JMIR Publications

ABSTRACT

Background:

Chronic kidney disease (CKD) affects 14% of the U.S. adult population, yet patient knowledge about kidney disease and engagement in their kidney health is low despite many CKD education programs, awareness campaigns, and clinical practice guidelines.

Objective:

To examine the impact of the Kidney Score Platform (a patient-facing, risk-based online tool that provides interactive health information tailored to an individual’s chronic kidney disease risk plus an accompanying clinician-facing Clinical Practice Toolkit) on individual engagement with CKD health and CKD communication between clinicians and patients.

Methods:

We conducted a pre-post intervention study in which English-speaking Veterans at risk for CKD in two primary care settings interacted with the Kidney Score platform’s educational modules and their primary care clinicians were encouraged to review the Clinical Practice Toolkit. Impact of the Kidney Score on Patient Activation (primary outcome), knowledge about CKD, and communication with their clinician about kidney health were determined with paired t-tests. Multivariable linear and logistic models were used to determine whether changes in outcomes post vs. pre-intervention were influenced by age, race/ethnicity, gender, and diabetes status, accounting for baseline values.

Results:

The study population (n=76) had a mean age of 64.4 years, 88% was male and 30.3% self-identified as African American. Approximately 71% had hypertension, 27% had diabetes and 9.2% had CKD by lab criteria but without an ICD10 diagnosis. Patient interaction with the Kidney Score did not change mean Patient Activation Measure (pre-intervention: 40.7%, post-intervention: 40.2%, p=0.23) but did increase mean CKD knowledge (pre-intervention: 40.0%, post-intervention 51.1%, p<0.01) and the percentage of Veterans who discussed CKD with their clinician (pre-intervention: 12.3%, post-intervention: 31.5%, p<0.01). Changes did not differ by age, sex, race, or diabetes status. Results were limited by small sample size due to low recruitment and minimal clinician engagement with the Clinical Practice Toolkit during the COVID-19 pandemic.

Conclusions:

One-time web-based tailored education for patients can increase CKD knowledge and encourage conversations about kidney health. Increasing patient activation for CKD management may require multi-level, longitudinal interventions that facilitate ongoing conversations about kidney health between patients and clinician teams.