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.
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。