J STEVENSON1,2, ZC CAMPBELL3, AC WEBSTER4,5,6, CK CHOW7,8, A TONG1,4, JC CRAIG1,4,6, KL CAMPBELL9, VW LEE1,2,5,10
1Centre For Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia, 2Westmead Clinical School, The University of Sydney, Sydney, Australia, 3Sydney Medical School, The University of Sydney, Sydney, Australia, 4School of Public Health, The University of Sydney, Sydney, Australia, 5Centre for Transplant and Renal Research, Westmead Millennium Institute, The University of Sydney at Westmead, Sydney, Australia, 6Cochrane Kidney and Transplant, Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia, 7Westmead Applied Research Centre, Westmead Clinical School, The University of Sydney, Sydney, Australia, 8Department of Cardiology, Westmead Hospital, Sydney, Australia, 9Faculty of Health Sciences and Medicine, Bond University, Robina, Australia, 10Department of Renal Medicine, Westmead Hospital, Sydney, Australia
Aim: To systematically evaluate the benefits and harms of using eHealth interventions in people with chronic kidney disease (CKD).
Background: There has been a tremendous increase in the use of technologies, with increasing interest in using eHealth interventions in healthcare. In CKD there is a need to develop innovative, effective and cost-efficient methods to improve health behaviours and outcomes.
Methods: Cochrane Kidney and Transplant Specialised Register were searched for randomised controlled trials that used an eHealth intervention to promote behaviour change in CKD populations.
Results: 43 studies were included. eHealth interventions were categorised by intention of intervention (e.g. self-monitoring, educational), with 98 outcomes identified. Only 3 outcomes could be meta-analysed due to heterogeneity with respect to study population and eHealth modalities. Using an eHealth intervention may reduce interdialytic weight gain by 0.14kg (3 studies, n=306, MD -0.14, 95% CI -0.28 to 0.01; I2 0%, p=0.06) and may reduce dietary sodium intake by 240mg per day (2 studies, n=181, SMD -0.24, 95% CI -0.54 to 0.05; I2 0%; p=0.10). There was no difference in mortality rate (3 studies, 147 events, RR 0.78, CI 0.49 to 1.24). However, all outcomes were graded as being of low or very low evidence due to risk of bias, indirectness, inconsistency and imprecision.
Conclusions: E-Health interventions may improve dietary sodium intake and fluid management. However, overall these data suggests that current evidence for the use of eHealth interventions in the CKD population is of low quality, with uncertain effects due to methodological limitations and heterogeneity of eHealth modalities and intervention types. There is a need for high quality research that reports uses a minimum (core) data set to enable meaningful evaluation.
Jess is a renal dietitian and PhD Candidate. Her PhD is evaluating the impact of using eHealth interventions to improve health behaviours through dietary and lifestyle management in patients with chronic kidney disease.