Abstract：
Diabetic Kidney Disease (DKD) is the most common cause of end-stage chronic kidney disease (CKD), conditioning these patients to a worse renal prognosis and higher cardiovascular mortality and/or requirement for renal replacement therapy. The use of novel information and communication technologies (ICTs) focused on the field of health, may facilitates a better quality of life and disease control in these patients. Our objective is to evaluate the effect of monitoring DKD patients using NORA-app.
Prospective feasibility/validation study of NORA-app in patients with DKD stage G3bA3 or higher, followed in outpatient clinics of a tertiary care hospital. NORA-app is an application for smartphones designed to control risk factors, share educational medical information, communicate via chat with health professionals, increase treatment compliance (Morisky-Green), and collect patient reported outcomes such as anxiety and depression using HADs scale. Clinical-laboratory variables were collected at 3 months and compared to control patients who declined using NORA-app.
From 01/01/2021 to 03/03/2022 the use of NORA-app was offered to 118 patients, 82 accepted and 36 declined (controls). After a mean follow-up period of 6,04 months and at the time of data extraction 71 (86.6%) NORA-app patients remain active users, 2 have completed the follow-up at one year and 9 are inactive (3 due to death and 6 due to non-locatable). There were no differences in baseline characteristics including Creatinine [2.1 (1.6-2.4) vs. 1.9 (1.5-2.5)] mg/dL and alb/creat [962 (475-1784) vs. 1036 (560-2183)] mg/gr between Nora and control patients respectively. The therapeutic compliance rate in the NORA-app group was 77%, improving at 90 days to 91%. Patients in the NORA-group showed significantly lower levels of alb/creat than controls (768(411-1971) mg/g Vs 2039 (974-3214) p = 0.047) at 90-day follow-up.
In patients with DKD the use of NORA-app was maintained in the long-term, leading to high levels of treatment compliance, and achieving a better disease control. Our study suggests that the generalized use of ICTs may help in the personalized monitoring of these patients to delay the progression of kidney disease.
Prospective feasibility/validation study of NORA-app in patients with DKD stage G3bA3 or higher, followed in outpatient clinics of a tertiary care hospital. NORA-app is an application for smartphones designed to control risk factors, share educational medical information, communicate via chat with health professionals, increase treatment compliance (Morisky-Green), and collect patient reported outcomes such as anxiety and depression using HADs scale. Clinical-laboratory variables were collected at 3 months and compared to control patients who declined using NORA-app.
From 01/01/2021 to 03/03/2022 the use of NORA-app was offered to 118 patients, 82 accepted and 36 declined (controls). After a mean follow-up period of 6,04 months and at the time of data extraction 71 (86.6%) NORA-app patients remain active users, 2 have completed the follow-up at one year and 9 are inactive (3 due to death and 6 due to non-locatable). There were no differences in baseline characteristics including Creatinine [2.1 (1.6-2.4) vs. 1.9 (1.5-2.5)] mg/dL and alb/creat [962 (475-1784) vs. 1036 (560-2183)] mg/gr between Nora and control patients respectively. The therapeutic compliance rate in the NORA-app group was 77%, improving at 90 days to 91%. Patients in the NORA-group showed significantly lower levels of alb/creat than controls (768(411-1971) mg/g Vs 2039 (974-3214) p = 0.047) at 90-day follow-up.
In patients with DKD the use of NORA-app was maintained in the long-term, leading to high levels of treatment compliance, and achieving a better disease control. Our study suggests that the generalized use of ICTs may help in the personalized monitoring of these patients to delay the progression of kidney disease.
摘要：
背景：糖尿病肾病（DKD）是终末期慢性肾病（CKD）的最常见原因，使这些患者的肾脏预后更差，心血管死亡率和/或肾脏替代疗法的需求更高。新的信息和通信技术(信通技术)的使用侧重于卫生领域，可以促进这些患者更好的生活质量和疾病控制。我们的目标是评估使用NORA-app监测DKD患者的效果。
方法：NORA-app在DKDG3bA3或更高分期患者中的前瞻性可行性/验证研究，随后在三级护理医院的门诊就诊。NORA-app是一款用于智能手机的应用程序，旨在控制风险因素，共享教育医疗信息，通过与健康专业人员聊天进行交流，提高治疗依从性（Morisky-Green），并使用HADs量表收集患者报告的结果，如焦虑和抑郁。在3个月时收集临床实验室变量，并与使用NORA-app拒绝的对照组患者进行比较。
结果：从2021年1月1日至2022年3月3日，向118名患者提供了NORA-app的使用，82人接受，36人拒绝（对照）。经过6,04个月的平均随访期，在数据提取时，71名(86.6%)NORA-app患者仍然是活跃用户，2人在一年内完成了随访，9人不活动（3人因死亡，6人因无法定位）。包括肌酐在内的基线特征没有差异[2.1（1.6-2.4）与1.9（1.5-2.5）]mg/dL和alb/creat[962（475-1784）与诺拉和对照组患者分别为1036(560-2183)]mg/gr。NORA-app组的治疗依从率为77%，在90天提高到91%。在90天的随访中，NORA组的患者的alb/creat水平显着低于对照组（768（411-1971）mg/gvs2039（974-3214）p=0.047）。
结论：在DKD患者中，长期维持使用NORA-app，导致高水平的治疗依从性，实现更好的疾病控制。我们的研究表明，广泛使用ICT可能有助于对这些患者进行个性化监测，以延迟肾脏疾病的进展。
方法：NORA-app在DKDG3bA3或更高分期患者中的前瞻性可行性/验证研究，随后在三级护理医院的门诊就诊。NORA-app是一款用于智能手机的应用程序，旨在控制风险因素，共享教育医疗信息，通过与健康专业人员聊天进行交流，提高治疗依从性（Morisky-Green），并使用HADs量表收集患者报告的结果，如焦虑和抑郁。在3个月时收集临床实验室变量，并与使用NORA-app拒绝的对照组患者进行比较。
结果：从2021年1月1日至2022年3月3日，向118名患者提供了NORA-app的使用，82人接受，36人拒绝（对照）。经过6,04个月的平均随访期，在数据提取时，71名(86.6%)NORA-app患者仍然是活跃用户，2人在一年内完成了随访，9人不活动（3人因死亡，6人因无法定位）。包括肌酐在内的基线特征没有差异[2.1（1.6-2.4）与1.9（1.5-2.5）]mg/dL和alb/creat[962（475-1784）与诺拉和对照组患者分别为1036(560-2183)]mg/gr。NORA-app组的治疗依从率为77%，在90天提高到91%。在90天的随访中，NORA组的患者的alb/creat水平显着低于对照组（768（411-1971）mg/gvs2039（974-3214）p=0.047）。
结论：在DKD患者中，长期维持使用NORA-app，导致高水平的治疗依从性，实现更好的疾病控制。我们的研究表明，广泛使用ICT可能有助于对这些患者进行个性化监测，以延迟肾脏疾病的进展。
