Transforming chronic kidney disease care with telemedicine: expert consensus recommendations from the Italian Society of Nephrology.

Chronic kidney disease (CKD) affects 10-13% of adults worldwide and imposes a substantial burden on healthcare systems. Telemedicine has emerged as a key tool to support nephrology care by improving access, continuity, and patient engagement across CKD, dialysis, and transplant pathways. To guide its integration into routine practice, the Italian Society of Nephrology (SIN) convened a multidisciplinary working group to develop expert consensus recommendations on the use of telemedicine in nephrology. The consensus process included moderated meetings, topic-specific task forces, iterative drafting, and review of randomized trials, policy frameworks, and national guidelines. The resulting recommendations address technological and regulatory requirements, organizational models, and clinical applications across CKD management, peritoneal dialysis, hemodialysis, home hemodialysis, kidney transplantation, rare kidney diseases, and telepathology for kidney biopsy interpretation. Key barriers-including infrastructure, digital literacy, and reimbursement-were also examined. Telemedicine was found to be most effective when implemented within hybrid care models supported by certified platforms, trained staff, and integrated workflows. While telemedicine can reduce hospital visits, enable early detection of complications, and enhance patient satisfaction, further research is needed to assess long-term outcomes and cost-effectiveness. These recommendations aim to support equitable, safe, and sustainable implementation of telenephrology within modern healthcare systems.