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Mobile health (mHealth) management is an emerging strategy of care for patients with chronic diseases. However, the effect of mHealth management on clinical outcomes of patients with chronic kidney disease (CKD) has not been well-studied. The aim of this study was to investigate the additional influence of mHealth on disease knowledge and self-care behavior in CKD patients who had received traditional education. We designed and developed a new healthcare mobile application, called iCKD, which has several major features, including home-based physiological signal monitoring, disease health education, nutrition analysis, medication reminder, and alarms and a warning system. Trained nurses interviewed patients with CKD using structured questionnaires of disease knowledge and self-care behavior. After propensity score matching, we analyzed 107 patients who used iCKD and traditional education, and 107 who received traditional education. The patients who used iCKD had higher disease knowledge scores than those who received traditional education. In multivariate analysis, iCKD was significantly and positively associated with disease knowledge scores. Patients with high education levels could have greater disease knowledge through using mHealth. There was no significant difference in total scores of self-care behavior between the two groups. In conclusion, mHealth can significantly increase disease knowledge in patients with CKD.

Multidisciplinary care can improve the outcomes of chronic kidney disease (CKD), however the contribution of self-care behavior and knowledge about CKD is unclear. This study enrolled 454 participants with CKD stages 1–5 not on dialysis. Structured questionnaires were used to evaluate self-care behavior and kidney disease knowledge. Rapid decline in renal function was defined as the decline in estimated filtration rate > 3 ml/min per 1.73 m2/year within 1-year prior to enrollment. The mean age of all study participants was 65.8 ± 12.1 years and 55.9% were male. The elderly had better self-care behavior while younger participants had better disease knowledge. Both high self-care and high disease knowledge scores were significantly associated with and had a synergistic effect on decreasing the risk of rapid decline in renal function. CKD patients with better self-care behavior and better kidney disease knowledge had lower risk of rapid decline in renal function.

BACKGROUND Mobile health (mHealth) management is an emerging strategy of care for patients with chronic diseases. mHealth has developed considerably over recent years, and it has been shown to promote communication between healthcare professionals and patients to improve the early detection of a worsening health status. However, the effect of mHealth management on clinical outcomes of patients with chronic kidney disease (CKD) has not been well-studied. OBJECTIVE The aim of this study was to investigate the additional influence of mHealth on disease knowledge and self-care behavior combined with traditional education compared with only traditional education in patients with CKD. METHODS Kaohsiung Medical University Hospital designed and developed a new healthcare mobile application, called iCKD. The application has several major features, including home-based physiological signal monitoring, disease health education, nutrition analysis, medication reminder, and alarms and a warning system to promote self-care for patients with CKD. Using structured questionnaires of disease knowledge and self-care behavior, trained nurses interviewed patients with CKD who received both mobile and traditional education and those who received only traditional education. After propensity score matching, we analyzed 107 patients who used iCKD and traditional education, and 107 who received traditional education. RESULTS The mean age of all study participants was 63.9±11.5 years, and 59.3 % were male. The patients who used iCKD had higher disease knowledge scores than those who received traditional education (24.6±6.6 v.s. 22.6±5.3, p=0.02). In multivariate analysis, iCKD was significantly and positively associated with disease knowledge scores (β=1.78, p=0.02). Patients with high education level could have greater disease knowledge through using mHealth (β=3.16, p=0.001). However, there was no significant difference in total scores of self-care behavior between the two groups. CONCLUSIONS mHealth can significantly increase disease knowledge in patients with CKD. CLINICALTRIAL

In recent years, improved mobile capacities and mobile-device computing capabilities as well as a maturing mobile-communications infrastructure have combined to promote the development and widespread use of mobile healthcare applications. Mobile healthcare supports the self-management of chronic diseases, enhances healthcare quality, and reduces medical costs. Due to the low rate of iCKD usage in our hospital, we set up a project team that was tasked to improve the rate of iCKD usage among chronic disease patients.To improve the iCKD usage rate from the current 5.8% to 9.3%.Questionnaire-based survey results indicated that the main reasons for the low iCKD usage rate in our hospital were: negative attitudes toward iCKD as a helpful tool in disease management, lack of awareness of the importance of using iCKD, unfamiliarity with how to operate smartphone applications, low numbers of iCKD physician referrals for patients, and slow Internet speeds. The improvement strategy included providing instructions on iCKD use, organizing a practical learning program, designing and printing a mobile healthcare referral form, and holding related events.The rate of iCKD usage increased to 21.3% after the intervention.The project team successfully increased the iCKD usage rate by getting more patients involved in mobile healthcare, which is expected to have a positive impact on the success of patient self-management.提升慢性腎臟病行動醫療照護「腎好APP」使用率.近年由於行動裝置容量和運算能力提升，行動通訊網路基礎建設的成熟，行動醫療照護已成為新興科技的領域。行動醫療照護可支持疾病自我管理、提升照護品質和減少醫療成本。然而，本院實際將行動醫療照護導入臨床，發現「腎好APP」使用率偏低，引發動機組成專案小組。.為了提升「腎好APP」使用率，目標設定現況值由5.8%提升至9.3%。.經問卷調查確立造成「腎好APP」使用率低的主因，為病人不覺得使用「腎好APP」對於疾病管理有幫助、病人不會操作智慧型手機、醫師忘記轉介病人及院內網路速度太慢。改善對策包括提供「腎好APP」衛教工具宣導、舉辦「腎好APP一指通」學習課程、制定「行動醫療照護個案轉介單」等。.專案介入後「腎好APP」使用率提升至21.3%。.本專案小組成功促使更多病人加入行動醫療照護，提高「腎好APP」使用率，進而有效促進病人自我管理行為。.

Chronic kidney disease (CKD) is a global public health issue that is associated with high rates of morbidity and mortality. Self-care behavior has been associated with clinical outcomes in chronic diseases, and adequate self-care behavior may mitigate adverse outcomes. Health literacy may be an important factor associated with self-care. The aim of this study was to examine the relationships between different domains of self-care behavior and health literacy in patients with CKD. This study enrolled 208 patients with CKD stages 1–5 who were not undergoing renal replacement therapy at Kaohsiung Medical University Hospital from April 2019 to January 2020. Health literacy was measured using a multidimensional health literacy questionnaire covering the following five dimensions: accessing, understanding, appraising, and applying health information, and communication/interaction. The CKD Self-Care scale, which is a 16-item questionnaire with five domains including medication adherence, diet control, exercise, smoking behavior, and home blood pressure monitoring was used to assess self-care behavior. Among the 208 patients, 97 had sufficient or excellent health literacy, and 111 had inadequate or limited/problematic health literacy. A higher health literacy score was significantly correlated with greater self-care behavior. Among the five domains of self-care behavior, the patients who had sufficient or excellent health literacy had higher diet, exercise, and home blood pressure monitoring scores than those who had inadequate or limited/problematic health literacy. This study demonstrated that health literacy was significantly and positively correlated with self-care behavior in patients with CKD.

AIM Self-care represents the 'action' element of self-management. This study aimed to use the chronic kidney disease self-care (CKDSC) scale to examine factors associated with self-care and aspects of self-care deficits among CKD patients in Taiwan. METHODS A cross-sectional investigation was conducted using the CKDSC scale with 449 CKD patients in Taiwan. The CKDSC is a 16-item questionnaire with five subscales, including medication adherence, diet control, exercise, smoking behaviours and blood pressure monitoring. Patient demographic and clinical factors taht may affect CKD self-care were analyzed in the multivariable regression models. RESULTS Overall CKDSC scores were significantly higher for women (P = 0.020), older patients (P

Objective To verify self-reported basic and instrumental activities of daily living (IADL) with a disability and the results of performance-based tests (namely the Taiwan performance-based IADL (TPIADL), the 2-minute step test (2MST), the 30-second chair-stand test (30-s CST), and handgrip dynamometer measurement) to identify disability early and assess the associations with functional fitness in patients with advanced chronic kidney disease (CKD). Methods A cross-sectional study of 99 patients with stage 4–5 CKD and 57 healthy elderly adults were recruited. Self-reported measures were used to collect information on basic (Barthel Index) and IADL (Lawton–Brody scale). Objective measures of the TPIADL and functional fitness (2MST, 30-s CST, handgrip dynamometer) were also assessed. Results Only IADL, as detected by the TPIADL, were impaired to a greater extent in the CKD patients than those of healthy elderly adults. Among all the patients with CKD, a greater impairment in the TPIADL remained statistically associated with a lower ability in the 2MST. A one step increase in the 2MST score was significantly associated with an improvement of 0.2 s in the total performance time of the TPIADL. Conclusion Performance-based measures, such as the TPIADL, may detect a functional limitation before it becomes measurable by traditional self-reported basic and IADL scales; functional limitation is mainly associated with cardiac endurance for advanced CKD.

Objectives Patients with chronic kidney disease (CKD) have been found to have cognitive impairment. However, the core features and clinical correlates of cognitive impairment are still unclear. Elevated homocysteine levels are present in CKD, and this is a risk factor for cognitive impairment and vascular diseases in the general population. Thus, this study investigated the core domains of cognitive impairment and investigated the associations of homocysteine level and vascular burden with cognitive function in patients with CKD. Methods Patients with CKD aged ≥ 50 years and age- and sex-matched normal comparisons were enrolled. The total fasting serum homocysteine level was measured. Vascular burden was assessed using the Framingham Cardiovascular Risk Scale. Cognitive function was evaluated using comprehensive neuropsychological tests. Results A total of 230 patients with CKD and 92 comparisons completed the study. Memory impairment and executive dysfunction were identified as core features of cognitive impairment in the CKD patients. Among the patients with CKD, higher serum homocysteine levels (β = -0.17, p = 0.035) and higher Framingham Cardiovascular Risk Scale scores (β = -0.18, p = 0.013) were correlated with poor executive function independently. However, an association with memory function was not noted. Our results showed that an elevated homocysteine level and an increased vascular burden were independently associated with executive function, but not memory, in CKD patients. Conclusions This findings suggested the co-existence of vascular and non-vascular hypotheses regarding executive dysfunction in CKD patients. Meanwhile, other risk factors related to CKD itself should be investigated in the future. Copyright © 2015 John Wiley & Sons, Ltd.

As the prevalence of chronic kidney disease (CKD) increases, it is important to understand the self-care behavior of CKD patients.To construct a CKD self-care scale and evaluate its metric properties.Through literature review and clinical experience, question items were constructed and validated using item analysis. Factors analysis was used to validate the reliability and validity of the resultant questionnaire in a cross-sectional study.Six subscales containing a total of 20 items were extracted from the original CKD self-care scale using item and exploratory factor analysis. After performing three-time model goodness of fit, only five subscales including regular medication (5 items), diet control (4 items), regular exercise (3 items), smoking habits (2 items), and blood pressure management (2 items) were included in the final scale. The total explained variance of the final subscales was 74.96%. The reliability of the scale was examined and found to be satisfactory. Each absolute factor loading value fell between .72 and .94. The Cronbach's alpha for the overall scale was .83 and those for the five subscales were .83, .83, .94, .81, and .87, respectively.Appropriate assessment tools that allow CKD health educators to evaluate the self-care behaviors of patients effectively are needed. The valid and reliable CKD self-care scale that was developed in the present study is able to assist CKD health educators to quickly evaluate the self-care behavior of patients and to make appropriate health plans.慢性腎臟病人自我照顧行為量表之發展與信效度檢定.隨著慢性腎臟病盛行率之增加，了解慢性腎臟病人的自我照顧行為是一個重要的議題。.發展及驗證慢性腎臟病人自我照顧行為量表之信度與效度。.採橫斷性研究，先依文獻查證及臨床經驗擬定量表的題項，再透過項目分析、探索性因素分析及驗證性因素分析，來檢測及建構量表之信、效度。.本量表經驗證性因素分析將此六因素進行三次模式配適度分析，最後結果共萃取五個因素，分別為：規律服藥、飲食控制、規律運動、吸菸習慣及監測血壓共16題，其為本量表最佳解釋模式（GFI = .91, AGFI = .88, CFI = .92），解釋總變異量為74.96%。因素負荷量介於 .72~.94，總量表及五個次量表的內在一致性Cronbach's α分別為 .83、.83、.83、.94、.81及. 87，皆達可接受範圍。.慢性腎臟病衛教人員需應用適當的工具，得以有效評估病人的自我照顧行為。本研究建構經驗證後具信、效度的慢性腎臟病自我照顧行為量表，可以協助臨床專業人員進行簡單而快速的評估，以提供符合病人個別化的慢性腎臟病照護計畫。.

Patients with chronic kidney disease (CKD) have been found to have cognitive impairment. However, the core features and clinical correlates of cognitive impairment are still unclear. Elevated homocysteine levels are present in CKD, and this is a risk factor for cognitive impairment and vascular diseases in the general population. Thus, this study investigated the core domains of cognitive impairment and investigated the associations of homocysteine level and vascular burden with cognitive function in patients with CKD.Patients with CKD aged ≥ 50 years and age- and sex-matched normal comparisons were enrolled. The total fasting serum homocysteine level was measured. Vascular burden was assessed using the Framingham Cardiovascular Risk Scale. Cognitive function was evaluated using comprehensive neuropsychological tests.A total of 230 patients with CKD and 92 comparisons completed the study. Memory impairment and executive dysfunction were identified as core features of cognitive impairment in the CKD patients. Among the patients with CKD, higher serum homocysteine levels (β = -0.17, p = 0.035) and higher Framingham Cardiovascular Risk Scale scores (β = -0.18, p = 0.013) were correlated with poor executive function independently. However, an association with memory function was not noted. Our results showed that an elevated homocysteine level and an increased vascular burden were independently associated with executive function, but not memory, in CKD patients.This findings suggested the co-existence of vascular and non-vascular hypotheses regarding executive dysfunction in CKD patients. Meanwhile, other risk factors related to CKD itself should be investigated in the future. Copyright © 2015 John WileySons, Ltd.

Patients with chronic kidney disease (CKD) are more readily prone to have impaired physical activity than the general population. The aim of this study is to examine the relationship between physical activity and adverse clinical outcomes and quality of life (QOL) in CKD. One hundred and sixty-one patients with CKD stages 1-5 was enrolled from February 2013 to September 2013 and followed up until June 2016. Physical activity was measured using high handgrip strength, 30-second chair stand, and 2-minute step. The QOL was assessed using the Taiwan version of the World Health Organization Quality of Life-BREF. Clinical outcomes included commencing dialysis, major adverse cardiovascular events (MACEs), and first hospitalization. Of all participants, 1 kgf increase in handgrip strength was significantly associated with 0.13 score increase in total scores of QOL and 0.05 score increase in physical domain of QOL in adjusted analysis. One time increase in 30-second chair stand was significantly correlated with 0.14 score increase in psychological domain of QOL. Over a mean follow-up period of 29.1±11.2 months, 37 (23.0%) reached commencing dialysis, 11(6.8%) had MACEs, and 50(31.1%) had first hospitalization. High handgrip strength (hazard ratio (HR): 0.89, 95% CI: 0.84-0.96) and high 2-minute step (HR: 0.04, 95% CI: 0.01-0.95) were significantly associated with decreased risk for commencing dialysis in multivariate analysis. Thirty-second chair-stand was negatively associated with MACEs (HR: 0.65, 95%CI: 0.47-0.89) and first hospitalization (HR: 0.84, 95%CI: 0.74-0.95). In conclusion, physical activity is a potential predictor of QOL and adverse clinical outcomes in patients with CKD.

Background. Quality of life (QOL) may be associated with morbidity and survival in end-stage renal disease (ESRD), and is considered to be an important outcome measure for patients with chronic kidney disease (CKD). However, the prognostic role of QOL for survival in CKD remains unclear. We studied the relationship between QOL and risks of ESRD and mortality in CKD patients. Methods. From 1 January 2007 to 31 December 2007, we prospectively used the Taiwan version of World Health Organization Quality-of-Life Questionnaire (Taiwan version) (WHOQOL-BREF(TW)) with 568 CKD patients at a medical centre in southern Taiwan, and patients were followed up for 1–2 years after enrollment. The primary outcome was the time to dialysis or death. We used Kaplan–Meier curve and Cox proportional hazard model for survival analyses. Results. Of the 568 patients enrolled, 423 were able to complete the questionnaires, and their data were analysed. The median follow-up time was 410 days. Progressive decreases in scores of QOL in all domains were noted with decrease in eGFR. In unadjusted analysis, dialysis and death were associated with lower scores of total and all four domains of WHOQOL-BREF(TW). In adjusted analysis, the total scores and scores of both physical and psychological domains predicted dialysis and mortality (every 1-point decrease hazard ratio (HR): 1.050, 95% CI: 1.008–1.095, P = 0.020; HR: 1.179, CI: 1.033–1.346, P = 0.014; HR: 1.167, CI: 1.016–1.339, P = 0.028, respectively). The adjusted risks of ESRD and mortality also increased in patients in the lowest tertile of psychological domain (P < 0.01), and physical domain and total scores (P < 0.05). Conclusions. Physical, psychological and total scores of QOL are significantly correlated with increased risks of ESRD and death in CKD patients. QOL should be considered as an independent predictor of risks of ESRD and mortality.