Abstract: FR-OR030

Mobile Text Messaging for Disease Activity, Stressors, and Treatment Adherence Monitoring in Pediatric Nephrotic Syndrome

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Wang, Chia- Shi, Emory University, Atlanta, Georgia, United States
  • Troost, Jonathan P., University of Michigan, Ann Arbor, Michigan, United States
  • Greenbaum, Larry A., Emory University, Atlanta, Georgia, United States
  • Srivastava, Tarak, Childrens's Mercy Hospital, Kansas City, Missouri, United States
  • Gibson, Keisha L., University of North Carolina Kidney Center, Chapel Hill, North Carolina, United States
  • Trachtman, Howard, NYU Langone Med Ctr, New York City, New York, United States
  • Herreshoff, Emily G., University of Michigan, Ann Arbor, Michigan, United States
  • Gipson, Debbie S., University of Michigan, Ann Arbor, Michigan, United States

Group or Team Name

  • cNEPTUNE Working Group
Background

There is limited information on the role of medication adherence or infectious/other stressors on the response to corticosteroids (IST) or risk of relapse in childhood nephrotic syndrome (NS). Mobile text messaging (SMS) technology may capture the impact of these factors on childhood NS disease course.

Methods

SMS data were collected on incident pediatric NS patients enrolled in the Nephrotic Syndrome Study Network (NEPTUNE) within 30 days of IST initiation. Parents or patients ≥12 years old responded to daily messages on the results of their urine protein testing and weekly messages on the presence of stressors (infections, allergies, or other) and adherence to NS medications. Non-adherence was defined as self-/parent-report of not taking prescribed NS medications in the first week of SMS. Time to remission was described using Kaplan-Meier method, stratified by adherent/non-adherent groups. Stressors were examined for relationship to disease relapses within a 7 day window via Chi-squared test.

Results

69 pediatric NS patients were included in this analysis. Response rate to messages was 95%. Median follow-up was 364 days. 52 (76%) patients reached complete remission during follow-up. Among those who remitted, 25 (48%) later relapsed, with 47 relapse events. Median time to remission was 7 days among adherent patients and 34 days among non-adherent patients (Figure; p=0.01). The frequency of stressor occurrence in the week prior to relapse did not differ from other weeks while a patient was in remission (6/47 (13%) vs. 171/1,641 (10%) p=0.63).

Conclusion

Mobile text messaging was an effective method to monitor disease activity and adherence in childhood NS. Non-adherence to medications was associated with a longer time to remission. Allergies, infections, or other stressors were not found to be associated with disease relapse.

FIGURE. Time to remission among incident pediatric NS patients: adherent vs. non-adherent to medications.

Funding

  • NIDDK Support