# Effect of the Chronic Kidney Disease—Peritoneal Dialysis (CKD-PD) App on Improvement of Overhydration Treatment in Patients on Peritoneal Dialysis: Randomized Controlled Trial

## TL;DR

A smartphone app for monitoring hydration in peritoneal dialysis patients led to earlier treatment and fewer hospitalizations for overhydration.

## Contribution

The CKD-PD app enables timely hydration monitoring and clinical interventions in PD patients.

## Key findings

- App users had 2.51 times more interventions for overhydration compared to the No-App group.
- The No-App group had significantly higher hospitalizations due to any cause and volume overload.
- The app did not affect survival or technique failure rates.

## Abstract

Overhydration is associated with increased morbidity and mortality in patients on peritoneal dialysis (PD). Early detection of overhydration is possible by monitoring hydration metrics, but the critical gap for treatment is obtaining timely and actionable data.

This study compares the detection of overhydration and clinical outcomes in patients on PD using the Chronic Kidney Disease—Peritoneal Dialysis (CKD-PD) smartphone app with standard monitoring and management.

An open-label randomized controlled trial was conducted at 3 hospitals in northeast Thailand. Enrolled participants from PD clinics were randomized into 2 equal groups: CKD-PD (App users) and usual management (No-App). Participants or their caregivers in the App group recorded hydration metrics in the CKD-PD app, which were uploaded to a central database monitored by nephrology staff. The No-App group used a handwritten logbook. Both groups had bimonthly clinic visits. The primary outcome was the incidence rate ratio (IRR) for clinical interventions for overhydration. Secondary outcomes included hospitalizations, technique failure, and death.

A total of 208 participants were randomized into App (N=103) and No-App (N=105) groups with the median follow-up time of 11.2 months. Hydration metric upload compliance in the App group was 85.7% (IQR 71.4-95.6). The IRR of overall interventions for overhydration was 2.51 times higher in the App group (95% CI 2.18-2.89; P<.001). Types of clinical interventions for overhydration differed between groups with dietary change and prescription of antihypertensive drugs more frequent in App users and diuretics and change of dialysis prescription more frequent in the No-App group. Hospitalizations were significantly higher in the No-App group due to any cause (adjusted IRR 1.58) and volume overload (adjusted IRR 4.07). There was no significant difference in survival analysis and technique failure between the 2 groups.

Use of the CKD-PD app improved early detection of overhydration and early treatment interventions, resulting in fewer all-cause and volume overload hospitalizations.

ClinicalTrials.gov NCT04797195; https://clinicaltrials.gov/study/NCT04797195