Aiming to Increase Adherence to Treatment in Patients with Chronic Kidney Disease: The Use of Technology

| Nephrology
*Geraldo Bezerra da Silva Junior, Juliana Gomes Ramalho de Oliveira, José Eurico Vasconcelos Filho,

The authors have declared no conflicts of interest.


The authors are grateful to the International Society of Nephrology (ISN) for the financial support that enabled the development of this project through its Clinical Research Program, the Brazilian Society of Nephrology (SBN) and the Edson Queiroz Foundation/University of Fortaleza (UNIFOR), who also support this project.

EMJ Nephrol. ;6[1]:44-45. Abstract Review No. AR2.

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Chronic kidney disease (CKD) is a public health problem worldwide, and, in Brazil, an increasing number of patients requiring dialysis and transplantation has been observed. Knowledge about CKD and other diseases is poor among the general population in many parts of the world.2-4 Adherence to treatment is a problem that impacts patient outcomes, and technology can be a good ally for increasing patient health education and adherence to treatment.5,6 At the ERA–EDTA Congress 2018, we presented the ‘Renal Health Project’, which used a multidisciplinary approach to build technological tools to increase patient education and self-monitoring of treatment through an application for smartphones and educational videos. The project was started in 2015 by a group of nephrology professors and students from the University of Fortaleza (UNIFOR), Fortaleza, Brazil, in partnership with the Technology Innovation Laboratory (UNIFOR) and with support from the International Society of Nephrology (ISN) Clinical Research Program, Brazilian Society of Nephrology (SBN), and Edson Queiroz Foundation/UNIFOR. The project was planned in three phases.

Phase 1: Development of an application for smartphones to help patients with CKD to better control their treatment. The application was intended for transplant patients and those undergoing dialysis. The application also provides information for the general population and provides a tool to estimate glomerular filtration rate and indicate if someone is at risk of CKD. This application was called ‘Renal Health’, and the first version was in Portuguese, the official language of Brazil. A team of professionals and students from the fields of health and computer sciences worked together to build the first version of the application, and then a usability test was performed with a group of nephrology professionals (physicians, nurses, dietitians, and psychologists) and patients (patients on haemodialysis and transplant patients).

Phase 2: Elaboration of the digital educational material to be connected to the application and available on the internet.

Phase 3: Clinical study on the impact of these tools on patient outcomes. The clinical study, which is designed to investigate if the use of the application has a beneficial effect on patient outcomes (both on dialysis and transplantation), is planned to start in Brazil by the second half of 2018. We also intend to test the application in other countries, so an English version is already being developed. We welcome partnerships with researchers interested in testing the application and developing educational materials for patients and testing technological tools to increase adherence to treatment.

Sesso RC et al. Brazilian chronic dialysis survey 2016. J Bras Nefrol. 2017;39(3):261-6. Gray NA et al. Patient kidney disease knowledge remains inadequate with standard nephrology outpatients care. Clin Kidney J. 2016;9(1):113-8. González JCS et al. The assessment of knowledge about treatment in hemodialysis patients. Enferm Nefrol. 2015;18(1):23-30. Kilkenny MF et al. Knowledge of risk factors for diabetes or cardiovascular disease (CVD) is poor among individuals with risk factors for CVD. PLoS One. 2017;12(2):e0172941. Wu SFV et al. Prediction of self-care behavior on the basis of knowledge about chronic kidney disease using self-efficacy as a mediator. J Clin Nurs. 2016;25 (17-18):2609-8. Johnson ML et al. Patient activation with knowledge, self-management and confidence in chronic kidney disease. J Ren Care. 2016;42(1):15-22.