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Letton ME, Trần TB, Flower S, Wewege MA, Wang AY, Sandler CX, Sen S, Arnold R. Digital Physical Activity and Exercise Interventions for People Living with Chronic Kidney Disease: A Systematic Review of Health Outcomes and Feasibility. J Med Syst 2024; 48:63. [PMID: 38951385 PMCID: PMC11217122 DOI: 10.1007/s10916-024-02081-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024]
Abstract
Physical activity is essential to interrupt the cycle of deconditioning associated with chronic kidney disease (CKD). However, access to targeted physical activity interventions remain under-supported due to limited funding and specialised staff. Digital interventions may address some of these factors. This systematic review sought to examine the evidence base of digital interventions focused on promoting physical activity or exercise and their effect on health outcomes for people living with CKD. Electronic databases (PubMed, CINAHL, Embase, Cochrane) were searched from 1 January 2000 to 1 December 2023. Interventions (smartphone applications, activity trackers, websites) for adults with CKD (any stage, including transplant) which promoted physical activity or exercise were included. Study quality was assessed, and a narrative synthesis was conducted. Of the 4057 records identified, eight studies (five randomised controlled trials, three single-arm studies) were included, comprising 550 participants. Duration ranged from 12-weeks to 1-year. The findings indicated acceptability and feasibility were high, with small cohort numbers and high risk of bias. There were inconsistent measures of physical activity levels, self-efficacy, body composition, physical function, and psychological outcomes which resulted in no apparent effects of digital interventions on these domains. Data were insufficient for meta-analysis. The evidence for digital interventions to promote physical activity and exercise for people living with CKD is limited. Despite popularity, there is little evidence that current digital interventions yield the effects expected from traditional face-to-face interventions. However, 14 registered trials were identified which may strengthen the evidence-base.
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Affiliation(s)
- Meg E Letton
- School of Medical, Indigenous & Health Sciences, University of Wollongong, Wollongong, NSW, Australia
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Thái Bình Trần
- School of Medical, Indigenous & Health Sciences, University of Wollongong, Wollongong, NSW, Australia
- School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
- Department of Renal Medicine, Concord Repatriation and General Hospital, Sydney, NSW, Australia
| | - Shanae Flower
- School of Medical, Indigenous & Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Michael A Wewege
- School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Amanda Ying Wang
- Department of Renal Medicine, Concord Repatriation and General Hospital, Sydney, NSW, Australia
- Concord Clinical School, University of Sydney, Sydney, NSW, Australia
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Carolina X Sandler
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Shaundeep Sen
- Department of Renal Medicine, Concord Repatriation and General Hospital, Sydney, NSW, Australia
- Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Ria Arnold
- School of Medical, Indigenous & Health Sciences, University of Wollongong, Wollongong, NSW, Australia.
- School of Health Sciences, University of New South Wales, Sydney, NSW, Australia.
- Department of Renal Medicine, Concord Repatriation and General Hospital, Sydney, NSW, Australia.
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Young HML, Castle EM, Briggs J, Walklin C, Billany RE, Asgari E, Bhandari S, Bishop N, Bramham K, Burton JO, Campbell J, Chilcot J, Cooper N, Deelchand V, Graham-Brown MPM, Haggis L, Hamilton A, Jesky M, Kalra PA, Koufaki P, Macdonald J, McCafferty K, Nixon AC, Noble H, Saynor ZL, Taal MW, Tollitt J, Wheeler DC, Wilkinson TJ, Greenwood SA. The development and internal pilot trial of a digital physical activity and emotional well-being intervention (Kidney BEAM) for people with chronic kidney disease. Sci Rep 2024; 14:700. [PMID: 38184737 PMCID: PMC10771473 DOI: 10.1038/s41598-023-50507-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024] Open
Abstract
This trial assessed the feasibility and acceptability of Kidney BEAM, a physical activity and emotional well-being self-management digital health intervention (DHI) for people with chronic kidney disease (CKD), which offers live and on-demand physical activity sessions, educational blogs and videos, and peer support. In this mixed-methods, multicentre randomised waitlist-controlled internal pilot, adults with established CKD were recruited from five NHS hospitals and randomised 1:1 to Kidney BEAM or waitlist control. Feasibility outcomes were based upon a priori progression criteria. Acceptability was primarily explored via individual semi-structured interviews (n = 15). Of 763 individuals screened, n = 519 (68%, 95% CI 65 to 71%) were eligible. Of those eligible, n = 303 (58%, 95% CI 54-63%) did not respond to an invitation to participate by the end of the pilot period. Of the 216 responders, 50 (23%, 95% CI 18-29%) consented. Of the 42 randomised, n = 22 (10 (45%) male; 49 ± 16 years; 14 (64%) White British) were allocated to Kidney BEAM and n = 20 (12 (55%) male; 56 ± 11 years; 15 (68%) White British) to the waitlist control group. Overall, n = 15 (30%, 95% CI 18-45%) withdrew during the pilot phase. Participants completed a median of 14 (IQR 5-21) sessions. At baseline, 90-100% of outcome data (patient reported outcome measures and a remotely conducted physical function test) were completed and 62-83% completed at 12 weeks follow-up. Interview data revealed that remote trial procedures were acceptable. Participants' reported that Kidney BEAM increased their opportunity and motivation to be physically active, however, lack of time remained an ongoing barrier to engagement with the DHI. An randomised controlled trial of Kidney BEAM is feasible and acceptable, with adaptations to increase recruitment, retention and engagement.Trial registration NCT04872933. Date of first registration 05/05/2021.
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Affiliation(s)
- Hannah M L Young
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK.
- Diabetes Research Centre, University of Leicester, Leicester, UK.
- National Institute of Health Research Leicester Biomedical Research Centre, Leicester, UK.
| | - Ellen M Castle
- School of Physiotherapy, Department of Health Sciences, Brunel University, London, UK
| | - Juliet Briggs
- Renal Department, King's College Hospital, London, UK
| | | | - Roseanne E Billany
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Elham Asgari
- Department of Nephrology, Guys and St Thomas's Hospital, London, UK
| | - Sunil Bhandari
- Department of Nephrology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Nicolette Bishop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Kate Bramham
- Renal Department, King's College Hospital, London, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jackie Campbell
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Joseph Chilcot
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nicola Cooper
- Department of Population Health Science, University of Leicester, Leicester, UK
| | | | | | - Lynda Haggis
- Renal Department, King's College Hospital, London, UK
| | - Alexander Hamilton
- Department of Nephrology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Mark Jesky
- Department of Nephrology, Nottingham NHS Trust, Nottingham, UK
| | - Philip A Kalra
- Department of Nephrology Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Pelagia Koufaki
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Edinburgh, UK
| | - Jamie Macdonald
- Institute for Applied Human Physiology, Bangor University, Bangor, UK
| | | | - Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Zoe L Saynor
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Maarten W Taal
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - James Tollitt
- Department of Nephrology Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Thomas J Wilkinson
- National Institute of Health Research Leicester Biomedical Research Centre, Leicester, UK
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Castle EM, Billany RE, Lightfoot CJ, Annema C, De Smet S, Graham-Brown MP, Greenwood SA. Exercise as a therapeutic intervention in chronic kidney disease: are we nearly there yet? Curr Opin Nephrol Hypertens 2023; 32:502-508. [PMID: 37622530 PMCID: PMC10552838 DOI: 10.1097/mnh.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE OF REVIEW The opportunity to review the more recent evidence for prescribing exercise-based physical rehabilitation for people living with chronic kidney disease (CKD) is timely. There has been a recent global focus evaluating how physical activity interventions might improve health-related quality of life and outcomes for people living with chronic health conditions in a post-COVID era. There is finally a long overdue commitment from the kidney research and clinical community to deliver pragmatic interventions to help people living with CKD to be able to live well with their condition. RECENT FINDINGS This article reviews recent research, and discusses the challenges and potential solutions, for providing exercise-based therapeutic options for people living with CKD; including predialysis self-management interventions, options for both prehabilitation and posttransplant rehabilitation, pragmatic considerations for delivery of exercise therapy for people receiving haemodialysis treatment and the role of virtual kidney-specific rehabilitation. SUMMARY Whilst there remains a need for further research in this area of patient care, there is now a body of evidence and kidney-specific guidelines that firmly support a rollout of pragmatic and scalable exercise-based interventions for people living with CKD. We are indeed nearly there now.
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Affiliation(s)
- Ellen M. Castle
- Physiotherapy, Department of Health Sciences, College of Health, Medicine, and life Sciences, Brunel University, London, UK
| | - Roseanne E. Billany
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Courtney J. Lightfoot
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Coby Annema
- Section of Nursing Science, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stefan De Smet
- Group Rehabilitation for Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Nephrology and Renal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | | | - Sharlene A. Greenwood
- Renal Therapies, King's College Hospital NHS Trust, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
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Wu HH, Poulikakos D, Hurst H, Lewis D, Chinnadurai R. Delivering Personalized, Goal-Directed Care to Older Patients Receiving Peritoneal Dialysis. KIDNEY DISEASES (BASEL, SWITZERLAND) 2023; 9:358-370. [PMID: 37901709 PMCID: PMC10601915 DOI: 10.1159/000531367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/26/2023] [Indexed: 10/31/2023]
Abstract
Background An aging population living with chronic kidney disease and progressing to kidney failure, subsequently receiving peritoneal dialysis (PD) is growing. A significant proportion of these patients are also living with multi-morbidities and some degree of frailty. Recent practice recommendations from the International Society of Peritoneal Dialysis advocate for high-quality, goal-directed PD prescription, and the Standardized Outcomes of Nephrology-PD initiative emphasized the need for an individualized, goal-based care approach in all patients receiving PD treatment. In older patients, this approach to PD care is even more important. A frailty screening assessment, followed by a comprehensive geriatric assessment (CGA) prior to PD initiation and when dictated by change in relevant circumstances is paramount in tailoring PD care and prescription according to the needs, life goals, as well as clinical status of older patients with kidney failure. Summary Our review aimed to summarize the different dimensions to be taken into account when delivering PD care to the older patient - from frailty screening and CGA in older patients receiving PD to employing a personalized, goal-directed PD prescription strategy, to preserving residual kidney function, optimizing blood pressure (BP) control, and managing anemia, to addressing symptom burden, to managing nutritional intake and promoting physical exercise, and to explore telehealth opportunities for the older PD population. Key Messages What matters most to older PD patients may not be simply extending survival, but more importantly, to be living comfortably on PD treatment with minimal symptom burden in a home environment and to minimize treatment complications.
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Affiliation(s)
- Henry H.L. Wu
- Department of Renal Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
- Renal Research, Kolling Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Dimitrios Poulikakos
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Helen Hurst
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Paula Ormandy School of Health and Society, University of Salford, Salford, UK
| | - David Lewis
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Rajkumar Chinnadurai
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
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Wu HHL, Chinnadurai R. Weighing up telehealth for older adults receiving home dialysis. THE LANCET. HEALTHY LONGEVITY 2023; 4:e455-e456. [PMID: 37659425 DOI: 10.1016/s2666-7568(23)00139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 09/04/2023] Open
Affiliation(s)
- Henry H L Wu
- Renal Research, Kolling Institute of Medical Research, Royal North Shore Hospital and The University of Sydney, Sydney, NSW 2065, Australia; Department of Renal Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia.
| | - Rajkumar Chinnadurai
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK
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Greenwood SA, Oliveira BA, Asgari E, Ayis S, Baker LA, Beckley-Hoelscher N, Goubar A, Banerjee D, Bhandari S, Chilcot J, Burton JO, Kalra PA, Lightfoot CJ, Macdougall IC, McCafferty K, Mercer TH, Okonko DO, Reid C, Reid F, Smith AC, Swift PA, Mangelis A, Watson E, Wheeler DC, Wilkinson TJ, Bramham K. A Randomized Trial of Intravenous Iron Supplementation and Exercise on Exercise Capacity in Iron-Deficient Nonanemic Patients With CKD. Kidney Int Rep 2023; 8:1496-1505. [PMID: 37547514 PMCID: PMC10403653 DOI: 10.1016/j.ekir.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/11/2023] [Accepted: 05/01/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Patients with chronic kidney disease (CKD) are often iron deficient, even when not anemic. This trial evaluated whether iron supplementation enhances exercise capacity of nonanemic patients with CKD who have iron-deficiency. Methods Prospective, multicenter double-blind randomized controlled trial of nondialysis patients with CKD and iron-deficiency but without anemia (Hemoglobin [Hb] >110 g/l). Patients were assigned 1:1 to intravenous (IV) iron therapy, or placebo. An 8-week exercise program commenced at week 4. The primary outcome was the mean between-group difference in 6-minute walk test (6MWT) at 4 weeks. Secondary outcomes included 6MWT at 12 weeks, transferrin saturation (TSAT), serum ferritin (SF), Hb, renal function, muscle strength, functional capacity, quality of life, and adverse events at baseline, 4 weeks, and at 12 weeks. Mean between-group differences were analyzed using analysis of covariance models. Results Among 75 randomized patients, mean (SD) age for iron therapy (n = 37) versus placebo (n = 38) was 54 (16) versus 61 (12) years; estimated glomerular filtration rate (eGFR) (34 [12] vs. 35 [11] ml/min per 1.73 m2], TSAT (23 [12] vs. 21 [6])%; SF (57 [64] vs. 62 [33]) μg/l; Hb (122.4 [9.2] vs. 127 [13.2] g/l); 6MWT (384 [95] vs. 469 [142] meters) at baseline, respectively. No significant mean between-group difference was observed in 6MWT distance at 4 weeks. There were significant increases in SF and TSAT at 4 and 12 weeks (P < 0.02), and Hb at 12 weeks (P = 0.009). There were no between-group differences in other secondary outcomes and no adverse events attributable to iron therapy. Conclusion This trial did not demonstrate beneficial effects of IV iron therapy on exercise capacity at 4 weeks. A larger study is needed to confirm if IV iron is beneficial in nondialysis patients with CKD who are iron-deficient.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Philip A. Kalra
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Courtney J. Lightfoot
- University of Leicester, Leicester, UK
- National Institute of Health Research Leicester Biomedical Research Center, Leicester, UK
| | - Iain C. Macdougall
- King’s College Hospital NHS Trust, London, UK
- King’s College London, London, UK
| | | | | | | | - Chante Reid
- King’s College Hospital NHS Trust, London, UK
| | | | - Alice C. Smith
- University of Leicester, Leicester, UK
- National Institute of Health Research Leicester Biomedical Research Center, Leicester, UK
| | | | | | | | | | - Thomas J. Wilkinson
- University of Leicester, Leicester, UK
- National Institute of Health Research, Applied Research Collaboration East Midlands, Leicester, UK
| | - Kate Bramham
- King’s College Hospital NHS Trust, London, UK
- King’s College London, London, UK
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Walklin CG, Young HML, Asghari E, Bhandari S, Billany RE, Bishop N, Bramham K, Briggs J, Burton JO, Campbell J, Castle EM, Chilcot J, Cooper N, Deelchand V, Graham-Brown MPM, Hamilton A, Jesky M, Kalra PA, Koufaki P, McCafferty K, Nixon AC, Noble H, Saynor ZL, Sothinathan C, Taal MW, Tollitt J, Wheeler DC, Wilkinson TJ, Macdonald JH, Greenwood SA. The effect of a novel, digital physical activity and emotional well-being intervention on health-related quality of life in people with chronic kidney disease: trial design and baseline data from a multicentre prospective, wait-list randomised controlled trial (kidney BEAM). BMC Nephrol 2023; 24:122. [PMID: 37131125 PMCID: PMC10152439 DOI: 10.1186/s12882-023-03173-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Physical activity and emotional self-management has the potential to enhance health-related quality of life (HRQoL), but few people with chronic kidney disease (CKD) have access to resources and support. The Kidney BEAM trial aims to evaluate whether an evidence-based physical activity and emotional wellbeing self-management programme (Kidney BEAM) leads to improvements in HRQoL in people with CKD. METHODS This was a prospective, multicentre, randomised waitlist-controlled trial, with health economic analysis and nested qualitative studies. In total, three hundred and four adults with established CKD were recruited from 11 UK kidney units. Participants were randomly assigned to the intervention (Kidney BEAM) or a wait list control group (1:1). The primary outcome was the between-group difference in Kidney Disease Quality of Life (KDQoL) mental component summary score (MCS) at 12 weeks. Secondary outcomes included the KDQoL physical component summary score, kidney-specific scores, fatigue, life participation, depression and anxiety, physical function, clinical chemistry, healthcare utilisation and harms. All outcomes were measured at baseline and 12 weeks, with long-term HRQoL and adherence also collected at six months follow-up. A nested qualitative study explored experience and impact of using Kidney BEAM. RESULTS 340 participants were randomised to Kidney BEAM (n = 173) and waiting list (n = 167) groups. There were 96 (55%) and 89 (53%) males in the intervention and waiting list groups respectively, and the mean (SD) age was 53 (14) years in both groups. Ethnicity, body mass, CKD stage, and history of diabetes and hypertension were comparable across groups. The mean (SD) of the MCS was similar in both groups, 44.7 (10.8) and 45.9 (10.6) in the intervention and waiting list groups respectively. CONCLUSION Results from this trial will establish whether the Kidney BEAM self management programme is a cost-effective method of enhancing mental and physical wellbeing of people with CKD. TRIAL REGISTRATION NCT04872933. Registered 5th May 2021.
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Affiliation(s)
- C G Walklin
- Renal Therapies, King's College Hospital NHS Trust, London, UK
| | - Hannah M L Young
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.
| | - E Asghari
- Department of Nephrology, Guy's and St Thomas' NHS Trust, London, UK
| | - S Bhandari
- Department of Nephrology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - R E Billany
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - N Bishop
- School of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, UK
| | - K Bramham
- Department of Women's Health, King's College London, London, UK
| | - J Briggs
- Renal Therapies, King's College Hospital NHS Trust, London, UK
| | - J O Burton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - J Campbell
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - E M Castle
- School of Physiotherapy, Department of Health Sciences, Brunel University, London, UK
| | - J Chilcot
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - V Deelchand
- Department of Nephrology, Royal Free Hospital, London, UK
| | | | - A Hamilton
- Department of Nephrology, Royal Exeter Hospital, Devon, UK
| | - M Jesky
- Department of Nephrology, Nottingham NHS Trust, Nottingham, UK
| | - P A Kalra
- Department of Nephrology, Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - P Koufaki
- Dietetics, Nutrition and Biological Sciences, Queen Margaret University, Edinburgh, UK
| | - K McCafferty
- Department of Nephrology, Barts Health NHS Trust, London, UK
| | - A C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - H Noble
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Z L Saynor
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - C Sothinathan
- Department of Physiotherapy, Chelsea and Westminster NHS Trust, London, UK
| | - M W Taal
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - J Tollitt
- Department of Renal Medicine, University College London, London, UK
| | - D C Wheeler
- National Institute of Health Research Leicester Biomedical Research Centre , Leicester, UK
| | - T J Wilkinson
- Institute for Applied Human Physiology, Bangor University, Bangor, Gwynedd, UK
| | - J H Macdonald
- Faculty of life sciences and medicine, King's College London, London, UK
| | - S A Greenwood
- Renal Therapies, King's College Hospital NHS Trust, London, UK
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Wu HHL. Improving physical functioning and activity of elderly peritoneal dialysis patients. Ther Apher Dial 2023; 27:373-374. [PMID: 36394359 DOI: 10.1111/1744-9987.13952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/02/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Henry H L Wu
- Department of Renal Medicine, Royal North Shore Hospital and the University of Sydney, St Leonards, Australia
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Castle EM, Frearson K, Ferguson J, El Gabry A, Coyle D, Murray JS, Keane DF. Patient involvement to maximise patient‐centred benefit of medical technology for people living with kidney disease. J Ren Care 2022; 48:218-219. [DOI: 10.1111/jorc.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ellen M. Castle
- Kidney Care Team at King's College Hospital NHS Foundation Trust London UK
- Therapies team at King's College Hospital NHS Foundation Trust London UK
- Department of Physiotherapy, School of Health Sciences Brunel University London UK
| | | | | | | | - David Coyle
- NIHR Devices for Dignity Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| | | | - David F. Keane
- CURAM SFI Research Centre for Medical Devices, HRB‐Clinical Research Facility Galway National University of Ireland Galway Galway Ireland
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Castle EM, Dijk G, Asgari E, Shah S, Phillips R, Greenwood J, Bramham K, Chilcot J, Greenwood SA. The Feasibility and User-Experience of a Digital Health Intervention Designed to Prevent Weight Gain in New Kidney Transplant Recipients—The ExeRTiOn2 Trial. Front Nutr 2022; 9:887580. [PMID: 35677553 PMCID: PMC9168981 DOI: 10.3389/fnut.2022.887580] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/03/2022] [Indexed: 12/02/2022] Open
Abstract
Half of kidney transplant recipients (KTRs) gain more than 5% of their body weight in the first year following transplantation. KTRs have requested support with physical activity (PA) and weight gain prevention, but there is no routine care offered. There are few high-quality studies investigating the clinical value of diet, PA or combined interventions to prevent weight gain. The development and evaluation of theoretically informed complex-interventions to mitigate weight gain are warranted. The aims of this mixed-methods randomized controlled trial (RCT) were to explore the feasibility, acceptability and user-experience of a digital healthcare intervention (DHI) designed to prevent post-transplant weight gain, in preparation for a large multi-center trial. New KTRs (<3 months) with access to an internet compatible device were recruited from a London transplant center. The usual care (UC) group received standard dietary and PA advice. The intervention group (IG) received access to a 12-week DHI designed to prevent post-transplant weight gain. Primary feasibility outcomes included screening, recruitment, retention, adherence, safety and hospitalizations and engagement and experience with the DHI. Secondary outcomes (anthropometrics, bioimpedance, arterial stiffness, 6-minute walk distance and questionnaires) were measured at baseline, 3- and 12-months. 38 KTRs were screened, of which 32 (84.2%) were eligible, and of those 20 (62.5%) consented, with 17 participants (85%) completing baseline assessment (Median 49 years, 58.8% male, Median 62 days post-transplant). Participants were randomized using a computer-generated list (n = 9 IG, n = 8 UC). Retention at 12-months was 13 (76.4%) (n = 6 IG, n = 7 UC). All a priori progression criteria were achieved. There were no associated adverse events. Reflexive thematic analysis revealed four themes regarding trial participation and experience whilst using the DHI. Halting recruitment due to COVID-19 resulted in the recruitment of 40% of the target sample size. Mixed-methods data provided important insights for future trial design. A definitive RCT is warranted and welcomed by KTRs.
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Affiliation(s)
- Ellen M. Castle
- Therapies Department, King's College Hospital, NHS Foundation Trust, London, United Kingdom
- King's Kidney Care, King's College Hospital, London, United Kingdom
- Renal Sciences, King's College London University, London, United Kingdom
- *Correspondence: Ellen M. Castle ; orcid.org/0000-0002-6961-6108
| | - Giulia Dijk
- Department of Nutrition and Dietetics, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Elham Asgari
- Kidney Services Team, Guy's and St Thomas' NHS Foundation Trust London, London, United Kingdom
| | - Sapna Shah
- King's Kidney Care, King's College Hospital, London, United Kingdom
- Renal Sciences, King's College London University, London, United Kingdom
| | - Rachel Phillips
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom
- Pragmatic Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, London, United Kingdom
| | - James Greenwood
- Victor Horsley Department of Neurosurgery, University College London Hospital, London, United Kingdom
| | - Kate Bramham
- King's Kidney Care, King's College Hospital, London, United Kingdom
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine King's College London, London, United Kingdom
| | - Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sharlene A. Greenwood
- Therapies Department, King's College Hospital, NHS Foundation Trust, London, United Kingdom
- King's Kidney Care, King's College Hospital, London, United Kingdom
- Renal Sciences, King's College London University, London, United Kingdom
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