Research Questions Value of mHealth Apps for Chronic Kidney Disease

mHealth apps for patients with chronic diseases work best if they allow the patient to share data with his or her care provider and offer personalized resources.

Yet a recent analysis of 10 top apps that offer dietary care management for those with chronic kidney disease (CKD) found only one that offered that function. And only four tailored recommendations based on the user’s diet preferences.

“Content is not the only important aspect of a CKD diet app,” researchers from Purdue University said in the study, recently published in the Journal of Renal Nutrition. “The option of sharing and storing data with physicians, dietitians or other health care providers could lead to more collaborative patient care. In fact, ensuring that physicians, dieticians, and patients all play a role in the development of a new app will be critical in ensuring its optimal design.”

The research team, led by Carl Russell III of the College of Engineering, sought to identify the ideal mHealth app for patients living with CKD by identifying what that app should include. They identified 14 criteria that should go into a connected health platform serving those patients, including adherence to the recently updated 2020 Kidney Disease Quality Outcomes Initiative (KDOQI) Clinical Practice Guideline for Nutrition in CKD.

“Internet-based applications offer the possibility of achieving these goals in ways that were not previously available by allowing individuals to easily access food and nutrition databases, count calories, track intake of macronutrients and micronutrients, and follow weight and other indices of nutrition,” Russell and his colleagues reported. “An ideal app would also allow physicians or registered dietitians secured access to these data if desired. Such an app would be able to help achieve the goals of enhancing both the health-care experience and a patient's health.”

The team then searched for apps available on Google Play and the Apple App store, and came up with 3,204 potential candidates. That list was narrowed down to 10 – four available on iOS platforms, four on Android platforms and only two which were available on both.

Of those 10 apps, eight were designed exclusively for those living with CKD, seven were offered free of charge and only half included CKD-friendly recipes. Just four offered personalized recommendations based on data submitted by the user, four tracked macronutrient and micronutrient intake and provided CKD stage-specific nutritional recommendations, and none adhered to the 2020 KDOQI nutritional guidelines.

“These criteria are all important as they involve tailoring recommendations to individual needs and severity of CKD, accessibility of app and data to patient and clinician, and enhancing the eating experience by offering different meal options,” the researchers noted.

Russell and his colleagues said their research found that patients living with CKD want mHealth resources to help with nutritional planning, and they aren’t getting what they want from the current app market. Aside from lacking updated dietary guidelines, they said, many apps were difficult to use and lacked interactive features or an evidence-based approach. In fact, the best performing app met seven of 10 criteria (four were not measured) and focused primarily on tracking phosphate, with less attention paid to calcium and other important micronutrients.

“In summary, the few CKD diet apps currently on the market for people with CKD have notable limitations in terms of content and software design,” the study concluded. “Opportunities therefore exist for improving on current CKD diet apps and thereby fulfilling an important unmet need for patients with CKD.”

The study mirrors research done over the years on connected health apps designed for specific chronic diseases. In many cases, the apps meet some of the needs but not all, and in some instances they might even put patients at risk by offering outdated or unproven advice.  

The challenge for care providers is in finding a reliable resource to evaluate the available apps for a specific condition, so that certain apps can be recommended or even prescribed to patients. Patients, on the other hand, should seek advice from their care providers, either on specific apps or on what resources they should look for in an app.