Background Chronic kidney disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the increased penetration of mobile phones, a mobile app could educate patients to autonomously monitor cardiorenal risk factors. Objective With this background in mind, we developed an integrated system of a server and app with the aim of improving self-monitoring of cardiovascular and renal risk factors and adherence to therapy. Methods The software infrastructure for both the Smit-CKD server and Smit-CKD app was developed using standard web-oriented development methodologies preferring open source tools when available. To make the Smit-CKD app suitable for Android and iOS, platforms that allow the development of a multiplatform app starting from a single source code were used. The integrated system was field tested with the help of 22 participants. User satisfaction and adherence to therapy were measured by questionnaires specifically designed for this study; regular use of the app was measured using the daily reports available on the platform. Results The Smit-CKD app allows the monitoring of cardiorenal risk factors, such as blood pressure, weight, and blood glucose. Collected data are transmitted in real time to the referring general practitioner. In addition, special reminders improve adherence to the medication regimen. Via the Smit-CKD server, general practitioners can monitor the clinical status of their patients and their adherence to therapy. During the test phase, 73% (16/22) of subjects entered all the required data regularly and sent feedback on drug intake. After 6 months of use, the percentage of regular intake of medications rose from 64% (14/22) to 82% (18/22). Analysis of the evaluation questionnaires showed that both the app and server components were well accepted by the users. Conclusions Our study demonstrated that a simple mobile app, created to self-monitor modifiable cardiorenal risk factors and adherence to therapy, is well tolerated by patients affected by chronic kidney disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence and if self-monitoring of risk factors will improve clinical outcomes in this population.

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BACKGROUND Chronic Kidney Disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the wide spreading of mobile phones, a mobile app could educate patients in self-monitoring cardio-renal risk factors. OBJECTIVE To develop an integrated system to educate patients in self-monitoring cardio-renal risk factors. METHODS We developed an integrated system made by a server and an app, with the aim of improving self-monitoring of cardiovascular and renal risk factors and of improving adherence to therapy. RESULTS The SMIT-CKD APP allows the monitoring of cardio-renal risk factors and their transmission to the referring GP. Special reminders help drug administration. Via the SMIT-CKD Server, GPs can monitor the clinical status of their patients and adherence to therapy. During the test, 73% of subjects entered all the required data regularly and sent feedbacks of drug intake. Looking at the evaluation questionnaires, both the app and the server counterpart were well accepted by the users. CONCLUSIONS Our study demonstrated that a simple Mobile APP, created to self-monitor modifiable cardio-renal risk factor and adherence to therapy, is well tolerated by patients affected by Chronic Kidney Disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence, and if self-monitoring of risk factors will improve clinical outcomes in this population. CLINICALTRIAL NA