Effect of the Chronic Kidney Disease-Peritoneal Dialysis (CKD-PD) App on Improvement of Overhydration Treatment in Patients on Peritoneal Dialysis: Randomized Controlled Trial.
Sirirat Anutrakulchai, Sajja Tatiyanupanwong, Sarassawan Kananuraks, Eakalak Lukkanalikitkul, Sawinee Kongpetch, Wijittra Chotmongkol, Michael G Morley, Wilaiphorn Thinkhamrop, Bandit Thinkhamrop, Chadarat Kleebchaiyaphum, Krongsin Khianchanach, Theenatchar Chunghom, Katharine E Morley
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引用次数: 0
Abstract
Background: Overhydration is associated with increased morbidity and mortality in patients on peritoneal dialysis (PD). Early detection of overhydration is possible by monitoring hydration metrics, but the critical gap for treatment is obtaining timely and actionable data.
Objective: This study compares the detection of overhydration and clinical outcomes in patients on PD using the Chronic Kidney Disease-Peritoneal Dialysis (CKD-PD) smartphone app with standard monitoring and management.
Methods: An open-label randomized controlled trial was conducted at 3 hospitals in northeast Thailand. Enrolled participants from PD clinics were randomized into 2 equal groups: CKD-PD (App users) and usual management (No-App). Participants or their caregivers in the App group recorded hydration metrics in the CKD-PD app, which were uploaded to a central database monitored by nephrology staff. The No-App group used a handwritten logbook. Both groups had bimonthly clinic visits. The primary outcome was the incidence rate ratio (IRR) for clinical interventions for overhydration. Secondary outcomes included hospitalizations, technique failure, and death.
Results: A total of 208 participants were randomized into App (N=103) and No-App (N=105) groups with the median follow-up time of 11.2 months. Hydration metric upload compliance in the App group was 85.7% (IQR 71.4-95.6). The IRR of overall interventions for overhydration was 2.51 times higher in the App group (95% CI 2.18-2.89; P<.001). Types of clinical interventions for overhydration differed between groups with dietary change and prescription of antihypertensive drugs more frequent in App users and diuretics and change of dialysis prescription more frequent in the No-App group. Hospitalizations were significantly higher in the No-App group due to any cause (adjusted IRR 1.58) and volume overload (adjusted IRR 4.07). There was no significant difference in survival analysis and technique failure between the 2 groups.
Conclusions: Use of the CKD-PD app improved early detection of overhydration and early treatment interventions, resulting in fewer all-cause and volume overload hospitalizations.
背景：腹膜透析（PD）患者的过度水合与发病率和死亡率增加有关。通过监测水合指标可以早期发现过度水合，但治疗的关键差距是获得及时和可操作的数据。目的：本研究比较慢性肾脏疾病-腹膜透析（CKD-PD）智能手机应用程序与标准监测和管理的PD患者的过度水合检测和临床结果。方法：在泰国东北部3家医院进行开放标签随机对照试验。从PD诊所招募的参与者被随机分为2个相等的组：CKD-PD（应用程序用户）和常规管理（无应用程序）。App组的参与者或他们的护理人员在CKD-PD应用程序中记录了水合指标，这些指标被上传到肾脏科工作人员监测的中央数据库。无应用程序组使用手写日志。两组患者每两个月去一次诊所。主要终点是临床干预的发病率比（IRR）。次要结局包括住院、技术失败和死亡。结果：208名参与者随机分为App组（N=103）和No-App组（N=105），中位随访时间为11.2个月。App组水合度量上传依从性为85.7% （IQR为71.4-95.6）。App组对过度水化的总体干预的IRR是前者的2.51倍(95% CI 2.18-2.89；结论：使用CKD-PD应用程序提高了对过度水合的早期发现和早期治疗干预，减少了全因和容量超载住院治疗。试验注册：ClinicalTrials.gov NCT04797195；https://clinicaltrials.gov/study/NCT04797195。
期刊介绍：
The Journal of Medical Internet Research (JMIR) is a highly respected publication in the field of health informatics and health services. With a founding date in 1999, JMIR has been a pioneer in the field for over two decades.
As a leader in the industry, the journal focuses on digital health, data science, health informatics, and emerging technologies for health, medicine, and biomedical research. It is recognized as a top publication in these disciplines, ranking in the first quartile (Q1) by Impact Factor.
Notably, JMIR holds the prestigious position of being ranked #1 on Google Scholar within the "Medical Informatics" discipline.
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