Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jan 5, 2023
Date Accepted: Apr 24, 2023
Improving Kidney Outcomes in Non-Diabetic CKD Patients through an AI-Based Health Coaching Mobile App: A Retrospective Cohort Study.
ABSTRACT
Background:
Chronic kidney disease (CKD) is a global health burden. The efficacy of different modes of e-health care in facilitating self-management for patients with CKD were unclear.
Objective:
The aim of this study was to evaluate the effectiveness of a mobile application-based, intelligent care system in improving the kidney outcomes of patients with CKD.
Methods:
Our study was a retrospective analysis based on the KidneyOnline intelligent system developed in China. Patients with CKD but not dependent on dialysis registered at KidneyOnline app between January 2017 and January 2021 were screened. Patients in the the KidneyOnline intelligent system group and those in the conventional care group were 1:1 matched according to their baseline characteristics. The intervention group received center-based follow-up combined with the KidneyOnline intelligent patient care system, which was a nurse-led, patient-oriented collaborative management system. Health-related data uploaded by the patients were integrated using deep-learning optical character recognition (OCR), artificial intelligent (AI)-generated personalized recipes, lifestyle intervention suggestions, early warnings, real-time Q&As and personalized follow-up plan were also provided. Patients in the conventional group could get professional suggestions from the nephrologists through regular clinical visits, but they did not have access to the service provided by AI and the health coach team. Patients were followed for at least 3 months after recruitment or until death or start of renal replacement therapy.
Results:
1600 eligible patients registered at KidneyOnline app from 2017 to 2021 were enrolled for the analysis. Of those, 902(57%) patients were assessed for survival analysis after propensity score matching, with 451 patients in the KidneyOnline intelligent patient care system group and 451 patients in the conventional care group. After a mean follow-up period of 15.8±9.5 months, the primary composite kidney outcome occurred in 28 participants (6%) in the KidneyOnline intelligent patient care system group and 32 (7%) in the conventional care group, with a hazard ratio of 0.402 ([95% CI, 0.239 to 0.675]; P<.001). Subgroup survival analysis demonstrated that the KidneyOnline care system significantly reduced the risk of composite kidney outcome, irrespective of age, sex, baseline eGFR and proteinuria. In addition, the mean arterial pressure(MAP) significantly decreased from 88.9±10.5 mmHg at baseline to 85.6±7.9 mmHg at 6 months (p<0.001) in the KidneyOnline intelligent patient care system group, and from 89.3±11.1 mmHg to 87.5±8.2 mmHg (P = .002) in the conventional CKD care group.
Conclusions:
Utilization of the KidneyOnline intelligent care system was associated with reduced risk of unfavorable kidney outcomes in non-dialysis CKD patients.
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