JMIR Publications

ABSTRACT

Background:

Chronic kidney disease (CKD) is a serious condition affecting millions of individuals worldwide. Adherence to medication regimens among CKD patients is often suboptimal, leading to poor health outcomes. In recent years, mobile applications have gained popularity as a promising tool to improve medication adherence and self-management in various chronic diseases.

Objective:

This study aims to evaluate the effectiveness of mobile applications to improve medication adherence among CKD patients (including end-stage and renal replacement therapy).

Methods:

A systematic search was conducted using Scopus, Cochrane, PubMed and EBSCOhost to include eligible articles that studied mobile applications to improve medication adherence among CKD patients. The quality of the selected studies was evaluated using the Newcastle‒Ottawa Scale (NOS).

Results:

Out of 231 relevant articles, only 9 studies were selected for this systematic review. Based on the NOS, seven were deemed to be of high quality, while others were of fair quality. Most of the included studies had a randomized controlled design. Of the nine selected studies, 3 papers represented medication adherence by a coefficient of 10 variability of tacrolimus, 3 papers utilized adherence measurement scales to calculate the score for assessing medication adherence, 2 papers represented medication adherence by self-reporting, 2 papers represented medication adherence using electronic monitoring, and 1 represented medication adherence by pill count. The mobile applications were identified as Transplant Hero®, Perx, SMASK, Adhere4U, My Dialysis, Kidney Love, and iCKD. Of these apps, three focused on evaluating Transplant Hero®, while the remaining investigated each of the other mentioned apps individually. The apps employed various strategies to promote medication adherence, including reminders, gamification, patient education, and medication monitoring. A majority, 5 out of 9 mobile applications, had a statistically significant (p<0.05) effect on medication adherence. There was strong evidence for a positive effect for interventions focusing on games and reminders combined with electronic medication tray monitoring and patient education.

Conclusions:

Mobile application effectively improved medication adherence in CKD patients, but low evidence and short intervention duration warrant caution. Future research should identify ideal features, provider costs, and user-friendly, secure apps.