Telemedicine versus Face-to-Face Follow-up in Post-Acute Kidney Injury Survivors

Background: Regular post-discharge follow-up with a nephrologist is recommended for post-acute kidney injury (AKI) survivors; however, accessibility barriers, particularly among patients with multiple comorbidities or those living in remote areas, often limit continuity of care. Telemedicine offers a potential solution, but evidence in post-AKI populations remains limited. Methods: This single-center, open-label, randomized controlled trial was conducted at Thammasat University Hospital, Thailand. Adults who survived hospitalization with stage II–III AKI and lived ≥15 km from the hospital were randomized to telemedicine follow-up using the secure “TUH Telemed” application or conventional face-to-face follow-up for six months. The primary outcome was feasibility, assessed using three process indicators: (i) follow-up adherence, (ii) serum creatinine measurement, and (iii) blood pressure (BP) measurement. Secondary outcomes included clinical (mortality, readmission, CKD progression, recurrent AKI, BP control) and patient-centered outcomes (satisfaction, waiting time, travel time, and travel cost). Results: A total of 58 post-AKI patients were enrolled, with 29 assigned to the conventional face-to-face follow-up group and 29 to the telemedicine follow-up group. The mean age was 65.2 ± 14.3 years, and 57% were male. At six months, follow-up adherence, the key feasibility indicator, was similar between the telemedicine and face-to-face groups (90% vs. 90%, p = 1.00). Blood pressure measurement rates were also comparable (92% vs. 100%, p = 0.15). However, serum creatinine measurement was significantly lower in the telemedicine group (58% vs. 100%, p < 0.001). Patients in the telemedicine group had significantly lower travel costs, shorter travel time, and shorter waiting time. Patient satisfaction remained high in both groups (9.2 ± 0.8 vs. 9.1 ± 0.7, p = 0.46). Conclusions: Telemedicine follow-up for post-AKI survivors achieved follow-up adherence comparable to conventional face-to-face care, supporting its feasibility. However, lower rates of laboratory monitoring highlight an important implementation limitation of virtual follow-up. In addition, telemedicine reduced travel and waiting times while maintaining high patient satisfaction.