JMIR Publications

ABSTRACT

Background:

The renal diet is complex and requires amendments in various nutrients. Elevated serum phosphorus is common among hemodialysis patients, and it is associated with many complications. Alternative approaches that support both dietitians and patients in overcoming these difficulties should be explored. Smartphone technology could be used to provide a source of accessible and reliable information.

Objective:

The aim of this pilot is to assess the potential efficacy of an intervention using KELA.AE on the phosphorous management in hemodialysis patients. Results will be used to improve both the application and a planned, rigorous large-scale trial intended to assess app efficacy.

Methods:

This is a pilot study performed at the hemodialysis unit of Al Qassimi Hospital (Emirate of Sharjah). All patients were assessed for eligibility, and based on inclusion criteria, they were considered for enrollment. Participants met with a dietitian once a week and used the mobile app. Outcomes were measured at baseline (T0) and two weeks post app usage (T1). This pilot is reported as per guidelines for non-randomized pilot and feasibility studies and in line with the CONSORT 2010 checklist for reporting pilot or feasibility trials.

Results:

Twenty-three subjects successfully completed the pilot. Patients knowledge improved to 68.1% (13.3) after intervention with a large effect size (d= 1.22, 95%CI 0.59-1.85). Dietary protein intakes increased from a mean of 0.9g/Kg (SD=0.3) per day to a mean of 1.3g/Kg (SD=0.5) per day with a large effect size (d= 1.07, 95%CI 0.45-1.69). Phosphorus to protein ratio dropped from a mean of 18.4 mg/g protein to 13.5mg/g protein with a large effect size (d= 0.83, 95%CI 0.22-1.43). There were no improvements in phosphorous intakes, self-reported non-adherence, and serum phosphorus.

Conclusions:

The findings of this pilot reveal potential efficacy for the use of a smartphone app as a supportive nutrition education tool for the phosphorus management in hemodialysis. This pilot study showed that KELA.AE app has the potential to improve knowledge and dietary choices. Processes related to the procedure, resources, tools, and app improvement for a future trial were assessed. A rigorous randomized controlled trial should be performed to evaluate the efficacy, assessing app usage of a long-term intervention.