi.org/10.2196/jmir.8914 https://doi.org/10.2196/jmir.8914... / Journal of Medical Internet Research/ China	Retrospective cohort/ Home-based / CKD ^† † ERC = Enfermedad Renal Crónica non-dialytic, dialytic and absence of CKD ^† † ERC = Enfermedad Renal Crónica	To evaluate the relationship between telehealth program adherence rates and hospitalizations in patien with and without CKD ^† † ERC = Enfermedad Renal Crónica .	Telehealth program of telephone follow-up with the monitoring of biometric data (electrocardiography, blood pressure, heart rate, and pulse oximetry).	The compliance rate had a three-phase relationship with cardiovascular and all-cause hospitalizations. Low or very high compliance rates were associated with a higher risk of hospitalization. Patients with CKD ^† † ERC = Enfermedad Renal Crónica were associated with a higher risk of hospitalization, and dialysis patients had an increased risk when they had low adherence rates, compared to patients with normal kidney function or non-dialysis CKD ^† † ERC = Enfermedad Renal Crónica . / Level IV
^{Gross. et al., 2017}65. Gross CR, Reilly-Spong M, Park T, Zhao R, Gurvich OV, Ibrahim HN. Telephone-adapted Mindfulness-based Stress Reduction (tMBSR) for Patients Awaiting Kidney Transplantation. Contemp Clin Trials. 2017;57:37-43. https://doi.org/10.1016/j.cct.2017.03.014 https://doi.org/10.1016/j.cct.2017.03.01... / Contemporary Clinical Trials/ United States	RCT ^* * ECA = Ensayo Clínico Aleatorizado; Home-based / Patients awaiting kidney transplantation	To test the effectiveness and establish the feasibility of stress reduction based on mindfulness adapted by telephone.	Stress reduction program based on Mindfulness Stress Reduction (MBSR) by meditation and collective Yoga with the community classroom by telephone.	There were low changes in the level of anxiety, which did not differ during follow-up. Mental QoL ^‡‡ ‡‡ CV = Calidad de Vida in IG ^§ § GI = Grupo Intervención improved significantly and 90% of participants reported that mindfulness practice helps manage stress./ Level II
^{Poorgholami, et al., 2015}64. Poorgholami F, Mansoori P, Montaseri Z, Najafi K. Effect of Self Care Education with and without Telephone Follow-Up on the Level of Hope in Renal Dialysis Patients: A Single-Blind Randomized Controlled Clinical Trial. Int J Community Based Nurs Midwifery [Internet]. 2016 [cited 2023 May 08];4(3):256-64. Available from: https://pubmed.ncbi.nlm.nih.gov/27382592/ https://pubmed.ncbi.nlm.nih.gov/27382592... / International Journal of Community Based Nursing & Midwifery/ Iran	RCT ^* * ECA = Ensayo Clínico Aleatorizado; Home-based / HD ^¶ ¶ HD = Hemodiálisis	To examine the effects of telephone monitoring on the level of hope in a self-care education program.	Telephone monitoring in an education program for self-care.	A priori, there were no significant differences between the groups for the hope scores. After the intervention, the level of hope in IG ^§ § GI = Grupo Intervención was significantly higher, especially in those with telephone follow-up./ Level II

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[1] Corresponding author:
Onislene Alves Evangelista de Almeida E-mail: onislene@gmail.com https://orcid.org/0000-0003-3878-3699