Effectiveness of self-management APP in different follow-up intervention among patients with chronic kidney disease: a retrospective cohort study with a 3-year follow-up (Preprint)

BACKGROUND The prevalence of CKD puts pressure on health systems providing care to patients and has led to an increase in mobile apps seeking to improve self-management for CKD patients. However, the impact of apps on the CKD population in different clinical locations and health systems remains unclear. OBJECTIVE This project developed SuYi APP for follow-up of CKD patients based on patient self-management theory. It was applied in clinic to determine which remote follow-up intervention (Simple APP remote follow-up vs. outpatient follow-up +APP remote follow-up) leads to improved endpoints in patients with chronic kidney disease (CKD). METHODS This was a retrospective cohort study. The subjects with stage 1-5 CKD without renal replacement therapy were enrolled at the CKD management center from January 2015 to December 2019 for long-term follow-up. The subjects were divided into the Simple APP remote follow-up group and outpatient follow-up +APP group. After 3 years of follow-up in December 2022, data on all-cause mortality and kidney replacement treatment were collected and compared between the two groups. RESULTS 5326 patients were included in the study, including 2492 in the APP group and 2834 in the outpatient+APP group. After IPTW virtualization matching, the final matched APP group consisted of 2489 cases (IQR, 33-55) and 2850 (IQR, 33-55) in the outpatient+APP group. By the end of the study, there were 34 deaths (1.4%) in the APP group and 16 deaths (1.6%) in the outpatient+APP group, with a rate difference of -0.26 (95% CI[-0.91-0.39], P=.49). The two groups were comparable after matching for renal replacement therapy outcomes (95% CI[0.72-1.08], P=.23) and survival curves, which were not significantly different. However, the selection rate of kidney transplantation in the outpatient+APP group was higher than that in the APP group (95% CI[0.09-0.81], P=.02), and the use of temporary catheters was lower in the outpatient+APP group during initial hemodialysis (95% CI[8.4%-29.8%], P<.001). CONCLUSIONS The development and application of the app combined with outpatient follow-up management can avoiding the initiation of urgent dialysis and improve kidney transplantation selectivity. Applying outpatient follow-up+APP pattern intervention will benefit chronic disease management and health care. CLINICALTRIAL ChiCTR2200060627