We are uncertain whether using eHealth interventions improves outcomes for people with CKD.
The quality of the included studies was low, meaning we could not be sure that future studies would find similar results. We found that it was uncertain whether using an eHealth interventions improved clinical and patient‐centred outcomes compared with usual care. We categorised outcomes into nine domains: dietary intake, quality of life, blood pressure control, medication adherence, results of blood tests, cost‐analysis, behaviour, physical activity and clinical end‐points such as death. Interventions were classified by their intention: educational, reminder systems, self‐monitoring, behavioural counselling, clinical decision‐aids and mixed interventions. eHealth interventions used different modes of technology, such as Telehealth, electronic monitors, mobile or tablet applications, text message or emails, websites, and DVDs or videos. We found 43 studies involving 6617 people who had CKD that examined if eHealth interventions improve patient care and health outcomes. We focused on randomised controlled trials (RCT), which enrolled people with CKD (including pre‐dialysis, dialysis or kidney transplant), and compared eHealth interventions to usual care. However, there is little research evaluating the impact of eHealth interventions in CKD.
eHealth interventions refer to "health services and information delivered or enhanced through the Internet and related technologies". Electronic health (eHealth) interventions may improve patients’ ability to look after themselves and improve care provided by healthcare services. Enabling patients to manage this condition by themselves improves quality and length of life and reduces healthcare costs. Some people with advanced CKD may need dialysis or treatment with a kidney transplant. To remain well people with CKD need to follow complex diet, lifestyle and medication advice and often need to use several specialist medical services. We are uncertain whether using eHealth interventions, in addition to usual care, impact on the number of deaths as the certainty of this evidence was graded as low due to high or unclear risk of bias, indirectness and imprecision.ĮHealth interventions for people with chronic kidney diseaseĬhronic kidney disease (CKD) is a condition where kidneys have reduced function over a period of time. Three studies reported death (2799 participants, 146 events), with 45 deaths/1000 cases compared to standard care of 61 deaths/1000 cases (RR 0.74, CI 0.53 to 1.03 P = 0.08). Both dietary sodium and fluid management outcomes were graded as being of low evidence due to high or unclear risk of bias and indirectness (interdialytic weight gain) and high or unclear risk of bias and imprecision (dietary sodium intake). There was found to be a reduction in interdialytic weight gain of 0.13kg (4 studies, 335 participants: MD ‐0.13, 95% CI ‐0.28 to 0.01 I 2 = 0%) and a reduction in dietary sodium intake of 197 mg/day (2 studies, 181 participants: MD ‐197, 95% CI ‐540.7 to 146.8 I 2 = 0%). Only three outcomes could be meta‐analysed as there was substantial heterogeneity with respect to study population and eHealth modalities utilised. We identified 98 outcomes, which were categorised into nine domains: blood pressure (9 studies) biochemical parameters (6 studies) clinical end‐points (16 studies) dietary intake (3 studies) quality of life (9 studies) medication adherence (10 studies) behaviour (7 studies) physical activity (1 study) and cost‐effectiveness (7 studies). Interventions were categorised into six types: educational reminder systems self‐monitoring behavioural counselling clinical decision‐aid and mixed intervention types. Three studies used a combination of eHealth interventions. The majority of studies (39 studies) were conducted in an adult population, with 16 studies (37%) conducted in those on dialysis, 11 studies (26%) in the pre‐dialysis population, 15 studies (35%) in transplant recipients and 1 studies (2%) in transplant candidates We identified six different eHealth modalities including: Telehealth mobile or tablet application text or email messages electronic monitors internet/websites and video or DVD. Included studies were heterogeneous in terms of eHealth modalities employed, type of intervention, CKD population studied and outcomes assessed.
We included 43 studies with 6617 participants that evaluated the impact of an eHealth intervention in people with CKD.