Previously submitted to: JMIR mHealth and uHealth (no longer under consideration since Apr 20, 2023)
Date Submitted: Mar 14, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effectiveness of self-management APP in different follow-up intervention among patients with chronic kidney disease: a retrospective cohort study with a 3-year follow-up
ABSTRACT
Background:
The prevalence of CKD puts pressure on health systems providing care to patients and has led to an increase in mobile apps seeking to improve self-management for CKD patients. However, the impact of apps on the CKD population in different clinical locations and health systems remains unclear.
Objective:
This project developed SuYi APP for follow-up of CKD patients based on patient self-management theory. It was applied in clinic to determine which remote follow-up intervention (Simple APP remote follow-up vs. outpatient follow-up +APP remote follow-up) leads to improved endpoints in patients with chronic kidney disease (CKD).
Methods:
This was a retrospective cohort study. The subjects with stage 1-5 CKD without renal replacement therapy were enrolled at the CKD management center from January 2015 to December 2019 for long-term follow-up. The subjects were divided into the Simple APP remote follow-up group and outpatient follow-up +APP group. After 3 years of follow-up in December 2022, data on all-cause mortality and kidney replacement treatment were collected and compared between the two groups.
Results:
5326 patients were included in the study, including 2492 in the APP group and 2834 in the outpatient+APP group. After IPTW virtualization matching, the final matched APP group consisted of 2489 cases (IQR, 33-55) and 2850 (IQR, 33-55) in the outpatient+APP group. By the end of the study, there were 34 deaths (1.4%) in the APP group and 16 deaths (1.6%) in the outpatient+APP group, with a rate difference of -0.26 (95% CI[-0.91-0.39], P=.49). The two groups were comparable after matching for renal replacement therapy outcomes (95% CI[0.72-1.08], P=.23) and survival curves, which were not significantly different. However, the selection rate of kidney transplantation in the outpatient+APP group was higher than that in the APP group (95% CI[0.09-0.81], P=.02), and the use of temporary catheters was lower in the outpatient+APP group during initial hemodialysis (95% CI[8.4%-29.8%], P<.001).
Conclusions:
The development and application of the app combined with outpatient follow-up management can avoiding the initiation of urgent dialysis and improve kidney transplantation selectivity. Applying outpatient follow-up+APP pattern intervention will benefit chronic disease management and health care. Clinical Trial: ChiCTR2200060627
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