A Text Messaging Intervention for Dietary Behaviors for People Receiving Maintenance Hemodialysis: A Feasibility Study of KIDNEYTEXT

Abstract

Rationale and Objective: An important component of hemodialysis management involves delivery of complex dietary recommendations. The aim of this study was to determine the feasibility of a mobile phone text message intervention to improve dietary behavior in people on hemodialysis. Study design: Six-month randomized feasibility study. Setting and participants: Patients receiving maintenance hemodialysis across two health districts in Sydney, Australia. Interventions: Participants randomized to the intervention received three text messages per week, in addition to standard dietary care, for six months. The usual care group received standard dietary care. Outcomes: The primary outcomes were feasibility, measured using recruitment and retention rates, acceptability of the intervention, and adherence to dietary recommendations. Secondary exploratory outcomes included information on certain clinical parameters related to dietary management of patients receiving maintenance hemodialysis. Results: 130 people were recruited. 48% (130/272) of eligible patients consented to participate and 88% (115/130) completed the study. Semi-structured interviews evaluating acceptability identified five themes: clear and comprehensive, engaging with consistent and relevant content, maintaining attention with timely reminders, sustaining interest through ongoing care and generic messages inadequate to prompt dietary change. There was no difference in adherence to dietary recommendations across treatment groups (odds ratio: 1.21, 95% CI 0.55, 2.72, p=0.6). Secondary exploratory analyses suggested reductions in dietary intake of single nutrients 4 (potassium, phosphorus, sodium, protein), interdialytic weight gains, and phosphate binder usage among intervention participants compared to participants assigned to standard of care. Limitations: Our feasibility study was of short duration. Adherence was based on self-reported data. Generalizability to populations receiving maintenance hemodialysis outside of an urban, Australian setting is unknown. Conclusions: A simple mobile phone text messaging intervention was feasible and acceptable to patients. Further investigation of the impact on patient-reported and clinical outcomes is warranted.

Patients' experiences and perspectives of a mobile phone text messaging intervention to improve dietary behaviours in haemodialysis

“…Participants enrolled in the intervention arm of a randomised controlled trial, KIDNEYTEXT 14 were eligible for this sub-study. The study protocol for this trial has been published in detail elsewhere.…”

“…13 Feasibility and impact of a mobile phone text messaging intervention (KIDNEYTEXT) to change dietary behaviours in haemodialysis patients have been reported. 14 Feasibility and impact were assessed using recruitment and retention rates and change to the intake of renal-specific nutrients (potassium, phosphorus, sodium and protein). Evaluation of participants' experiences with KIDNEYTEXT is an important step to understand how the participants engaged with the intervention and to the extent it impacted on their dietary behaviours.…”

Cost‐effectiveness of a mobile phone text messaging program (KIDNEYTEXT) targeting dietary behaviours in people receiving haemodialysis

“…31 Further limitations of the KIDNEYTEXT trial have been outlined elsewhere. 13 This simple mobile phone text message intervention may be adopted as an additional tool for patient care. There may be a cost saving for dialysis units in using text messages, in addition to individualised dietary counselling.…”

“…The clinical outcomes of this text message based intervention on dietary behaviours have been published previously. 13 Here, we present the results of the trial-based economic evaluation.…”

Dietary interventions with dietitian involvement in adults with chronic kidney disease: A systematic review

“…This was the only included study to report on the patient experience of the intervention. Our search identified a protocol for a study (KIDNEYTEXT), 37 which has subsequently published feasibility results in January 2021 38 . KIDNEYTEXT included three text messages per week (in addition to standard care) designed to improve dietary behaviours, and demonstrated that this type of intervention was feasible and acceptable to people on maintenance haemodialysis.…”