Tuot Delphine, Crowley Susan, Katz Lois, Leung Joseph, Alcantara-Cadillo Delly, Ruser Christopher, Talbot-Montgomery Elizabeth, Vassalotti Joseph
Division of Nephrology, University of California, San Francisco, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, Bldg 100, Room 342, San Francisco, CA, 94110, United States.
Veterans Administration Connecticut Healthcare System, New Haven, CT, United States.
JMIR Form Res. 2025 Apr 29;9:e56855. doi: 10.2196/56855.
Chronic kidney disease (CKD) affects 14% of the US adult population, yet patient knowledge about kidney disease and engagement in their kidney health is low despite many CKD education programs, awareness campaigns, and clinical practice guidelines.
We aimed to examine the impact of the Kidney Score Platform (a patient-facing, risk-based online tool that provides interactive health information tailored to an individual's CKD risk plus an accompanying clinician-facing Clinical Practice Toolkit) on individual engagement with CKD health and CKD communication between clinicians and patients.
We conducted a pre-post intervention study in which English-speaking veterans at risk for CKD in two primary care settings interacted with the Kidney Score platform's educational modules and their primary care clinicians were encouraged to review the Clinical Practice Toolkit. The impact of the Kidney Score on the Patient Activation Measure (the primary outcome), knowledge about CKD, and communication with their clinician about kidney health was determined with paired t tests. Multivariable linear and logistic models were used to determine whether changes in outcomes after versus before intervention were influenced by age, race or ethnicity, sex, and diabetes status, accounting for baseline values.
The study population (n=76) had a mean (SD) age of 64.4 (8.2) years, 88% (67/76) was male, and 30.3% (23/76) self-identified as African-American. Approximately 93% (71/76) had hypertension, 36% (27/76) had diabetes, and 9.2% (7/76) had CKD according to the laboratory criteria but without an ICD-10 (International Classification of Diseases, 10th Edition) diagnosis. Patient interaction with the Kidney Score did not change the mean Patient Activation Measure (preintervention: 40.7%, postintervention: 40.2%, P=.23) but increased the mean CKD knowledge score (preintervention: 40.0%, postintervention 51.1%, P<.01), and changed the percentage of veterans who discussed CKD with their clinician (preintervention: 12.3%, postintervention: 31.5%, P<.01). Changes did not differ by age, sex, race, or diabetes status. Results were limited by the small sample size due to low recruitment and minimal clinician engagement with the Clinical Practice Toolkit during the COVID-19 pandemic.
One-time web-based tailored education for patients can increase CKD knowledge and encourage conversations about kidney health. Increasing patient activation for CKD management may require multilevel, longitudinal interventions that facilitate ongoing conversations about kidney health between patients and clinician teams.
慢性肾脏病（CKD）影响着14%的美国成年人口，然而尽管有许多CKD教育项目、宣传活动和临床实践指南，患者对肾脏疾病的了解以及对自身肾脏健康的参与度仍然很低。
我们旨在研究肾脏评分平台（一个面向患者的、基于风险的在线工具，提供根据个体CKD风险量身定制的交互式健康信息以及配套的面向临床医生的临床实践工具包）对个体参与CKD健康管理以及临床医生与患者之间CKD沟通的影响。
我们进行了一项干预前后研究，在两个初级保健机构中，有CKD风险的讲英语的退伍军人与肾脏评分平台的教育模块进行互动，并鼓励他们的初级保健医生查阅临床实践工具包。通过配对t检验确定肾脏评分对患者激活量表（主要结局）、CKD知识以及与临床医生就肾脏健康进行沟通的影响。使用多变量线性和逻辑模型来确定干预前后结局的变化是否受到年龄、种族或族裔、性别和糖尿病状态的影响，并考虑基线值。
研究人群（n = 76）的平均（标准差）年龄为64.4（8.2）岁，88%（67/76）为男性，30.3%（23/76）自我认定为非裔美国人。根据实验室标准，约93%（71/76）患有高血压，36%（27/76）患有糖尿病，9.2%（7/76）患有CKD，但没有国际疾病分类第10版（ICD - 10）诊断。患者与肾脏评分的互动并未改变患者激活量表的平均值（干预前：40.7%，干预后：40.2%，P = 0.23），但提高了CKD知识的平均得分（干预前：40.0%，干预后：51.1%，P < 0.01），并改变了与临床医生讨论CKD的退伍军人比例（干预前：12.3%，干预后：31.5%，P < 0.01）。这些变化在年龄、性别、种族或糖尿病状态方面没有差异。由于招募人数少以及在新冠疫情期间临床医生对临床实践工具包的参与度低，导致样本量小，研究结果受到限制。
为患者提供一次性的基于网络的量身定制教育可以增加CKD知识并鼓励关于肾脏健康的对话。提高患者对CKD管理的激活度可能需要多层次、纵向的干预措施，以促进患者与临床医生团队之间关于肾脏健康的持续对话。
