The prevalence of chronic kidney disease (CKD), particularly end-stage renal disease (ESRD), has been steadily growing. Managing conditions like kidney and heart disease effectively relies heavily on adhering to medical recommendations regarding diet, especially limiting the intake of certain nutrients. Information technology (IT) tools have emerged as effective resources to empower patients through monitoring, training, and self-management. A vast array of medical reference materials is available to patients through the internet and mobile apps, offering them a better understanding of their diseases and best practices. These apps can not only reduce costs and burdens on others but can also assist in tracking diet and nutrition, recommend healthy foods nearby, supplement medical intervention through drug information, identify pills, check drug interactions, and record personal medication. They can also estimate kidney function, provide diagnostic tests and information on disease signs and symptoms, function as medical calculators, and help manage the progression of CKD. With the increasing availability of smartphones, numerous mobile applications (apps) related to health and diet have been developed. One-third of these apps focus on specific chronic diseases.
The Rise of Renal Diet Apps
The rise in CKD cases is primarily attributed to increasing health conditions linked to CKD, such as diabetes, hypertension, and obesity, as well as aging. Slowing the disease progression requires significant personal involvement for CKD/ESRD patients. The patients face complex recommendations on medication adherence, lifestyle modification, and nutritional adaptation. Meeting specific nutrition guidelines is particularly challenging for ESRD patients on dialysis. The burdens of complying with these guidelines are considerable, not only for the patients themselves but also for their families and caregivers.
The development of IT tools provides patients with access to numerous apps and portals for health information. A vast array of medical reference materials is available to patients through the internet and mobile apps, offering them a better understanding of their diseases and best practices.
Key Features of Renal Diet Apps
Renal diet apps are designed to assist individuals with kidney disease in making informed dietary choices. If you are facing Chronic Kidney Disease (CKD) or End Stage Renal Disease (ESRD), becoming aware of the sodium, protein, phosphorus, potassium and fluids in your diet is of utmost importance. These apps typically offer a range of features to help users manage their diet effectively.
Nutrient Tracking
KidneyDiet® helps you watch the 3Ps: Phosphorus and Potassium. These apps often focus on nutrients crucial for those on a renal diet, such as protein, potassium, phosphorus, and sodium. Some apps allow users to track their intake of these nutrients, helping them stay within recommended limits.
Read also: Renal Diet Guide: Navigating Orange Juice Consumption
Food Databases
Have you ever wished you could instantly peak at the nutrient content of a food while making weekly menus, grocery shopping or eating out on a kidney diet? KidneyDiet is an iPhone app that allows a quick, easy way to view thousands of foods from the USDA food database, including some of the major restaurant chains. It’s difficult to remember which foods are better for you than others when following a renal diet. So, just type an item into the search field or use the barcode scanner and quickly determine the nutritional counts of a variety of foods. Many apps include extensive food databases with nutritional information, allowing users to quickly look up the nutrient content of various foods. DecideDiet is a free app that allows patients to simply scan a barcode or manually enter the food they are going to eat.
Educational Resources
Watching your nutrient intake and educating yourself about your nutrition needs changes during the course of kidney disease. Many renal diet apps provide educational information about nutrients, kidney disease, and dietary recommendations. After the trial period, you will still have access to the "learning" section of the app which provides educational information about nutrients and you will still be able to search for foods, accessing an extensive database. This can help users better understand their condition and make informed food choices.
Goal Setting and Reminders
The initial assessment of the 12 apps revealed that their interface designs typically include data entry, goal and reminder settings, and graphing and analytics of achievements. In terms of the functions, these apps typically included calorie intake calculation, goal setting, reminders, access to social networks, and game elements such as rewards or competition among users. Some apps allow users to set personalized dietary goals and receive reminders to help them stay on track.
Examples of Renal Diet Apps
Supports Numerous free and low-cost mobile apps for the care management of kidney disease have become available in recent years. Several popular kidney diet apps, including Kidney APPetite, KidneyDiet and Pocket Dietitian have been discontinued or do not work with newer operating systems.
KidneyDiet
KidneyDiet helps people with kidney disease make better dietary choices. KidneyDiet is an iPhone app that allows a quick, easy way to view thousands of foods from the USDA food database, including some of the major restaurant chains. The featured nutrients are focused on those most important in a kidney diet: protein, potassium, phosphorus and sodium. KidneyDiet® helps you watch the 3Ps. Phosphorus. Potassium.
Read also: Kidney-Friendly Cat Food Explained
DecideDiet
A new app created by a UConn physician helps renal patients make smart choices when it comes to diet. DecideDiet is a free app that allows patients to simply scan a barcode or manually enter the food they are going to eat. Users should try to eat at least 75% of their foods in the green and avoid foods in the red. One challenge for DecideDiet and patients with these diseases in general is a lack of data about the phosphorous content of foods.
KDOQI App
Download now to access guidelines and commentaries at your fingertips.
Journal of Renal Nutrition (JRN) app
Keep up with the most important advances in the science and practice of nephrology. The Journal of Renal Nutrition app is available for iOS and Android, bringing you the convenience of reading your favorite articles online or offline.
Gout Central
“Gout Central" empowers patients with the most essential tools and information for controlling gout and protecting their kidneys. Guidance is provided on the optimal use of nutrition, lifestyle, and medication for the prevention and treatment of gout flares.
eGFR Calculator App
Helps medical professionals estimate kidney function using five separate eGFR calculators.
Read also: Comprehensive Guide to Renal Diet Meals
My Kidneys, My Health Handbook
The 3 apps with the highest combined scores were My Kidneys, My Health Handbook (MARS=4.68); The top 2 apps (My Kidneys, My Health Handbook and My Food Coach) demonstrated similar scores for all criteria, except that My Kidneys, My Health Handbook was slightly superior in terms of functionality and aesthetics. The reviewers noted that the app stood out aesthetically with the quality, color coordination, and resolution of the graphics as well as the stylistically consistent interface. The app was also highly interactive and allowed direct access to various support groups.
My Food Coach
My Food Coach (MARS=4.48); My Food Coach received a high score in engagement primarily because of the GPS locator for restaurants and their menus. Similar to My Kidneys, My Health Handbook, it was also highly interactive, supporting access to a registered dietitian.
National Kidney Foundation Malaysia
National Kidney Foundation Malaysia (MARS=4.20). National Kidney Foundation Malaysia generally scored similar to H2O Overload but stood out for its highly interactive nature, allowing users to set specific and measurable goals and providing feedback. This resulted in its high engagement score.
H2O Overload
H2O Overload, the app ranked fourth best (MARS=4.18), was ranked very close to National Kidney Foundation Malaysia. H2O Overload was considered superior to My Food Coach in terms of functionality, whereas it was inferior in all other areas, but especially in terms of engagement and subjective quality.
Evaluating the Quality of Renal Diet Apps
Although these appear to be promising tools, physicians and patients are often overwhelmed with the profusion of these low-cost technologies, which limits their utilization of such innovations. Concurrently, very few apps have a Food and Drug Administration (FDA) clearance or any clinical validation. A systematic review framework was applied to the search, screening, and assessment of apps identified and downloaded from the iOS and Android app stores. We selected apps using 13 relevant search terms, narrowed down based on a set of inclusion and exclusion criteria, and then used the Mobile App Rating Scale (MARS), a widely adopted app evaluation tool to assess the effectiveness of apps. The MARS total score had excellent internal consistency (Cronbach alpha=.90) and a moderate level of interrater reliability (2-way mixed ICC 0.65). Overall, 11 out of the 12 reviewed apps met the minimum acceptable score of 3.0 in MARS rating.
Researchers found that the majority of these apps provided information on food nutrients and composition and served as an educational tool. Some of the apps that were considered good quality and accurate include My Food Coach and H2O Overload from the National Kidney Foundation.
The Mobile App Rating Scale (MARS)
This study used a rigorous assessment framework, known as the Mobile App Rating Scale (MARS), developed by researchers at the Queensland University. Broadly speaking, MARS developed by Stoyanov et al offers a promising evaluation scheme for classifying and rating the quality of mobile health apps. quality scale based on the 20 to 23 items of MARS subcriteria. Although engagement addressed questions such as “is it fun, interesting, customizable, interactive, well-targeted to the audience?,” functionality measured app functioning level, reflecting how easy it is to learn or navigate, flow logic, and gestural design of apps. The score of aesthetics assessed the apps’ graphic design, such as overall visual appeal, color scheme, and consistent style. The quality and quantity of information, credibility of the sources of information, evidence, etc, built the score of information criterion. quality assessed overall satisfaction level and whether the app is worth recommending, stimulates repeat use, etc. To evaluate the final set of apps, 3 reviewers performed scoring for the apps on a 5-point scale, producing a comprehensive final mean score for each app. The internal consistency of the MARS quality subscales and total quality score were calculated using Cronbach alpha. This alpha coefficient indicates the degree (correlations) to which items measuring the same general construct produce similar scores. Interclass correlation coefficients (ICCs) were calculated using 2-way mixed effects for agreement. There were 6 apps that were available on more than 1 device. We used independent scores by each reviewer to calculate ICC. For those 6 apps, reviewers had disagreements in their individual scores.
Key Dimensions of MARS
- Engagement: Is the app fun, interesting, customizable, interactive, and well-targeted to the audience?
- Functionality: How easy is it to learn and navigate the app? Does it have a logical flow and good gestural design?
- Aesthetics: What is the app's graphic design like? Does it have a good visual appeal, color scheme, and consistent style?
- Information: What is the quality and quantity of information provided? Is the information credible and evidence-based?
- Subjective Quality: Does the app provide overall satisfaction? Is it worth recommending and does it stimulate repeat use?
Challenges and Future Directions
One challenge for DecideDiet and patients with these diseases in general is a lack of data about the phosphorous content of foods. Although these appear to be promising tools, they have not been evaluated comparatively based on standard mobile app metrics, and thus, limited evidence is available regarding their efficacy.
Elali has a background training in pediatrics, internal medicine and nephrology. He is the director of the inpatient renal replacement therapy service, and the plasmapheresis unit at UConn Health. The next step for Elali is to conduct a clinical trial of the app to see if its use has a measurable impact on patient health. Physicians already know diet has a tremendous impact on patients’ health outcomes. “Physicians talk about diet a lot, but we don’t have the tools,” Elali says.
Bailey et al systematically reviewed mobile apps available to patients to support outpatient medication self-management and found that hundreds of apps exist in the marketplace with a variety of quality, content, and functions. They recommended that determining optimal capabilities and clinical benefits as well as evaluating the utility of these existing mobile apps are necessary. Although there are studies that assessed the effectiveness of mobile apps supporting DM, mental health, bipolar disorder, suicide prevention, and asthma, those that support dialysis patients have not yet been assessed. Hence, no evidence is currently available regarding the effectiveness of these mobile apps that solely support dialysis patients who indeed follow more stringent diet than others.
To promote accuracy, renal dietitians are encouraged to partake in the development of these apps.