JMIR Publications

ABSTRACT

Background:

Chronic kidney disease (CKD) stage 5 presents a high risk for dialysis initiation and for complications such as uremic encephalopathy, uremic symptoms, gastrointestinal bleeding, and infection. Among the most common barriers to health care during CKD stage 5 is poor continuity of care due to unresolved communication gaps.

Objective:

Our aim was to determine the potential value of a care model that uses a social networking service (SNS) to improve the quality of CKD health care and delay dialysis initiation.

Methods:

We used a retrospective cohort of CKD patients aged 20–85 years who received care between 2007 and 2017 to evaluate the efficacy of incorporating an SNS into health care. In 2014, Dr H started to use an SNS app to connect with CKD stage 5 patients and their families. In cases of emergency, patients and families could quickly report any condition to Dr H. Using this app, Dr H helped facilitate “productive interactions” between patients with CKD stage 5 and the health care system. The intention was to safely delay initiation of dialysis therapy. We divided patients into four groups: Group 1 (G1) included patients at the study hospital during the period 2007–2014 who had contact only with nephrologists other than Dr H; Group 2 (G2) included patients who visited Dr H during the period 2007–2014, before he began using the SNS app; Group 3 (G3) included patients who visited nephrologists other than Dr H during the period 2014–2017 and had no interactions using the SNS; and Group 4 (G4) included patients who visited Dr H during the period 2014–2017 and interacted with him using the SNS app.

Results:

We recruited 209 patients with stage 5 CKD who had been enrolled in the study hospital’s CKD program between 2007 and 2017. Each of the four groups had a different time to dialysis. Before adjusting for baseline estimated glomerular filtration rate (eGFR), the G4 patients had a longer time to dialysis (a mean [SD] of 761.7 [616.2] days) than the other groups (G1: 403.6 [409.4] days, P=.011 for G4 vs G1; G2: 394.8 [318.8] days, P=.039; G3: 369.1 [330.8] days, P=.049). After adjusting for baseline eGFR, G4 had a longer duration for each eGFR drop (84.8 [65.1] days) than the other groups (G1: 43.5 [45.4] days, P=.005; G2: 42.5 [26.5] days, P=.032; G3: 38.7 [33.5] days, P=.002).

Conclusions:

Use of an SNS app between patients with CKD stage 5 and their physicians can reduce the communication gap between them and create benefits such as prolonging time to dialysis initiation. The role of SNSs and associated care models should be further investigated in a larger population.