Kidney Week

Abstract: FR-PO333

Physician-Guided CKD Self-Management via Smartphone App Is Associated with Proteinuria Reduction: A Retrospective Cohort Study

Session Information

• CKD: Clinical, Outcomes, Trials - II
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Song, Rui, Brigham and Women''s Hospital, Boston, Massachusetts, United States

Rui Song,

• Chen, Xuyong, Beijing Kidney Health Technology Company, Beijing, China

Xuyong Chen,

• Zhuo, Min, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Min Zhuo,

• Sarvode Mothi, Suraj, Brigham and Women's Hospital, Boston, Massachusetts, United States

Suraj Sarvode Mothi,

• Luo, Yueming, Guangzhou university of Chinese Medicine, Guangzhou, Guangdong, China

Yueming Luo,

• Hsiao, Li-Li, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

Li-Li Hsiao,

• Li, Jiahua, Brigham and Women's Hospital, Boston, Massachusetts, United States

Jiahua Li,

Background

Smartphone apps are increasingly popular for chronic disease management. However, the feasibility and effectiveness of smartphone apps to manage Chronic Kidney Disease (CKD) are unknown. This study assessed the feasibility and effectiveness of a smartphone app for self-management of CKD.

Methods

“Kidney online” is a patient-facing, algorithm assisted, physician-guided, and interactive app in Chinese. Patients with a self-reported diagnosis of CKD used the app to track their symptoms, physical activities, vital signs, and laboratory test results. Patients received automatic recommendations by the proprietary algorithm and consulted their assigned tele-nephrologists on an ad-hoc basis. Patients who were enrolled in this app for more than 3 months between Dec. 2016 to Nov. 2018 with proteinuria ≥ 500mg/24hr were eligible for analysis. Changes in blood pressure (BP), estimated glomerular filtration rate (eGFR), and 24-hr proteinuria level were evaluated as outcomes between quartile groups, stratified by the total number of patient-physician conversations. Content analysis of the conversations was performed.

Results

Among the 2351 adult app users, 468 patients were identified for analysis. The total number of patient-physician conversations was 26 ± 10, 60 ± 10, 103 ± 16, and 259 ± 148 from the 1^st to the 4^th quartile respectively; and the reduction of 24-hr proteinuria was 162.2 ± 195.3, 859.8 ± 193.6, 676.4 ± 194.5, and 889.3 ± 194.5mg respectively (p=0.03). The odds ratio of <30% proteinuria reduction in the 4^th quartile compared to the 1^st quartile was 0.452 (p=0.007) after adjusting for age, sex, clinical parameters, and medications. Compared to the 1^st quartile, the 4^th quartile received more alerts in hypertension (43.6% vs. 24.1%, p=0.02), and hypotension (53.9% vs. 31.9%, p<0.0001). The textual analysis of the patient-physician conversations revealed themes on self-monitoring of BP, awareness of laboratory results, medication optimization and adherence, dietary modification, and education in CKD and the comorbidities.

Conclusion

More frequent patient-physician interactions via smartphone app are associated with better proteinuria control. A patient-friendly smartphone app for record keeping and communication is feasible and effective for physician-guided CKD self-management.

Funding

• Commercial Support –