More than one in seven US adults—that’s 37 million people—are estimated to have chronic kidney disease (CKD), according to the National Institutes of Health. The prevalence within the Veteran population is estimated to be 34 percent higher than the general population.

Due to a national shortage of nephrologists (kidney specialists), Veterans seeking treatment for CKD in rural communities have said they can live hours from the nearest specialist and it can take over six months to be seen outside of the VA system.

Enter Clinical Resource Hubs, a national program launched by VA to tackle access to care issues by deploying innovative technologies and resources to improve access to a wide range of specialties, including much needed nephrology services. All 18 VISNs have a CRH that can help support access to clinical care for Veterans when local facilities have gaps in staffing.

“This is one of those instances where VA cannot rely on the community to step in and provide specialty care,” said Dr. David T. Moore, a VA Clinical Resource Hubs (CRH) director.

Bringing specialized kidney services to rural communities

Moore and Kathy Tuozzo, MSN, CRH associate chief nurse, are working with nephrologists in Boston and Connecticut led by Dr. Ramon Bonegio and Dr. Susan Crowley to apply this approach nationally.

They are tapping into New England’s wealth of medical training programs and specialty services, connecting nephrologists at affiliated universities with rural VISNs. In doing so, the VISN 1 CRH is bringing these specialized services to rural communities ranging from Maine to the Rocky Mountains.

This program is also building capacity and expertise to treat CKD locally at rural facilities. At facilities without an on-site nephrologist, CRH specialists from Boston and Connecticut are training nurses and Advanced Practice Providers to become local experts in kidney care so that they can take care of their own panels of patients under guidance from the remote nephrologists in New England.

Provided services for more than 500 Veterans

“Through CRH, you can really start to see we are building this valuable infrastructure for doing interfacility care whether it be in the same time zone or not,” said Dr. Moore.

Already, the program is seeing improvements in outcomes. Veterans in the CRH telenephrology program are transitioning to dialysis with safer types of vascular access and are receiving newer treatments such as SGLT2 inhibitors, which reduce the need for dialysis and transplant.

The VISN 1 CRH telenephrology program is providing excellent care to Veterans from coast to coast. To date, over 500 Veterans have received telenephrology services from this innovative program.

For more on how CRH is working to expand care for rural Veterans nationwide, see VA Enterprise-Wide Initiatives here.

By Dr. Ramon Bonegio, Dr. David T. Moore, Kathy Tuozzo, and Kim Waller

VISN 1 telenephrology services

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Published on Aug. 17, 2022

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  1. James Getter August 29, 2022 at 12:44 pm

    I have had kidney disease for several years and the VA knows about it but has done nothing.

  2. Steven Stokke August 24, 2022 at 6:31 pm

    I am interested in learning more about how Firefighting Foam (Aqueous Film Form Foam)(AFFF)) affects the kidneys specifically because it contains PFAS/PFOA’s and other toxic chemicals. I have no family history of Kidney Disease or Diabetes however, I was a military Firefighter and was frequently exposed to AFFF including accidental ingestion and numerous dermal exposure.

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