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Effect of the Chronic Kidney Disease—Peritoneal Dialysis (CKD-PD) App on Improvement of Overhydration Treatment in Patients on Peritoneal Dialysis: Randomized Controlled Trial
Effect of CKD-PD App on Improvement of Overhydration Treatment in Patients on Peritoneal Dialysis: A Randomized Controlled Trial
Sirirat Anutrakulchai;
Sajja Tatiyanupanwong;
Sarassawan Kananuraks;
Eakalak Lukkanalikitkul;
Sawinee Kongpetch;
Wijittra Chotmongkol;
Michael G Morley;
Wilaiphorn Thinkhamrop;
Bandit Thinkhamrop;
Chadarat Kleebchaiyaphum;
Krongsin Khianchanach;
Theenatchar Chunghom;
Katharine E Morley
ABSTRACT
Background:
Overhydration is associated with increased morbidity and mortality in peritoneal dialysis (PD) patients. Early detection of overhydration is possible by monitoring hydration metrics, but the critical gap for treatment is obtaining timely and actionable data.
Objective:
This study compares the detection of overhydration and clinical outcomes in PD patients using the Chronic Kidney Disease – Peritoneal Dialysis (CKD-PD) smartphone application with standard monitoring and management.
Methods:
An open-label randomized control trial was conducted at three hospitals in northeast Thailand. Enrolled participants from PD clinics were randomized into two equal groups: CKD-PD App users, and usual management (No-App). Participants or their caregivers in the App group recorded hydration metrics in the CKD-PD app, which were uploaded to a central database monitored by nephrology staff. The No-App group used a handwritten logbook. Both groups had bimonthly clinic visits. The primary outcome was the incidence rate ratio (IRR) for clinical interventions for overhydration. Secondary outcomes included hospitalizations, technique failure, and death.
Results:
208 participants were randomized into App (N=103) and No-App (N=105) groups with the median followed-up time 11.2 months. Hydration metric upload compliance in the App group was 85.7 % (71.4 - 95.6). The IRR of overall interventions for overhydration was 2.51 times higher in the App group (95% confidence interval 2.18-2.89, P< .001). Types of clinical interventions for overhydration differed between groups with dietary change and prescription of antihypertensive drugs more frequent in App users and diuretics and change of dialysis prescription more frequent in the No-App group. Hospitalizations were significantly higher in the No-App group due to any cause (adjusted IRR 1.58) and volume overload (adjusted IRR 4.07). There was no significant difference in survival analysis and technique failure between the two groups.
Conclusions:
Use of the CKD-PD app improved hydration status monitoring. Contact with personal led to early detection and management of overhydration, and a decrease in all cause and volume overload hospitalizations. Clinical Trial: ClinicalTrials.gov NCT04797195
Effect of the Chronic Kidney Disease—Peritoneal Dialysis (CKD-PD) App on Improvement of Overhydration Treatment in Patients on Peritoneal Dialysis: Randomized Controlled Trial