Abstract
Background: The purpose of this study was to observe the impact of an internet-based management system on the incidence of intradialytic hypotension (IDH) and muscle cramps in hemodialysis patients. Methods: The patients, who underwent maintenance hemodialysis in the center from January 2018 to June 2020, were recruited and divided into the pre-intervention group (before operation of the internet-based hemodialysis management system, from January 2018 to December 2018) and intervention group (after operation of the system, from June 2019 to June 2020). The clinical outcomes were compared between groups. Results: The compound endpoint of >1 IDH or muscle cramps happened in 182 patients (61.7%) in the pre-intervention group and 99 participants (30.8%) in the intervention group (relative risk [RR] = 0.50 [95% confidence interval [CI], 0.42; 0.60]). IDH occurred in 122 patients (1–5 episodes in 47 patients, 6–10 episodes in 25 patients, and >10 episodes in 50 patients) and 33 patients (30 patients had 1–5 episodes and 3 patients had 6–10 episodes) before and after execution of the internet-based management system, respectively (RR = 0.25 [95% CI, 0.18; 0.35]). The incidence of muscle cramps was significantly decreased (RR = 0.57 [95% CI, 0.45; 0.73]) after the implementation of the system, and the number of patients with 6–10 episodes dropped from 10 to 1. Multivariate analyses also showed significantly lower RRs in the intervention group: 0.29 ([95% CI, 0.20; 0.41]) for IDH and 0.58 ([95% CI, 0.45; 0.74]) for muscle cramps. Compared with the pre-intervention, participants in the intervention group had a large improvement in self-management (p < 0.001) and self-efficacy (p < 0.001). Conclusion: The study found that the internet-based hemodialysis management system was effective in reducing the IDH and muscle cramp events and improving self-management. It provided a significant implication for the development and application of internet-based programs in hemodialysis management.
References
1.
Chou
JA
, Streja
E
, Nguyen
DV
, Rhee
CM
, Obi
Y
, Inrig
JK
, Intradialytic hypotension, blood pressure changes and mortality risk in incident hemodialysis patients
. Nephrol Dial Transplant
. 2018 Jan 1
;33
(1
):149
–59
. .2.
Moledina
DG
, Perry Wilson
F
. Pharmacologic treatment of common symptoms in dialysis patients: a narrative review
. Semin Dial
. 2015 Jul–Aug
;28
(4
):377
–83
. .3.
K/DOQI Workgroup
. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients
. Am J Kidney Dis
. 2005 Apr
;45
(4 Suppl 3
):S1
–153
.4.
Kooman
J
, Basci
A
, Pizzarelli
F
, Canaud
B
, Haage
P
, Fouque
D
, EBPG guideline on haemodynamic instability
. Nephrol Dial Transplant
. 2007 May
;22
(Suppl 2
):ii22
–44
. .5.
Watanabe
Y
, Kawanishi
H
, Suzuki
K
, Nakai
S
, Tsuchida
K
, Tabei
K
, Japanese society for dialysis therapy clinical guideline for “Maintenance hemodialysis: hemodialysis prescriptions”
. Ther Apher Dial
. 2015 Mar
;19
(Suppl 1
):67
–92
. .6.
Gullapudi
VRL
, Kazmi
I
, Selby
NM
. Techniques to improve intradialytic haemodynamic stability
. Curr Opin Nephrol Hypertens
. 2018 Nov
;27
(6
):413
–9
. .7.
Wild
MG
, Wallston
KA
, Green
JA
, Beach
LB
, Umeukeje
E
, Wright Nunes
JA
, The perceived medical condition self-management scale can be applied to patients with chronic kidney disease
. Kidney Int
. 2017 Oct
;92
(4
):972
–8
. .8.
Rosenthal Asher
D
, Ver Halen
N
, Cukor
D
. Depression and nonadherence predict mortality in hemodialysis treated end-stage renal disease patients
. Hemodial Int
. 2012 Jul
;16
(3
):387
–93
. .9.
Griva
K
, Nandakumar
M
, Ng
JH
, Lam
KFY
, McBain
H
, Newman
SP
. Hemodialysis self-management intervention randomized trial (HED-SMART): a practical low-intensity intervention to improve adherence and clinical markers in patients receiving hemodialysis
. Am J Kidney Dis
. 2018 Mar
;71
(3
):371
–81
. .10.
Bergrath
S
, Brokmann
JC
, Beckers
S
, Felzen
M
, Czaplik
M
, Rossaint
R
. Implementation of a full-scale prehospital telemedicine system: evaluation of the process and systemic effects in a Pre-Post Intervention Study
. BMJ Open
. 2021 Mar 24
;11
(3
):e041942
. .11.
McDonnell
JM
, Ahern
DP
, Ross
TD
, Gibbons
D
, Synnott
KA
, Butler
JS
. The efficacy of remote virtual care in comparison to traditional clinical visits for elective orthopaedic patients: a meta-analysis of prospective randomised controlled trials
. Surgeon
. 2021 Mar 21
.12.
Liang
G
, Jiang
H
, Huang
C
, Que
X
, Tang
J
, Lu
J
, Diabetes health management strategy based on internet plus graded diagnosis and treatment strategy
. Ann Palliat Med
. 2020 Nov
;9
(6
):3915
–22
. .13.
Gohir
SA
, Eek
F
, Kelly
A
, Abhishek
A
, Valdes
AM
. Effectiveness of internet-based exercises aimed at treating knee osteoarthritis: the iBEAT-OA randomized clinical trial
. JAMA Netw Open
. 2021 Feb 1
;4
(2
):e210012
. .14.
Kastner
M
, Makarski
J
, Hayden
L
, Hamid
JS
, Holroyd-Leduc
J
, Twohig
M
, Effectiveness of an eHealth self-management tool for older adults with multimorbidity (KeepWell): protocol for a hybrid effectiveness-implementation randomised controlled trial
. BMJ Open
. 2021 Feb 17
;11
(2
):e048350
. .15.
Labovitz
DL
, Shafner
L
, Reyes Gil
M
, Virmani
D
, Hanina
A
. Using artificial intelligence to reduce the risk of nonadherence in patients on anticoagulation therapy
. Stroke
. 2017 May
;48
(5
):1416
–9
. .16.
Lo
WLA
, Lei
D
, Li
L
, Huang
DF
, Tong
KF
. The perceived benefits of an artificial intelligence-embedded mobile app implementing evidence-based guidelines for the self-management of chronic neck and back pain: Observational Study
. JMIR Mhealth Uhealth
. 2018 Nov 26
;6
(11
):e198
. .17.
Persell
SD
, Karmali
KN
, Stein
N
, Li
J
, Peprah
YA
, Lipiszko
D
, Design of a randomized controlled trial comparing a mobile phone-based hypertension health coaching application to home blood pressure monitoring alone: the Smart Hypertension Control Study
. Contemp Clin Trials
. 2018 Oct
;73
:92
–7
. .18.
Tisler
A
, Akocsi
K
, Borbas
B
, Fazakas
L
, Ferenczi
S
, Gorogh
S
, The effect of frequent or occasional dialysis-associated hypotension on survival of patients on maintenance haemodialysis
. Nephrol Dial Transplant
. 2003 Dec
;18
(12
):2601
–5
.19.
National Kidney Foundation
. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease
. Am J Kidney Dis
. 2003 Oct
;42
(4 Suppl 3
):S1
–201
.20.
China Medical Association Nephrology Branch Hemodialysis Adequacy Cooperation Group
. Clinical practice guide on adequate blood purification in China
. Natl Med J China
. 2015 Sep
;95
(34
):2748
–53
.21.
Flythe
JE
, Curhan
GC
, Brunelli
SM
. Disentangling the ultrafiltration rate-mortality association: the respective roles of session length and weight gain
. Clin J Am Soc Nephrol
. 2013 Jul
;8
(7
):1151
–61
. .22.
Liang
OS
, Chen
Y
, Bennett
DS
, Yang
CC
. Identifying self-management support needs for pregnant women with opioid misuse in online health communities: mixed methods analysis of web posts
. J Med Internet Res
. 2021 Feb 4
;23
(2
):e18296
. .23.
McManus
RJ
, Little
P
, Stuart
B
, Morton
K
, Raftery
J
, Kelly
J
, Home and online management and evaluation of blood pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial
. BMJ
. 2021 Jan 19
;372
:m4858
. .24.
Perez-Aldana
CA
, Lewinski
AA
, Johnson
CM
, Vorderstrasse
AA
, Myneni
S
. Exchanges in a virtual environment for diabetes self-management education and support: social network analysis
. JMIR Diabetes
. 2021 Jan 25
;6
(1
):e21611
.25.
Bivia-Roig
G
, Blasco-Sanz
R
, Boldo-Roda
A
, Vara
MD
, Escriva-Martinez
T
, Herrero
R
, Efficacy of an internet-based intervention to promote a healthy lifestyle on the reproductive parameters of overweight and obese women: study Protocol for a Randomised Controlled Trial
. Int J Environ Res Public Health
. 2020 Nov 10
(22
):17
.26.
Lokker
C
, Jezrawi
R
, Gabizon
I
, Varughese
J
, Brown
M
, Trottier
D
, Feasibility of a web-based platform (trial my app) to efficiently conduct randomized controlled trials of mHealth apps for patients with cardiovascular risk factors: protocol for evaluating an mHealth app for hypertension
. JMIR Res Protoc
. 2021 Feb 1
;10
(2
):e26155
. .27.
Agarwal
R
, Flynn
J
, Pogue
V
, Rahman
M
, Reisin
E
, Weir
MR
. Assessment and management of hypertension in patients on dialysis
. J Am Soc Nephrol
. 2014 Aug
;25
(8
):1630
–46
. .28.
Sars
B
, van der Sande
FM
, Kooman
JP
. Intradialytic hypotension: mechanisms and outcome
. Blood Purif
. 2020
;49
(1–2
):158
–67
. .29.
Dasgupta
I
, Farrington
K
, Davies
SJ
, Davenport
A
, Mitra
S
. UK national survey of practice patterns of fluid volume management in haemodialysis patients: a need for evidence
. Blood Purif
. 2016
;41
(4
):324
–31
. .30.
Dimitrov
DV
. Medical internet of things and big data in healthcare
. Healthc Inform Res
. 2016 Jul
;22
(3
):156
–63
. .31.
Kang
M
, Park
E
, Cho
BH
, Lee
KS
. Recent patient health monitoring platforms incorporating internet of things-enabled smart devices
. Int Neurourol J
. 2018 Jul
;22
(Suppl 2
):313
–82
. .32.
McIntyre
D
, Havas
K
, Bonner
A
. Monitoring for intradialytic hypotension: an audit of nursing practice
. J Ren Care
. 2021 Mar
;47
(1
):27
–33
.33.
Carlos
RC
, Kahn
CE
, Halabi
S
. Data science: big data, machine learning, and artificial intelligence
. J Am Coll Radiol
. 2018 Mar
;15
(3 Pt B
):497
–8
. .34.
Fitzgerald
RC
. Big data is crucial to the early detection of cancer
. Nat Med
. 2020 Jan
;26
(1
):19
–20
. .© 2021 S. Karger AG, Basel
2021
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
