Optimization of the Chronic Kidney Disease-Peritoneal Dialysis App to Improve Care for Patients on Peritoneal Dialysis in Northeast Thailand: User-Centered Design Study

Renal health: Evaluation of the spontaneous use of a new m-health technology and validation of its content to support patients undergoing peritoneal dialysis

INTRODUCTION

Chronic kidney disease is a worldwide public health problem, with a high prevalence of patients on dialysis. mHealth technologies can greatly support the treatment and monitoring of these patients. Thus, this study aimed to evaluate the spontaneous use of the application (app) Renal Health, a previously available technology, for patients on hemodialysis and validate content to support patients undergoing peritoneal dialysis.

METHODS

The first stage consisted of evaluating the spontaneous use of the app, and the second stage consisted of methodological research for the development, evaluation, and improvement of a technological instrument for use in clinical practice as a support for patients undergoing peritoneal dialysis (PD). The association between categorical variables was performed using the chi-square test, adopting a significance level of 5%.

RESULTS

The app was accessed by 753 users and of these, 34 % accessed the hemodialysis section. Most accesses were in the state of São Paulo/Brazil and performed by women. The records of biochemical tests did not vary according to gender and age group (p > 0.05). The developed and validated PD section enables section control, allowing the user to manage their sessions. The analysis of the technology by the specialists showed good results for the global content validity index (CVI) regarding objectives (CVI = 0.95), structure (CVI = 0.97), and relevance (CVI = 1.0).

CONCLUSION

It is concluded that the hemodialysis section of the Renal Health app aroused the interest of the population and that the developed peritoneal dialysis section was validated by specialists.

Reach, Acceptability, and Patient Preferences of a Mobile Health-Based Survey to Assess COVID-19 Vaccine Hesitancy Among Patients Receiving Dialysis

Rationale & Objective

The majority of patients with kidney failure receiving dialysis own mobile devices, but the use of mobile health (mHealth) technologies to conduct surveys in this population is limited. We assessed the reach and acceptability of a short message service (SMS) text message-based survey that assessed coronavirus disease 2019 (COVID-19) vaccine hesitancy among patients receiving dialysis.

Study Design & Exposure

A cross-sectional SMS-based survey conducted in January 2021.

Setting & Participants

Patients receiving in-center hemodialysis, peritoneal dialysis, or home hemodialysis in a nonprofit dialysis organization in New York City.

Outcomes

(1) Reach of the SMS survey, (2) Acceptability using the 4-item Acceptability of Intervention Measure, and (3) Patient preferences for modes of survey administration.

Analytical Approach

We used Fisher exact tests and multivariable logistic regression to assess sociodemographic and clinical predictors of SMS survey response. Qualitative methods were used to analyze open-ended responses capturing patient preferences.

Results

Among 1,008 patients, 310 responded to the SMS survey (response rate 31%). In multivariable adjusted analyses, participants who were age 80 years and above (aOR, 0.49; 95% CI, 0.25-0.96) were less likely to respond to the SMS survey compared with those aged 18 to 44 years. Non-Hispanic Black (aOR, 0.58; 95% CI, 0.39-0.86), Hispanic (aOR, 0.31; 95% CI, 0.19-0.51), and Asian or Pacific Islander (aOR, 0.46; 95% CI, 0.28-0.74) individuals were less likely to respond compared with non-Hispanic White participants. Participants residing in census tracts with higher Social Vulnerability Index, indicating greater neighborhood-level social vulnerability, were less likely to respond to the SMS survey (fifth vs first quintile aOR, 0.61; 95% CI, 0.37-0.99). Over 80% of a sample of survey respondents and nonrespondents completely agreed or agreed with the Acceptability of Intervention Measure. Qualitative analysis identified 4 drivers of patient preferences for survey administration: (1) convenience (subtopics: efficiency, multitasking, comfort, and synchronicity); (2) privacy; (3) interpersonal interaction; and (4) accessibility (subtopics: vision, language, and fatigue).

Limitations

Generalizability, length of survey.

Conclusions

An SMS text message-based survey had moderate reach among patients receiving dialysis and was highly acceptable, but response rates were lower in older (age ≥ 80), non-White individuals and those with greater neighborhood-level social vulnerability. Future research should examine barriers and facilitators to mHealth among patients receiving dialysis to ensure equitable implementation of mHealth-based technologies.

Mobile Apps for Patients with Peritoneal Dialysis: Systematic App Search and Evaluation

BACKGROUND

Peritoneal dialysis (PD) is one type of renal replacement therapy. If patients have problems during the dialysis process, healthcare providers may not be able assist the patients immediately. mHealth can provide patients with information and help them to solve problems in real-time, potentially increasing their willingness to choose PD.

OBJECTIVE

The objectives of this study were to conduct a comprehensive review of free mobile applications for patients with PD on the Internet and to recommend suitable mobile applications to facilitate patient self-management and health.

METHODS

We conducted a systematic search for PD mobile applications on Google Play and the Apple iTunes Store from 3 to 16 June 2023.

RESULTS

A total of 828 identifiable mobile applications were initially identified, and ultimately, 21 met the inclusion criteria. The Mobile App Rating Scale (MARS) assessment of the applications revealed the highest score in the functionality domain, followed by the aesthetics, information, app-specific, subjective quality, and engagement domains, respectively. In the comprehensive self-management of PD, the highest percentage was related to disease-related information.

CONCLUSION

The findings of this study suggest that some applications, with the highest quality, can be recommended to patients for use in English or traditional Chinese.

Functionality and Usability of mHealth Apps in Patients with Peritoneal Dialysis: A Systematic Review

mHealth has been utilized in the care of patients with chronic kidney disease, allowing the collection of patient health-related data, offering disease-related information, enabling the tracking and recording of biochemical parameters, and enabling communication with healthcare providers in real time through applications. mHealth may improve the health outcomes in patients with peritoneal dialysis. This systematic review aimed to summarize evidence regarding the functionality and usability of mHealth apps in patients with peritoneal dialysis. We conducted a comprehensive literature review, searching in five databases, including CINAHL, Cochrane, PsycINFO, PubMed, and Web of Science, to retrieve titles and abstracts related to peritoneal dialysis and mHealth applications for PRISMA recommendations from January 2013 to December 2023. Overall, 11 studies met all the inclusion criteria. The functionality of mHealth apps included inform, instruct, record, display, guide, remind/alert, and communicate. Most of the apps have multifunctionality. The usability was categorized into three aspects: efficiency (self-efficacy and usability), satisfaction, and effectiveness (underwent kidney transplantation and switched to hemodialysis, rehospitalization, peritonitis rate, infection rates at exit sites, mortality, fluid overload, inadequate solute clearance, biochemical values, quality of life, consumer quality index, and technology readiness). Generally, outcomes in the intervention group had better effects compared to those in the control group. Multifunctional mHealth apps show a good potential in improving the efficiency, satisfaction, and effectiveness for patients compared to traditional care. Future research should include more studies and participants to explore and verify the long-term effectiveness of mHealth apps.

Effects of a mobile application on improving self-management of adult patients receiving peritoneal dialysis: A randomized controlled trial

AIM

This study aimed to develop a mobile application for improving self-management and to evaluate its effects in adult patients on peritoneal dialysis (PD).

METHODS

This randomized controlled trial was registered with the Korean Clinical Research Information Service Registry (KCT0007267) and conducted at a tertiary hospital. A self-management mobile application (SMA) was developed based on social cognitive theory and the ADDIE (analysis, design, development, implementation, and evaluation) model. The SMA includes information about disease management; self-recording of data on diet, exercise, medication, and health behavior; and healthcare providers' support and feedback. Participants aged 19-65 years were randomly allocated to the intervention group (n = 27) using the SMA for 10 weeks, and the control group (n = 26) receiving usual care. PD-related knowledge and self-efficacy, PD-related health behavior, biomarkers, and health-related quality of life (HRQoL) were surveyed pretest/posttest and analyzed using SPSS 23.0.

RESULTS

Compared to the controls, the intervention group showed significant improvement in PD-related knowledge and health behavior, albumin, and hemoglobin. HRQoL domains of symptoms/problems of kidney disease and disease impact on daily activity were improved in the intervention group.

CONCLUSION

The SMA is an effective intervention for enhancing health behaviors as well as improving the HRQoL of patients with PD. Without any limitations on time or location, patients with PD can easily use the SMA to monitor their health conditions, efficiently manage their disease, and perform PD-related behaviors. Nurses can implement high-quality tailored healthcare by using patients' lifelog data from the SMA.

Monitoring Risk Factors and Improving Adherence to Therapy in Patients With Chronic Kidney Disease (Smit-CKD Project): Pilot Observational Study

BACKGROUND

Chronic kidney disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the increased penetration of mobile phones, a mobile app could educate patients to autonomously monitor cardiorenal risk factors.

OBJECTIVE

With this background in mind, we developed an integrated system of a server and app with the aim of improving self-monitoring of cardiovascular and renal risk factors and adherence to therapy.

METHODS

The software infrastructure for both the Smit-CKD server and Smit-CKD app was developed using standard web-oriented development methodologies preferring open source tools when available. To make the Smit-CKD app suitable for Android and iOS, platforms that allow the development of a multiplatform app starting from a single source code were used. The integrated system was field tested with the help of 22 participants. User satisfaction and adherence to therapy were measured by questionnaires specifically designed for this study; regular use of the app was measured using the daily reports available on the platform.

RESULTS

The Smit-CKD app allows the monitoring of cardiorenal risk factors, such as blood pressure, weight, and blood glucose. Collected data are transmitted in real time to the referring general practitioner. In addition, special reminders improve adherence to the medication regimen. Via the Smit-CKD server, general practitioners can monitor the clinical status of their patients and their adherence to therapy. During the test phase, 73% (16/22) of subjects entered all the required data regularly and sent feedback on drug intake. After 6 months of use, the percentage of regular intake of medications rose from 64% (14/22) to 82% (18/22). Analysis of the evaluation questionnaires showed that both the app and server components were well accepted by the users.

CONCLUSIONS

Our study demonstrated that a simple mobile app, created to self-monitor modifiable cardiorenal risk factors and adherence to therapy, is well tolerated by patients affected by chronic kidney disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence and if self-monitoring of risk factors will improve clinical outcomes in this population.

Research features between Urology and Nephrology authors in articles regarding UTI related to CKD, HD, PD, and renal transplantation

BACKGROUND

A urinary tract infection (UTI) is one of the most common types of infections affecting the urinary tract. When bacteria enter the bladder or kidney and multiply in the urine, a URI can occur. The urethra is shorter in women than in men, which makes it easier for bacteria to reach the bladder or kidneys and cause infection. A comparison of the research differences between Urology and Nephrology (UN) authors regarding UTI pertaining to the 4 areas (i.e., Chronic Kidney Disease, Hemodialysis, Peritoneal Dialysis, and Renal Transplantation [CHPR]) is thus necessary. We propose and verify 2 hypotheses: CHPR-related articles on UTI have equal journal impact factors (JIFs) in research achievements (RAs) and UN authors have similar research features (RFs).

METHODS

Based on keywords associated with UTI and CHPR in titles, subject areas, and abstracts since 2013, we obtained 1284 abstracts and their associated metadata (e.g., citations, authors, research institutes, departments, countries of origin) from the Web of Science core collection. There were 1030 corresponding and first (co-first) authors with hT-JIF-indices (i.e., JIF was computed using hT-index rather than citations as usual). The following 5 visualizations were used to present the author's RA: radar, Sankey, time-to-event, impact beam plot, and choropleth map. The forest plot was used to distinguish RFs by observing the proportional counts of keyword plus in Web of Science core collection between UN authors.

RESULTS

It was observed that CHPR-related articles had unequal JIFs (χ2 = 13.08, P = .004, df = 3, n = 1030) and UN departments had different RFs (Q = 53.24, df = 29, P = .004). In terms of countries, institutes, departments, and authors, the United States (hT-JIF = 38.30), Mayo Clinic (12.9), Nephrology (19.14), and Diana Karpman (10.34) from Sweden had the highest hT-JIF index.

CONCLUSION

With the aid of visualizations, the hT-JIF-index and keyword plus were demonstrated to assess RAs and distinguish RFs between UN authors. A replication of this study under other topics and in other disciplines is recommended in the future, rather than limiting it to UN authors only, as we did in this study.

Authors who contributed most to the fields of hemodialysis and peritoneal dialysis since 2011 using the hT-index: Bibliometric analysis

BACKGROUND

The h-index does not take into account the full citation list of a researcher to evaluate individual research achievements (IRAs). As a generalization of the h-index, the hT-index takes all citations into account to evaluate IRAs. Compared to other bibliometric indices, it is unclear whether the hT-index is more closely associated with the h-index. We utilized articles published on hemodialysis and peritoneal dialysis (HD/PD) to validate the hT-index as a measure of the most significant contributions to HD/PD.

METHODS

Using keywords involving HD/PD in titles, subject areas, and abstracts since 2011, we obtained 7702 abstracts and their associated metadata (e.g., citations, authors, research institutes, countries of origin). In total, 4752 first or corresponding authors with hT-indices >0 were evaluated. To present the author's IRA, the following 4 visualizations were used: radar, Sankey, impact beam plot, and choropleth map to investigate whether the hT-index was more closely associated with the h-index than other indices (e.g., g-/x-indices and author impact factors), whether the United States still dominates the majority of publications concerning PD/HD, and whether there was any difference in research features between 2 prolific authors.

RESULTS

In HD/PD articles, we observed that (a) the hT-index was closer to and associated with the h-index; (b1) the United States (37.15), China (34.63), and Japan (28.09) had the highest hT-index; (b2) Sun Yat Sen University (Chian) earned the highest hT-index (=20.02) among research institutes; (c1) the authors with the highest hT-indices (=15.64 and 14.39, respectively) were David W Johnson (Australia) and Andrew Davenport (UK); and (c2) their research focuses on PD and HD, respectively.

CONCLUSION

The hT-index was demonstrated to be appropriate for assessing IRAs along with visualizations. The hT-index is recommended in future bibliometric analyses of IRAs as a complement to the h-index.