The prevalence of chronic kidney disease continues to rise globally, posing significant challenges to healthcare systems and negatively impacting patient quality of life. Effective management relies heavily on patient adherence to complex treatment regimens, including diet, medication, and lifestyle modifications. Traditional methods often fall short in sustaining long-term engagement. Digital health solutions, particularly mHealth applications, offer a scalable and accessible means to empower patients, provide continuous support, and improve disease self-management, thereby potentially mitigating disease progression and reducing complications.
The aim of the study.
This study aimed to evaluate the efficacy of a comprehensive mHealth application in improving medication adherence, clinical outcomes (eGFR, blood pressure), and patient-reported quality of life in adult patients with stages 3-4 chronic kidney disease.
Material and methods.
A prospective, unblinded, randomized controlled trial was conducted involving 300 adult patients diagnosed with CKD stages 3-4 from three major hospitals. Participants were randomized 1:1 to either the intervention group (n=150) receiving access to a dedicated mHealth application for 12 months, or the control group (n=150) receiving standard clinical care. The mHealth app featured medication reminders, dietary guidance, symptom tracking, and direct messaging with a healthcare provider. Primary endpoints included changes in eGFR, systolic and diastolic blood pressure, and self-reported medication adherence (Morisky Medication Adherence Scale-8). Secondary endpoints encompassed patient quality of life (KDQOL-SF™) and hospitalization rates. Statistical analysis included independent t-tests for continuous variables and chi-square tests for categorical variables, with significance set at p < 0.05.
After 12 months, the intervention group demonstrated a statistically significant improvement in medication adherence (mean MMS-8 score increase of 1.2 ± 0.3 vs. 0.4 ± 0.2 in control, p < 0.001). Systolic blood pressure decreased by an average of 6.2 mmHg (SD 3.5) in the intervention group compared to 2.1 mmHg (SD 2.8) in the control group (p = 0.003). While eGFR decline was slower in the intervention group (average 2.5 mL/min/1.73m²/year vs. 3.8 mL/min/1.73m²/year), this difference did not reach statistical significance (p = 0.06). Patient satisfaction with care was significantly higher in the intervention group (p < 0.01). Hospitalization rates were nominally lower in the mHealth group (15% vs. 22%), but this difference was not statistically significant (p = 0.12).
This study provides evidence that mHealth applications can significantly improve medication adherence and contribute to better blood pressure control in patients with chronic kidney disease. While the impact on eGFR decline requires further investigation, the enhanced patient engagement and satisfaction highlight the value of digital interventions in chronic disease management. Future research should explore longer-term outcomes and cost-effectiveness in diverse patient populations.
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