A Dietary Mobile App for Patients Undergoing Hemodialysis: Prospective Pilot Study to Improve Dietary Intakes

Abstract

Background Mobile technology has an impact on the health care sector, also within dietetics. Mobile health (mHealth) apps may be used for dietary assessment and self-monitoring, allowing for real-time reporting of food intakes. Changing eating behaviors is quite challenging, and patients undergoing hemodialysis, particularly, struggle to meet the target intakes set by dietary guidelines. Usage of mobile apps that are developed in a person-centered approach and in line with recommendations may support both patients and health care practitioners. Objective This study is a pilot that aims at estimating the potential efficacy of a dietary intervention using a theory-based, person-centered smartphone app. Results will be used to improve both the app and a planned large-scale trial intended to assess app efficacy thoroughly. Methods A prospective pilot study was performed at the hemodialysis unit of Al Qassimi Hospital (The Emirate of Sharjah). All patients that fulfilled the study inclusion criteria were considered eligible to be enrolled in the pilot study. Upon successful installation of the app, users met with a dietitian once a week. Outcomes were measured at baseline (T0) and 2 weeks post app usage (T1). This pilot is reported as per guidelines for nonrandomized pilot and feasibility studies and in line with the CONSORT 2010 checklist for reporting pilot or feasibility trials. Results A total of 23 patients completed the pilot intervention. Mean energy intakes increased from 24.4 kcal/kg/day (SD 8.0) to 29.1 kcal/kg/day (SD 7.8) with a medium effect size (d=0.6, 95% CI 0.0-1.2). Mean protein intakes increased from 0.9 g/kg/day (SD 0.3) to 1.3 g/kg/day (SD 0.5) with a large effect size (d=1.0, 95% CI 0.4-1.6); mean intake of high biological value (%HBV) proteins also increased from 58.6% (SD 10.1) to 70.1% (SD 10.7) with a large effect size (d=1.1, 95% CI 0.5-1.7). Dietary intakes of minerals did not change, apart from sodium which decreased from a mean intake of 2218.8 mg/day (SD 631.6) to 1895.3 mg/day (SD 581.0) with a medium effect size (d=0.5, 95% CI 0.1-1.1). Mean serum phosphorus, potassium, and albumin levels did not change relevantly. Mean serum iron increased from 7.9 mg/dL (SD 2.8) to 11.5 mg/dL (SD 7.9) postintervention with a medium effect size (d=0.6, 95% CI 0.0-1.2). Conclusions This pilot study showed that the KELA.AE app has the potential to improve dietary intakes. Processes related to procedure, resources, tools, and app improvement for a future trial were assessed. A more extended intervention using a randomized controlled trial is required to estimate parameters concerning app efficacy accurately.

A Mobile App for Triangulating Strategies in Phosphate Education Targeting Patients with Chronic Kidney Disease in Malaysia: Development, Validation, and Patient Acceptance

“…These stakeholder feedbacks necessitated further improvement of the PMA. In contrast, two studies reporting on mobile apps development sharing the same objective as our study did not detail expert validation [ 34 , 55 ].…”

“…Our engagement with the MAUQ to measure acceptance is for the first time been reported in the literature. Two other studies on PMAs specific to the HD patient population were the KELA.AE in the Arabic language relevant to the United Arab Emirates [ 34 ] and Easy Diet Diary Renal TM in the English language in Australia [ 56 ]. The KELA.AE PMA was validated with only 23 adult HD patients and focused on PMA efficacy instead of acceptance and usability.…”

“…In the field of renal nutrition, several mobile apps have shown improvement in terms of self-monitoring for glucose, inter-dialytic weight gain, and reductions in sodium, potassium, and fluid intakes [ 29 , 30 , 31 ]. The interest in mobile app use for phosphate management has been gaining momentum with studies from Canada [ 32 , 33 ], United Arab Emirates [ 34 ], and Taiwan [ 35 ].…”

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

“…Seven trial registrations were excluded from the narrative synthesis as they did not contain enough information ( S2 Table ). Two articles [ 25 , 26 ] reported the same study but in different journals, and a further trial was published as two reports in the same journal [ 27 , 28 ]. This left 54 individual articles (52 separate studies).…”

“…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 ).…”