Chronic Kidney Disease Self-management Research Articles

Assessment of Patient Awareness Regarding Chronic Kidney Disease Management in Santhal Parganas

Background: Chronic kidney disease (CKD) is a global health challenge, and effective self-management is crucial for optimal outcomes. Assessing the prevailing knowledge about CKD in patients can help strategies information education communication program to better manage the disease. This study evaluated the current knowledge of self-management of CKD among patients suffering from CKD in Santhal Parganas of Jharkhand state in India. Materials and Methods: This cross-sectional survey was conducted in a tertiary care teaching hospital situated in Deoghar, Jharkhand, India from June to December 2023. Patients suffering from CKD were enrolled for this study from the Outpatient Department. The Chronic Kidney Disease Self-Management Knowledge Tool (CKD-SMKT) was used to measure patients’ knowledge through face-to-face interviews conducted by a trained local surveyor. Results: A total of 228 patients with a mean age of 52.63±10.65 years (men 136 [59.65%], women 92 [40.35%]) participated in the survey. All the patients (100%) gained knowledge about CKD from doctors, followed by other patients (63.6%) and relatives (41.23%). On average, 53.61% did not have proper knowledge about overall kidney disease. Correct knowledge about maintaining kidney health was among 38.1% of patients with 36.59% unsure about their knowledge and 25.31% declaring their lack of knowledge. Conclusion: A low level of knowledge about kidney health was found among the patients suffering from CKD in Santhal Parganas, a region with a tribal population with a low literacy rate. The identified knowledge gap emphasizes the need for a tailored educational program for CKD patients by doctors and patients relative.

Key stakeholders' perspectives on the development of an early dietary phosphate self-management strategy for children and young people with chronic kidney disease stages 1-3: A modified Delphi consensus process.

An early dietary phosphate intervention (EPI) can provide vital medical benefits supporting self-management of chronic kidney disease (CKD) in childhood. To utilise expert consensus to provide early modelling for an EPI to guide clinical practice across a paediatric renal network. Forty-eight statements across six domains were constructed following a systematic review and semi-structured interviews with children and young people (CYP), parents and healthcare professionals (HCP). A three-round online Delphi survey with parents and paediatric renal multi-disciplinary healthcare experts was undertaken. Twenty-one experts agreed on 56 statements over three Delphi rounds. Statements were accepted in all six domains: definition of an EPI (2), rationale (12), intended users (3), delivery (14) (when [1], where [3], who [2], how [8]), other considerations (16) and potential concerns (9). Consensus was reached on a definition and a set of guiding principles, providing some early modelling for implementation and future research on the development of an EPI strategy for CYP with CKD.

Effectiveness of the Nurse-led Self and Family Management Support Program among Adults with Early-stage Chronic Kidney Disease: A Randomized Controlled Trial

Chronic kidney disease is a significant health problem that leads to severe complications and premature death. Adults with early-stage chronic kidney disease need to maintain renal function and prevent the progression, which can be achieved through effective self-management. This randomized control trial with a two-arm pre-post-test aimed to investigate the effectiveness of the Nurse-led Self and Family Management Support Program for increasing disease knowledge and self-management among adults with early-stage chronic kidney disease. The sample consisted of dyads of 64 adults with the disease and their family members. The dyads were randomly assigned to the experimental arm (n = 32) and the control arm (n = 32). The experimental arm received the Nurse-led Self and Family Management Support Program, while the control arm received only usual care. Data was collected using a demographic data recording form, the Disease Knowledge Scale, and the Chronic Kidney Disease Self-Management Scale. Data analysis was undertaken using descriptive statistics, two-way repeated ANOVA with post hoc test, and independent t-test. From the results, the participants in the experiment arm had better disease knowledge and self-management than the control group at 4, 8, and 12 weeks after the program and were better than before the program. Nurses can apply this program to encourage individuals and family members to be involved in providing all aspects of support for self-management for adults with early-stage chronic kidney disease. However, further testing in other settings is needed.

Network analysis of negative emotion and self-management in Chinese patients with early chronic kidney disease

The number of patients with chronic kidney disease (CKD) is increasing worldwide, and the disease carries a serious physical and psychological burden that creates negative emotions among patients. The negative emotions limits patients’ ability to manage their disease and prevents them from effectively delaying disease progression. In this study, we applied a network analysis to explore the network relationship between negative emotions and self-management in patients with CKD and to investigate the risk or protective effects of different components of negative emotions on self-management. The study was conducted from September 2021 to March 2022 in three tertiary hospitals in China, with data gathered via a convenience sampling method. 360 patients with CKD at stages 1 ~ 3 in the department of nephrology completed the Sociodemographic Questionnaire, Positive Affect and Negative Affect Scale and Chronic Kidney Disease Self-management Instrument. We used R4.1.1 software to estimate the network model and calculate the related indicators. The network showed that among negative emotions “irritated” was negatively correlated with “self-integration”, “problem solving”, “seeking social support” and “adherence to recommended regimen” in self-management. The correlations between “scared” and “self-integration”, “nervous” and “problem solving”, and “ashamed” and “seeking social support” were all positive. The bridge expected influence of “irritated” and “adherence to recommended regimen” were the highest, with values of -0.19 and 0.13, respectively. “Irritated” has a more obvious risk effect on self-management. This study provides an important target for interventions to reduce negative emotions and improve self-management ability in patients with CKD.

Psychological Distress and Self-Management in CKD: A Cross-Sectional Study

Patients with chronic kidney disease (CKD) not receiving dialysis, including kidney transplant recipients, often experience difficulties regarding self-management. An important barrier for adherence to self-management recommendations may be the presence of psychological distress, consisting of depressive and anxiety symptoms. We investigated relationships between psychological distress and adherence to self-management recommendations. Cross-sectional online questionnaire data as part of the E-GOAL study. Patients with CKD (estimated glomerular filtration rate, 20-89mL/min/1.73m2) were recruited from April 2018 to October 2020 at 4 hospitals in The Netherlands and completed online screening questionnaires. Psychological distress, depressive symptoms, and anxiety symptoms. Dietary adherence, physical activity, medication adherence, smoking, body mass index, and a CKD self-management index (ie, the sum of 5 binary indicators of nonadherence to the recommended self-management factors). Adjusted multivariable regression and ordinal logistic regression analyses. In our sample (N=460), 27.2% of patients reported psychological distress, and 69.8% were nonadherent to 1 or more recommendations. Higher psychological distress was significantly associated with poorer dietary adherence (βadj,-0.13; 95% CI,-0.23 to-0.04), less physical activity (βadj,-0.13; 95% CI,-0.22 to-0.03), and lower medication adherence (βadj,-0.15; 95% CI,-0.24 to-0.05), but not with smoking and body mass index. Findings were similar for depressive symptoms, whereas anxiety was only associated with poorer dietary and medication adherence. Every 1-point higher psychological distress was also associated with a higher likelihood of being nonadherent to an accumulating number of different recommendations (adjusted OR, 1.04; 95% CI, 1.02-1.07). Cross-sectional design, possible residual confounding, and self-report. Many people with CKD experience psychological distress, of whom most have difficulties self-managing their CKD. Given the relationship between psychological distress and adherence to CKD self-management recommendations, behavioral interventions are needed to identify and treat psychological distress as a potential barrier to CKD self-management. This online questionnaire study investigated relationships between psychological distress and self-management among 460 people with chronic kidney disease. Over a quarter of them reported mild-to-severe psychological distress. Alarmingly, 4 out of 5 patients with psychological distress were also nonadherent to 1 or more self-management recommendations, and higher levels of psychological distress were associated with poorer dietary and medication adherence and lower physical activity. Moreover, patients who suffered from moderate-to-severe distress were relatively more often nonadherent to 3 or more recommendations compared with patients with no or mild distress symptoms. So, it seems that psychological distress can be a barrier for self-management. To support patients in managing chronic kidney disease, researchers and health professionals should not overlook patients' mental health.

#3956 PRIORITY OUTCOMES FOR EDUCATION AND SELF-MANAGEMENT IN NON-DIALYSIS CHRONIC KIDNEY DISEASE: A PATIENT AND PROFESSIONAL DELPHI SURVEY

Abstract Background and Aims It is important for people living with Chronic Kidney Disease (CKD) to develop the knowledge, skills, and confidence (patient activation) to effectively self-manage their health in partnership with their healthcare team. Resources intended to educate and support self-management should be subject to robust evaluation to provide the evidence base for clinical implementation. Trials in both research and clinical practice settings should include outcomes which are meaningful and valued by all users, but these are not known for CKD education and self-management interventions. We carried out a Delphi survey to identify the priorities valued by both CKD patients and healthcare professionals (HCPs) in the UK. Method Kidney patients and multidisciplinary kidney HCPs based in the UK were invited to complete two sequential rounds of an online Delphi survey. People with CKD and their significant others (SOs) were invited via social media, and HCPs via direct email. For Round One, participants were asked to identify in their own words the 3 potential benefits (outcomes) for CKD self-management that they personally considered to be most important. These free-text responses were collated and analysed inductively using conventional content analysis to identify dominant themes and constituent items. In Round Two, participants were asked to rate each of these items on a 9-point Likert scale from 1 (least important) to 9 (most important), and overall median ratings were calculated for each theme. Results 135 participants contributed to Round One: 47% (64) CKD patients/SOs; 51% (69) kidney HCPs; 2 individuals identified in both groups. 58% of HCPs who were invited by email agreed to take part. Round One analysis identified 28 outcome items which fell into 5 main themes: clinical; knowledge, skills, and confidence to manage own health; behaviour and self-care; psychological and social factors; healthcare usage. 69% (44) of invited CKD patients/SOs and 77% (53) HCPs took part in Round Two. Table 1 shows the median ratings for each theme. The highest-ranked overall and for both groups was “clinical”, while “healthcare usage” was ranked the lowest. Conclusion Our UK Delphi survey has identified a range of potential benefits for successful self-management in non-dialysis CKD, which were categorised into 5 main themes. Clinical outcomes such as improving blood pressure management or avoiding progression to end stage kidney disease were the top priority for both CKD patient/SO and HCP participants. Aspects of patient activation (knowledge, skills, and confidence to manage health) were also rated as important by both groups. This Delphi survey identified which benefits kidney patients and HCPs value most from effective CKD education and self-management. It is important that the views of intended users of new interventions are consulted throughout the development process to ensure that the product meets their needs and expectations. The information we present here is vital for the successful design, evaluation and implementation of interventions and support tools to educate people with CKD and enable them to improve self-management behaviours.

Network structure of family function and self-management in patients with early chronic kidney disease amid the COVID-19 pandemic.

Family function plays a pivotal role in self-management among patients with early chronic kidney disease (CKD), which has been especially important during the COVID-19 pandemic. Previous studies have investigated the relationships between family function and self-management using total scores through self-report questionnaires while ignoring the different components in both family function and self-management. The specific objective of this study was to explore the network structure of family function and self-management at the component level. A total of 360 patients with early CKD from three tertiary hospitals were enrolled in our cross-sectional survey from September to December 2021 in China. Components of family function were measured by the Family Adaptation Partnership Growth and Resolve Index, and components of self-management were measured by the Chronic Kidney Disease Self-management Instrument. Network analysis was used to establish the network structure. Edges across the community of family function and self-management were mainly positive. Edges between F3 "Growth" and M1 "Self-integration", F2 "Partnership" and M3 "Seeking social support," F5 "Resolve" and M3 "Seeking social support" were the strongest. F3 "Growth" had the greatest positive bridge expected influence of family function community (0.12), and M3 "Seeking social support" had the greatest positive bridge expected influence of self-management community (0.16). We explored the potential pathways between different components of family function and self-management among patients with early CKD during the COVID-19 pandemic and found fine-grained relationships between them. The two nodes F3 "Growth" and M3 "Seeking social support" may provide a new idea from the perspective of family function for interventions to improve self-management.

Smartphone and application use in self-management of chronic kidney disease: a cross-sectional feasibility study.

Smartphone and application use can improve communication and monitoring of chronic diseases, including chronic kidney disease, through self-management and increased adherence to treatment. To assess smartphone use in patients with chronic kidney disease on dialysis and their willingness to use mobile applications as a disease self-management strategy. This was a cross-sectional study of chronic kidney disease patients on hemodialysis in the São Francisco Valley in the Northeast Region, Brazil. The questionnaire developed by the authors was administered between April and June 2021. Cronbach's alpha coefficient for the construct was 0.69. Associations between the dependent and independent variables were determined using univariate analysis. Multivariate analysis with logistic regression analysis was also performed. A total of 381 patients were included, of whom 64% had a smartphone, although only 3.1% knew of a kidney disease-related application. However, 59.3% believed that using an application could help them manage their disease. Having a smartphone was associated with treatment adherence, higher educational attainment, and higher per capita income. Educational attainment remained an independent factor in multivariate analysis. More than 64% of patients had a smartphone, although few knew of applications developed for kidney disease. More than half of the population believed that technology use could benefit chronic kidney disease treatment. Smartphone ownership was more common among the younger population, with higher educational attainment and income, and was associated with greater adherence to hemodialysis sessions.

Evaluation-of-the-impact-of-clinical-pharmacists-educational-intervention-on-the-knowledge-of-patients-with-chronic-kidney-disease

Introduction: Chronic kidney disease (CKD) is a progressive disease associated with high morbidity and mortality at all stages. Objective: To determine the impact of pharmacists’ educational interventions on the CKD knowledge and knowledge levels of patients with pre-dialysis CKD, and to identify potential predictors of good CKD knowledge. Method: Two main healthcare facilities in Maiduguri, Nigeria, were the study settings for this randomised, controlled, prospective study with a 12-month follow-up. Participants were randomised to the usual care (UC) and pharmacists’ intervention (PI) groups on a 1:1 ratio. The PI group was offered usual care plus face-to-face CKD education and self-management of CKD, an educational CKD infographic leaflet, and telephonic interventions. Categorical data were compared using Chi-square or Fisher exact tests where relevant, while an independent sample T-test was used to compare the mean values of the two study groups. A p-value of less than 0.05 was considered to be statistically significant. Result: Baseline characteristics were similar between the PI (n = 73) and UC (n = 74) patients, although participants in the PI group were significantly more female (71.2% vs. 52.7%; p = 0.021). The overall mean knowledge score of the PI group was significantly higher than the UC group at 6 months (18.9 ± 3.4 vs.14.6 ± 4.4, p < 0.001), and at 12 months (19.5 ± 3.8 vs.16.8 ± 6.0, p < 0.001), respectively. At 6 months, a significant proportion of the participants in the intervention group had high knowledge compared with those in the UC group (16.4% vs. 9.0%, p < 0.001). At the end of the study, the adjusted analysis revealed that those between 40 and 64 years of age (AOR 26.3, 95% CI 2.1 – 331.0) and 65 years of age or more (AOR 10.1 95% CI 1.1 - 89.7) were more likely to have good CKD knowledge. Also, participants in the intervention group (AOR 2.7, 95% CI1.0 - 7.2) had a higher likelihood of having good CKD knowledge. Conclusion: Educational interventions provided by pharmacy students/clinical pharmacists resulted in significant improvements in the CKD knowledge of patients with pre-dialysis CKD.

Preferring self-management behavior of patients with chronic kidney disease.

This study explores the preferred behavior of self-management among chronic kidney disease (CKD) patients and offers suggestions for different patients from personalized medicine. According to some related references, a questionnaire was designed in 2020 to collect data from 131 patients with CKD in a general hospital. The Sampling patients showed no difference in their disease progress. The questionnaire covered two aspects of demographic and behavior with 29 items on six dimensions. Statistical methods such as a descriptive analysis of the F test in behavior dimensions on demographic characteristics and Principal component analysis from items have been applied to classify some kinds of self-management behavior into different groups. In the demographic insight, employment status closely relates to self-management behavior, and income is insignificant. In the behavior aspects, according to some key items, we found four types of self-management behavior preferred in the sorting: cognitive-knowledge, Diet-exercise-medical, emotion management, and exercise-medical, which were defined by behavior dimensions. Although patients had the same disease progress, their self-management behavior mainly existed in four types based on critical factors. According to their favorite behavior and personality group, healthcare stakeholders can offer lean support for improving patients' self-management of CKD in China.

Cultural adaptation and validation of the Malay Chronic Kidney Disease Self-management instrument (MCKD-SM)

BackgroundThere is growing evidence that self‐management behaviour can improve outcomes for patients with chronic kidney disease (CKD). However, no measures are available in Malay to effectively assess the self-management of CKD. The aim of this study was to translate, culturally adapt and validate the Malay Chronic Kidney Disease Self-Management (MCKD-SM) instrument for Malay-speaking health professionals and patients.MethodsThis study was carried out in two phases: the translation and cultural adaptation phase and the validation phase. The instrument was translated from English to Malay and then adapted and validated in a sample of 337 patients with CKD stages 3–4 attending a nephrology clinic in a tertiary hospital in Malaysia. Structural validity was evaluated by exploratory factor analysis. The instrument’s reliability was assessed by internal consistency and test–retest reliability. The correlations between the MCKD-SM and kidney disease knowledge and the MCKD-SM and self-efficacy were hypothesised a priori and investigated.ResultsThe MCKD-SM instrument has 29 items grouped into three factors: ‘Understanding and Managing My CKD’, ‘Seeking Support’ and ‘Adherence to Recommended Regimen’. The three factors accounted for 56.3% of the total variance. Each factor showed acceptable internal reliability, with Cronbach’s α from 0.885 to 0.960. The two-week intra-rater test–retest reliability intraclass correlation coefficient values for all items ranged between 0.938 and 1.000. The MCKD-SM scores significantly correlated with kidney disease knowledge (r = 0.366, p < 0.01) and self-efficacy (r = 0.212, p < 0.01).ConclusionThe MCKD-SM was found to be a valid and reliable patient‐reported outcome measure of pre-dialysis CKD self-management behaviour in the Malay-speaking population.

Influence of positive and negative affect on self-management among patients with early chronic kidney disease during the COVID-19 pandemic: The mediating and suppressing effect of ego depletion.

BackgroundSelf-management in patients with early chronic kidney disease (CKD) can effectively delay damage to renal function. However, with the continuous spread of COVID-19, patients cannot receive timely treatment, which can lead to different affects, resulting in ego depletion and serious challenges to self-management. This study aimed to investigate the mediating and suppressing roles of ego depletion on the relationship between positive and negative affect and self-management among patients with early CKD during the COVID-19 pandemic in China.MethodsA total of 383 patients with early CKD from three tertiary hospitals were enrolled by convenience sampling in our cross-sectional study from September 2021 to March 2022. Participants completed the Sociodemographic Questionnaire, Positive Affect and Negative Affect Scale, Self-Regulating Fatigue Scale and Chronic Kidney Disease Self-Management Instrument. A structural equation model was conducted to test the mediating and suppressing effects of ego depletion on the relationship between positive and negative affect and self-management.ResultsThe average score of the participants' self-management was 84.54 (SD: 19.72), and nearly 60% of them were at low and moderate levels. The mediating effect of positive affect on self-management through ego depletion was significant (β = 0.248, 95% CI: 0.170 to 0.376), accounting for 53.22% of the total effect. The suppressing effect of negative affect on self-management through ego depletion was significant (β = −0.191, 95% CI: −0.310 to −0.118), and the absolute value of the ratio of the suppressing effect to the direct effect was 66.55%.ConclusionsEgo depletion partially mediated the relationship between positive affect and self-management while suppressing the relationship between negative affect and self-management among patients with early CKD during the COVID-19 pandemic. The reduction of patients' ego depletion must be taken as the intervention target to improve self-management and delay the progression of CKD.

An eHealth self-management intervention for adults with chronic kidney disease, My Kidneys My Health: a mixed-methods study.

Background:There is limited research of electronic tools for self-management for patients with chronic kidney disease (CKD). We sought to evaluate participant engagement, perceived self-efficacy and website usage in a preliminary evaluation of My Kidneys My Health, a patient-facing eHealth tool in Canada.Methods:We conducted an explanatory sequential mixed-methods study of adults with CKD who were not on kidney replacement therapy and who had access to My Kidneys My Health for 8 weeks. Outcomes included acceptance (measured by the Technology Acceptance Model), self-efficacy (measured by the Chronic Disease Self-Efficacy Scale [CDSES]) and website usage patterns (captured using Google Analytics). We analyzed participant interviews using qualitative content analysis.Results:Twenty-nine participants with CKD completed baseline questionnaires, of whom 22 completed end-of-study questionnaires; data saturation was achieved with 15 telephone interviews. Acceptance was high, with more than 70% of participants agreeing or strongly agreeing that the website was easy to use and useful. Of the 22 who completed end-of-study questionnaires, 18 (82%) indicated they would recommend its use to others and 16 (73%) stated they would use the website in the future. Average scores for website satisfaction and look and feel were 7.7 (standard deviation [SD] 2.0) and 8.2 (SD 2.0) out of 10, respectively. The CDSES indicated that participants gained an increase in CKD information. Interviewed participants reported that the website offered valuable information and interactive tools for patients with early or newly diagnosed CKD, or for those experiencing changes in health status. Popular website pages and interactive features included Food and Diet, What is CKD, My Question List and the Depression Screener.Interpretation:Participants indicated that the My Kidneys My Health website provided accessible content and tools that may improve self-efficacy and support in CKD self-management. Further evaluation of the website’s effectiveness in supporting self-management among a larger, more heterogenous population is warranted.

Digital tools/eHealth to support CKD self-management: A qualitative study of perceptions, attitudes and needs of patients and health care professionals in China

BackgroundA growing body of evidence supports the potential effectiveness of electronic health (eHealth) self-management interventions in improving disease self-management skills and health outcomes of patients suffering from chronic kidney disease (CKD). However, current research on CKD eHealth self-management interventions has almost exclusively focused on high-income, western countries. ObjectiveTo inform the adaptation of a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) intervention, we examined the perceptions, attitudes and needs of Chinese patients with CKD and health care professionals (HCPs) towards eHealth based (self-management) interventions in general and the Dutch MD intervention in specific. MethodsWe conducted a basic interpretive, cross-sectional qualitative study comprising semi-structured interviews with 11 patients with CKD and 10 HCPs, and 2 focus group discussions with 9 patients with CKD. This study was conducted in the First Affiliated Hospital of Zhengzhou University in China. Data collection continued until data saturation was reached. All data were transcribed verbatim and analyzed using a framework approach. ResultsThree themes emerged: (1) experience with eHealth in CKD (self-management), (2) needs for supporting CKD self-management with the use of eHealth, and (3) adaptation and implementation of the Dutch MD intervention in China. Both patients and HCPs had experience with and solely mentioned eHealth to ‘inform, monitor and track’ as potentially relevant interventions to support CKD self-management, not those to support ‘interaction’ and ‘data utilization’. Factors reported to influence the implementation of CKD eHealth self-management interventions included information barriers (i.e. quality and consistency of the disease-related information obtained via eHealth), perceived trustworthiness and safety of eHealth sources, clinical compatibility and complexity of eHealth, time constraints and eHealth literacy. Moreover, patients and HCPs expressed that eHealth interventions should support CKD self-management by improving the access to reliable and relevant disease related knowledge and optimizing the timeliness and quality of patient and HCPs interactions. Finally, suggestions to adaptation and implementation of the Dutch MD intervention in China were mainly related to improving the intervention functionalities and content of MD such as addressing the complexity of the platform and compatibility with HCPs’ workflows. ConclusionsThe identified perceptions, attitudes and needs towards eHealth self-management interventions in Chinese settings should be considered by researchers and intervention developers to adapt a tailored eHealth self-management intervention for patients with CKD in China. In more detail, future research needs to engage in co-creation processes with vulnerable groups during eHealth development and implementation, increase eHealth literacy and credibility of eHealth (information resource), ensure eHealth to be easy to use and well-integrated into HCPs’ workflows.

Healthcare professionals\u2019 perspectives on facilitators of and barriers to CKD management in primary care: a qualitative study in Singapore clinics

IntroductionThe burden of chronic kidney disease (CKD) is rising globally including in Singapore. Primary care is the first point of contact for most patients with early stages of CKD. However, several barriers to optimal CKD management exist. Knowing healthcare professionals’ (HCPs) perspectives is important to understand how best to strengthen CKD services in the primary care setting. Integrating a theory-based framework, we explored HCPs’ perspectives on the facilitators of and barriers to CKD management in primary care clinics in Singapore.MethodsIn-depth interviews were conducted on a purposive sample of 20 HCPs including 13 physicians, 2 nurses and 1 pharmacist from three public primary care polyclinics, and 4 nephrologists from one referral hospital. Interviews were audio recorded, transcribed verbatim and thematically analyzed underpinned by the Theoretical Domains Framework (TDF) version 2.ResultsNumerous facilitators of and barriers to CKD management identified. HCPs perceived insufficient attention is given to CKD in primary care and highlighted several barriers including knowledge and practice gaps, ineffective CKD diagnosis disclosure, limitations in decision-making for nephrology referrals, consultation time, suboptimal care coordination, and lack of CKD awareness and self-management skills among patients. Nevertheless, intensive CKD training of primary care physicians, structured CKD-care pathways, multidisciplinary team-based care, and prioritizing nephrology referrals with risk-based assessment were key facilitators. Participants underscored the importance of improving awareness and self-management skills among patients. Primary care providers expressed willingness to manage early-stage CKD as a collaborative care model with nephrologists. Our findings provide valuable insights to design targeted interventions to enhance CKD management in primary care in Singapore that may be relevant to other countries.ConclusionsThe are several roadblocks to improving CKD management in primary care settings warranting urgent attention. Foremost, CKD deserves greater priority from HCPs and health planners. Multipronged approaches should urgently address gaps in care coordination, patient-physician communication, and knowledge. Strategies could focus on intensive CKD-oriented training for primary care physicians and building novel team-based care models integrating structured CKD management, risk-based nephrology referrals coupled with education and motivational counseling for patients. Such concerted efforts are likely to improve outcomes of patients with CKD and reduce the ESKD burden.

Healthcare provider perspectives on integrating peer support in non-dialysis-dependent chronic kidney disease care: a mixed methods study

BackgroundPeer support complements traditional models of chronic kidney disease (CKD) care through sharing of peer experiences, pragmatic advice, and resources to enhance chronic kidney disease self-management and decision-making. As peer support is variably offered and integrated into multi-disciplinary CKD care, we aimed to characterize healthcare providers’ experiences and views on peer support provision for people with non-dialysis-dependent CKD within Canada.MethodsIn this concurrent mixed methods study, we used a self-administered online survey to collect information from multi-disciplinary CKD clinic providers (e.g., nurses, nephrologists, allied health professionals) on peer support awareness, program characteristics and processes, perceived value, and barriers and facilitators to offering peer support in CKD clinics. Results were analyzed descriptively. We undertook semi-structured interviews with a sample of survey respondents to elaborate on perspectives about peer support in CKD care, which we analyzed using inductive, content analysis.ResultsWe surveyed 113 providers from 49 clinics. Two thirds (66%) were aware of formal peer support programs, of whom 19% offered in-house peer support through their clinic. Peer support awareness differed by role and region, and most referrals were made by social workers. Likert scale responses suggested a high perceived need of peer support for people with CKD. Top cited barriers to offering peer support included lack of peer support access and workload demands, while facilitators included systematic clinic processes for peer support integration and alignment with external programs. Across 18 interviews, we identified themes related to peer support awareness, logistics, and accessibility and highlighted a need for integrated support pathways.ConclusionsOur findings suggest variability in awareness and availability of peer support among Canadian multi-disciplinary CKD clinics. An understanding of the factors influencing peer support delivery will inform strategies to optimize its uptake for people with advanced CKD.

Experiences and disease self-management in individuals living with chronic kidney disease: qualitative analysis of the National Kidney Foundation\u2019s online community

BackgroundSelf-management of chronic kidney disease (CKD) is one of the keys in improving CKD outcomes and quality of life. There has been an increased use of online health communities to share the experiences of those living with CKD. By analyzing the CKD online forum data, this study aims to: 1) understand the experiences and challenges of individuals living with CKD, and 2) explore how online communities may help CKD patients in improving CKD self-management.MethodsPublicly available posts of peer interactions on the National Kidney Foundation’s online community for individuals affected by CKD were extracted in April 2021 using computer programming. A total of 20,436 posts were collected, of which 400 posts were analyzed using inductive thematic analysis, and saturation was reached. Two researchers coded each post independently, and discrepancies were discussed to reach consensus.ResultsThe analysis identified seven themes: 1) Dynamics of CKD status, 2) CKD comorbidities, 3) Managing CKD and symptoms, 4) Life participation and outlook; 5) Navigating healthcare and clinical needs, 6) Medical tests and results; and 7) Support on the forum. The results revealed that comorbidities were common in CKD patients and early-stage CKD was not communicated in a timely manner to patients by the health care community; living with CKD challenged both CKD and caregivers; some common challenges included but were not limited to the management of a diet for CKD and co-morbidities (especially co-morbid diabetes), CKD dynamics and symptoms, and fear of/ways to prevent progression. Individuals living with CKD primarily used the online forum to share and seek information and emotional support for managing CKD (including co-morbidities).ConclusionsChallenges of living with CKD were found not only in those with advanced kidney disease and those on dialysis, but also in those with early and middle stages. Information and emotional support from the online forum serve as a platform to empower CKD individuals with the knowledge, skills and confidence for CKD self-management. Proactive and innovative strategies with a combination of virtual and real settings to improve self-management for individuals with all-stage CKD needs to be explored and tailored.

A Mobile App to Support Self-management of Chronic Kidney Disease: Development Study.

BackgroundChronic kidney disease (CKD) is a common and costly condition that is usually accompanied by multiple comorbidities including type 2 diabetes, hypertension, and obesity. Proper management of CKD can delay or prevent kidney failure and help mitigate cardiovascular disease risk, which increases as kidney function declines. Smart device apps hold potential to enhance patient self-management of chronic conditions including CKD.ObjectiveThe objective of this study was to develop a mobile app to facilitate self-management of nondialysis-dependent CKD.MethodsOur stakeholder team included 4 patients with stage 3-4 nondialysis-dependent CKD; a kidney transplant recipient; a caretaker; CKD care providers (pharmacists, a nurse, primary care physicians, a nephrologist, and a cardiologist); 2 health services and CKD researchers; a researcher in biomedical informatics, nutrition, and obesity; a system developer; and 2 programmers. Focus groups and in-person interviews with the patients and providers were conducted using a focus group and interview guide based on existing literature on CKD self-management and the mobile app quality criteria from the Mobile App Rating Scale. Qualitative analytic methods including the constant comparative method were used to analyze the focus group and interview data.ResultsPatients and providers identified and discussed a list of requirements and preferences regarding the content, features, and technical aspects of the mobile app, which are unique for CKD self-management. Requirements and preferences centered along themes of communication between patients and caregivers, partnership in care, self-care activities, adherence to treatment regimens, and self-care self-efficacy. These identified themes informed the features and content of our mobile app. The mobile app user can enter health data including blood pressure, weight, and blood glucose levels. Symptoms and their severity can also be entered, and users are prompted to contact a physician as indicated by the symptom and its severity. Next, mobile app users can select biweekly goals from a set of predetermined goals with the option to enter customized goals. The user can also keep a list of medications and track medication use. Our app includes feedback mechanisms where in-range values for health data are depicted in green and out-of-range values are depicted in red. We ensured that data entered by patients could be downloaded into a user-friendly report, which could be emailed or uploaded to an electronic health record. The mobile app also includes a mechanism that allows either group or individualized video chat meetings with a provider to facilitate either group support, education, or even virtual clinic visits. The CKD app also includes educational material on CKD and its symptoms.ConclusionsPatients with CKD and CKD care providers believe that a mobile app can enhance CKD self-management by facilitating patient-provider communication and enabling self-care activities including treatment adherence.

OP348 Assessing The Potential Value Of Wearable Digital Health Technologies In Chronic Kidney Disease Using Early Health Technology Assessment Methods

IntroductionWearable digital health technologies (WDHTs) offer several solutions in terms of disease monitoring, management and delivery of specific interventions. In chronic conditions, WDHTs can be used to support individuals’ self-management efforts, potentially improving adherence to (and outcomes resulting from) interventions. Early health technology assessment (HTA) methods can inform considerations about the potential clinical and economic benefits of technology in the initial phases of the product's lifecycle, facilitating identification of those Research &amp; Development (R&amp;D) investments with the greatest potential stakeholders’ payoff. We report our experience of using early HTA methods to support R&amp;D decisions relating to novel WDHT being designed to support self-management of chronic kidney disease (CKD).MethodsWe performed a literature review, focus-group interviews with patients, and qualitative interviews with the prototype development team to understand the relevant characteristics of WDHTs, quantify relevant clinical indications and existing technological constraints. An early economic evaluation was used to identify the key drivers of value for money, and a discrete choice experiment shed light onto patient preferences towards what key features the WDHT should have for the users to adopt it. Then a model-based cost-effectiveness analysis was undertaken incorporating headroom analysis, return on investment, one-way sensitivity analysis and scenario analyses using data from secondary sources.ResultsThe review of the literature, focus groups with CKD patients, and qualitative interviews with technology developers helped to understand relevant characteristics of WDHT and user preferences helped inform the next R&amp;D iteration. Compared to the standard care, WDHT that support stage ≥3 CKD patients self-management at home by measuring blood pressure and monitor mobility has the potential to be cost-effective at conventional cost-effectiveness threshold levels. From the headroom analysis, novel WDHT can be priced up to GBP280 (EUR315, USD360) and still be cost-effective compared to standard home blood pressure monitoring.ConclusionsOur study provides valuable information for the further development of the WDHT, such as defining a go/no-go decision, as well as providing a template for performing early HTA of Digital Health Interventions.

Differences in self-care knowledge, self-efficacy, psychological distress and self-management between patients with early- and end-stage chronic kidney disease.

The study compares the differences in self-care knowledge, self-efficacy, psychological distress and self-management between patients with early- and end-stage chronic kidney disease (CKD), and predicts the influential factors of self-management. A cross-sectional study. A total of 185subjects by using convenience sampling from one teaching hospital were collected. The research instruments included the Chronic Kidney Disease Self-Care Instrument Knowledge, the Chronic Kidney Disease Self-Efficacy Instrument, the Hospital Anxiety and Depression Scale, and the Chronic Kidney Disease Self-Management Instrument. Descriptive statistics is used frequency, percentage, mean and standard deviation. Inferential statistics is used independent t-test, one-way ANOVA and multiple linear regression analysis. STROBE checklist was used as the guideline for this study. Our results showed that a significant difference was found in the age (p=0.005), systolic pressure (p=.006), self-care knowledge (p=.011) and depression level (p=.003) between patients with early- and end-stage CKD. Furthermore, patients with early-stage CKD have less self-care knowledge and lower depression levels compared with patients with end-stage CKD. However, self-efficacy is the most significant predictor of self-management for patients with early- and end-stage CKD. For patients with early-stage CKD, self-efficacy explained 69.1% of the variation in self-management. According to our results, the management of depression in patients with CKD may improve their outcomes. Improving self-care knowledge of patients with end-stage CKD may improve their self-management. Therefore, our findings suggest various interventions with different necessary and prioritised precision care at early- and late-stage of CKD. Nurses should strive to improve the self-care knowledge of patients with early-stage CKD to delay the progression of the disease to end-stage. Screening for depression among patients with end-stage CKD is relevant, and these patients should be referred to professional counsellors when necessary.