Study reports few errors when applied to patients with chronic kidney disease

 

It can be difficult for patients with complex chronic diseases to take medications appropriately, but a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN) finds that tailored mobile health technologies can help ensure the safety of their care. To determine whether user-friendly mobile technologies might help keep patients with chronic kidney disease (CKD) on track with their medications, Clarissa Jonas Diamantidis, MD, MHS, of the Duke University School of Medicine, and her colleagues at the University of Maryland School of Medicine evaluated the home-based usability of a mobile health medication inquiry system (MIS) that they designed as a patient-centered medication safeguard. The MIS application responds to study medications with 3 potential responses: "not safe in chronic kidney disease," "use with caution, speak with your healthcare provider," and "safe in chronic kidney disease." The investigators randomized 20 patients with CKD to a text-based MIS platform or a personal digital assistant (PDA)-based MIS platform. Participants were then mailed 3 randomly selected sample prescription pill bottles and asked to input the medication into the MIS and record the system responses to determine their appropriateness in CKD. "General usability of the MIS application was high, regardless of platform type, with only a 5% error rate," said Dr. Diamantidis. Two errors occurred in the text-based group and 1 in the PDA-based group. "The majority of participants found the application easy to use and helpful in avoiding the use of harmful medications, and they would recommend the application to others." Despite general proficiency with the mobile health MIS application, the study uncovered variable electronic health literacy among patients. When participants were administered the eHealth Literacy Scale, which evaluates individuals' perceived abilities to effectively apply electronic health information to health problems, the majority of participants felt the Internet was a useful source of health information, but only about half felt they knew where to find helpful health resources on the Internet. Even fewer reported being able to tell high quality from low quality Internet-based health information. In an accompanying editorial, Bryan Becker, MD, of the University of Chicago, noted that harnessing mobile technology to better treat CKD is logical. "What Diamantidis and colleagues have done is extend that treatment platform beyond traditional care settings into the home," he wrote. "They have used a tool to create a small but very important first step in achieving patient engagement and patient satisfaction in self-care." Story Source: The above post is reprinted from materials provided by American Society of Nephrology. Note: Materials may be edited for content and length. Journal References: Clarissa J. Diamantidis, Jennifer S. Ginsberg, Marni Yoffe, Lisa Lucas, Divya Prakash, Saurabh Aggarwal, Wanda Fink, Stefan Becker, and Jeffrey C. Fink. Remote Usability Testing and Satisfaction with a Mobile Health Medication Inquiry System in CKD. Clinical Journal of the American Society of Nephrology, July 2015 DOI: 10.2215/CJN.12591214 Bryan N. Becker. Medication Safety Mobile Health = Patient Engagement in Chronic Kidney Disease. Clinical Journal of the American Society of Nephrology, July 2015 DOI: 10.2215/CJN.06970615

New definition of kidney disease for clinical trials could lead to new treatments

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A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health suggests that new therapies for kidney disease could be developed more quickly by revising the definition of kidney disease progression used during clinical trials. If adopted, the new definition could shorten the length of some clinical trials and also potentially encourage more clinical trials in kidney disease. The findings will be published in the June 3, 2014 online edition of the Journal of the American Medical Association.

Chronic kidney disease (CKD) is a worldwide public health problem that affects 26 million people in the U.S., with 600,000 requiring dialysis or kidney transplantation. Despite its prevalence, there are fewer clinical trials for kidney disease than any other common disease. In December 2012, the National Kidney Foundation (NKF) and the Food and Drug Administration (FDA), challenged the research community to evaluate the current definition of kidney disease progression and examine whether improvements were possible. At that time, NFK and FDA officials viewed favorably emerging evidence that a decline in estimated kidney function was promising as a reliable indicator of kidney disease progression. This research grew directly out of the NFK-FDA challenge.

For the study, a global Chronic Kidney Disease Prognosis Consortium led by Josef Coresh, MD, PhD, MHS, a professor at the Bloomberg School, analyzed data from 1.7 million participants recruited into 35 cohorts in dozens of countries from 1975-2011 and followed for an average of 5 years. The researchers' points of comparison were the FDA's current definition of CKD disease onset for clinical trials -- a doubling of serum creatinine, a blood marker that assesses kidney function -- and the emerging evidence on a decline in estimated kidney function.

Researchers first analyzed kidney disease progression among all participants during a baseline period of two years. They then examined how this progression predicted subsequent disease progression to the observed 12,344 cases of end-stage renal diseases (ESRD) and 223,944 deaths. The study found that the current serum-creatinine standard used in clinical trials which is associated with a 57% reduction in kidney function carried very high risk -- a 32-fold increased risk of ESRD and 3.7-fold increased risk of mortality but only occurred in less than 1% of participants in the two-year baseline period.

In contrast, a 30% decline in kidney function, also measured by serum creatinine levels, occurred in 7% of participants in the two-year baseline period. This was associated with a 5-fold higher risk of end-stage renal disease (ESRD) and 1.8-fold higher risk of mortality. This level of risk is high and yet common and early enough to facilitate testing if new therapies are working.

"Chronic kidney disease is often asymptomatic until it's too late," notes Dr. Coresh. "This new definition will help standardize following patients to determine when their disease progresses significantly enough to elevate risk. This will assist in patient care, research studies and development of new therapies."

Walking may have profound benefits for patients with kidney disease

 

May 15, 2014

American Society of Nephrology (ASN)

Among patients with chronic kidney disease who were followed for an average of 1.3 years, those who walked for exercise were 33% less likely to die and 21% less likely to need dialysis or a kidney transplant. Physical inactivity is common among patients with chronic kidney disease (CKD). The researchers found that the presence of other, or comorbid, conditions such as cardiovascular disease and diabetes was similar between walking and non-walking patients.

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Just over 21% of patients reported walking as their most common form of exercise. During follow-up, those who walked were 33% less likely to die and 21% less likely to need dialysis or a kidney transplant.

For individuals with kidney disease, walking may help prolong life and reduce the risk of needing dialysis or a kidney transplant. That's the conclusion of a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).

Physical inactivity is common among patients with chronic kidney disease (CKD). Che-Yi Chou MD, PhD, Chiz-Tzung Chang, PhD (China Medical University Hospital, in Taiwan) and their colleagues looked to see if an activity as simple as walking might provide benefits to patients. The researchers studied all 6,363 patients with CKD stages 3 to 5 in the CKD program of China Medical University Hospital from June 2003 to May 2013. Patients were an average of 70 years old, and they were followed for an average of 1.3 years.

Just over 21% of patients reported walking as their most common form of exercise. During follow-up, those who walked were 33% less likely to die and 21% less likely to need dialysis or a kidney transplant. The more patients walked, the more they benefited. Compared with those who did not walk, patients who walked 1-2, 3-4, 5-6, and ≥ 7 times per week were 17%, 28%, 58%, and 59% less likely to die during the study, respectively. They were also 19%, 27%, 43%, and 44% less likely to need dialysis or a transplant.

The researchers found that the presence of other, or comorbid, conditions such as cardiovascular disease and diabetes was similar between walking and non-walking patients.

"We have shown that CKD patients with comorbidities were able to walk if they wanted to, and that walking for exercise is associated with improved patient survival and a lower risk of dialysis," said Dr. Chou. "A minimal amount of walking -- just once a week for less than 30 minutes -- appears to be beneficial, but more frequent and longer walking may provide a more beneficial effect."

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Story Source:

The above story is based on materials provided by American Society of Nephrology (ASN). Note: Materials may be edited for content and length.

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Journal Reference:

1. I.-R. Chen, S.-M. Wang, C.-C. Liang, H.-L. Kuo, C.-T. Chang, J.-H. Liu, H.-H. Lin, I.-K. Wang, Y.-F. Yang, C.-Y. Chou, C.-C. Huang. Association of Walking with Survival and RRT Among Patients with CKD Stages 3-5. Clinical Journal of the American Society of Nephrology, 2014; DOI: 10.2215/CJN.09810913