MyKidneyCoach, Patient Activation, and Clinical Outcomes in Diverse Kidney Transplant Recipients: A Randomized Control Pilot Trial

Abstract

C ompared with dialysis, kidney transplantation (KT) offers superior quality of life and decreased morbidity for patients with end-stage kidney disease. 1,2 Yet despite advances in transplant care and immunosuppression, KT clinical outcomes remain suboptimal and are disproportionately observed among Black transplant recipients who, compared with White recipients, suffer more allograft rejection and dysfunction. [3][4][5][6][7][8][9][10][11][12][13] Although reasons for these differences are multifactorial, issues related to inadequate patient activation and self-management skills play a significant role. 14,15 One-third of KT failures and 125 000 annual deaths can be attributed to inadequate patient activation and self-management skills, with an incremental lifetime cost of $78 709 per patient and loss of 1.66 quality-adjusted life years. 16,17 Posttransplant management consists of multidrug regimens and consistent healthcare navigation, including adhering to medications, monitoring for signs of rejection, maintaining a healthy lifestyle, and sustaining emotional health and stability. 15,18 Thus, KT recipients must develop self-management skills and become active and engaged patients to manage their health effectively and remain vigilant over potential complications of transplantation, including the risk of graft loss and future comorbid conditions. 15,18 There is a critical need for interventions that improve patient activation and selfmanagement skills after transplant to mitigate inequities in allograft loss.

Lifestyle interventions delivered by eHealth in chronic kidney disease: A scoping review

“…There were eight RCTs [ 43 , 47 , 49 , 51 – 54 , 56 ], nine non-randomised study designs [ 25 , 26 , 40 – 42 , 44 , 45 , 48 , 50 , 55 ] and two process evaluations [ 39 , 46 ] of dietary or lifestyle interventions primarily delivered by mobile applications on a range of outcomes ( Table 1 ). There were six reports of feasibility/usability [ 26 , 42 , 44 , 48 , 49 , 52 ], five for self-efficacy [ 40 , 43 , 47 , 49 , 56 ] and acceptability [ 42 , 44 , 49 , 52 , 56 ], and four for health related quality of life (HRQoL) [ 42 , 43 , 47 , 48 ], with positive effects generally reported for these outcomes ( Table 3 ). Similarly, there were three reports on knowledge [ 25 , 40 , 53 ], two for self-management [ 43 , 48 ] and one for disease knowledge [ 55 ] with positive effects reported on these outcomes ( Table 3 ).…”

“…Majority of reports were of no change for body mass [ 26 , 43 , 50 , 51 ], circulating lipids [ 43 , 51 , 54 ], and energy and protein intake [ 25 , 50 , 53 , 56 ]. With positive effects reported for blood pressure [ 49 – 51 ] and no change or positive effects reported for intradialytic weight gain [ 42 , 48 , 54 , 56 ]. ( Table 4 ).…”

“…There were eight RCTs [43,47,49,[51][52][53][54]56], nine non-randomised study designs [25, 26, 40-42, 44, 45, 48, 50, 55] and two process evaluations [39,46] of dietary or lifestyle interventions primarily delivered by mobile applications on a range of outcomes (Table 1). There were six reports of feasibility/usability [26,42,44,48,49,52], five for self-efficacy [40,43,47,49,56] and acceptability [42,44,49,52,56], and four for health related quality of life (HRQoL) [42,43,47,48], with positive effects generally reported for these outcomes (Table 3).…”

“…Majority of reports were of no change for body mass [26,43,50,51], circulating lipids [43,51,54], and energy and protein intake [25,50,53,56]. With positive effects reported for blood pressure [49][50][51] and no The app and the wearable (physical activity tracker) allowed participants to track their step counts. This was supplemented with telephone calls and text messages.…”

“…improve adherence to dietary restrictions pertaining to sodium, potassium, phosphorus, protein, calories and fluid within CKD [80], in like manner to our review. However, they only included two RCTs in the review [80], the present review included eight RCTs [43,47,49,[51][52][53][54]56] assessing dietary or lifestyle mobile applications reporting outcomes such phosphorus, potassium and sodium, and found some improvement in these outcomes. Assessing the effect of dietary mobile applications on circulating clinical markers such as those aforementioned may be an area for an updated systematic review (and meta-analysis).…”