Mobile Apps Show Promise for Improving CKD Medication Adherence

New research is shedding light on the potential utility of mobile apps for improving medication adherence among patients with chronic kidney disease (CKD).1

The systematic review included 9 studies comprising 1023 participants at various stages of CKD management, including hemodialysis, peritoneal dialysis, and post-kidney transplant. Results highlight statistically significant improvements in medication adherence with use of different mobile apps, but low evidence and short intervention duration necessitate further research.1

According to the American Kidney Fund, an estimated 35.5 million people in the US have kidney disease, approximately 815,000 of whom are living with kidney failure. Kidney disease is the fastest-growing noncommunicable disease in the US, and it is not reversible, it is treatable – when caught and treated early, it is often possible to slow or stop the progression of kidney disease and avoid serious complications.2

Medication adherence is a critical aspect of disease management for patients with CKD, but complex medication regimens, forgetfulness, lack of understanding about the importance of adherence, and limited patient-provider communication can all lead to nonadherence and subsequent poor outcomes.1

“Despite the growing body of research on the efficacy of mobile apps in fostering medication adherence for various chronic diseases, there is a noticeable gap in the literature regarding their application in CKD management,” Ganesh Sritheran Paneerselvam, a senior lecturer at Taylor's University in Malaysia, and colleagues wrote.1 “The unique challenges and complexities of CKD warrant a specialized investigation into the role of mobile apps in enhancing medication adherence among this specific patient group.”

To evaluate the effectiveness of mobile apps for improving medication adherence among patients with CKD, investigators systematically searched Scopus, Cochrane, PubMed, and EBSCOhost databases for quantitative studies involving patients with CKD. The primary intervention of interest was mobile apps specifically designed for managing medication adherence in patients with CKD, but investigators included apps with additional functionalities if they addressed this focus.1

Out of 231 relevant articles, 9 studies were selected for systematic review. Of these studies, 4 were conducted in the United States, 2 were conducted in South Korea, and 1 study each was performed in Australia, Iran, and Taiwan. Most (n = 3) were randomized controlled studies, 2 were prospective cohort studies, 2 were quasi-experimental studies, and 2 were observational studies.1

Investigators noted the sample size of the included studies ranged from a minimum of 67 participants to a maximum of 214 participants. Among the total 1023 participants included in the analysis, the mean age was 52.65 (standard deviation, 5.93) years.1

Mobile apps examined in the studies included Transplant Hero, Perx, Smartphone Medication Adherence Saves Kidneys (SMASK), Adhere4U, My Dialysis, Kidney Love, and iCKD, all of which used various strategies to promote medication adherence, including reminders, gamification, patient education, and medication monitoring.1

Of the 9 selected studies, 7 used objective measures of adherence, such as pill counting, coefficient of variability for immunosuppressants, electronic monitoring, and adherence scales. Subjective measures were utilized in 2 studies with self-report questionnaires. One study used 2 objective measures along with self-reporting, while another combined both subjective and objective measures.1

Overall, 5 out of the 9 studies demonstrated ≥ 1 statistically significant (P <.05) measure of medication adherence in patients with CKD due to the intervention of a mobile app. However, investigators called attention to methodological diversity, variations in-app functionalities, and outcome measurement approaches between the studies.1

“The findings of this review underscore the potential of mobile apps to improve medication adherence among patients with CKD, though the impact on clinical outcomes remains an area for further exploration,” investigators concluded.1

References

1. Paneerselvam GS, Lua PL, Chooi WH, et al. Effectiveness of Mobile Apps in Improving Medication Adherence Among Chronic Kidney Disease Patients: Systematic Review. J Med Internet Res. doi:10.2196/53144

2. American Kidney Fund. Quick kidney disease facts and stats. February 11, 2025. Accessed April 18, 2025. https://www.kidneyfund.org/all-about-kidneys/quick-kidney-disease-facts-and-stats