Transforming CKD Management: Leveraging Digital Solutions for Enhanced Care and Patient Outcomes - Wellthy Therapeutics

Transforming CKD Management: Leveraging Digital Solutions for Enhanced Care and Patient Outcomes

Picture of adult hands holding a paper cutout of kidneys., Accompanied by the Title of the Position Paper: "Transforming CKD Management: Leveraging Digital Solutions for Enhanced Care and Patient Outcomes"

Abstract

Chronic kidney disease (CKD) is a global health issue with increasing prevalence and significant associated morbidity and mortality. The burden of chronic disease is rapidly rising on a global scale. The management of the disease is complicated by comorbid conditions like hypertension, diabetes, and hyperlipidemia, which leaves unmet patient needs. The high symptom burden, inadequate symptom management, and challenges in systematic symptom assessment create hurdles in delivering optimal care for CKD patients. Mental health and social support are also essential considerations, given the impact of cerebrovascular disease on cognitive and emotional functioning. Despite significant advancements in CKD management, there are still several areas where patients’ needs are not adequately addressed. This article emphasizes the importance of early detection and diagnosis, symptom management, addressing mental health, social support, and improving treatment options for CKD patients.

Early detection and diagnosis of CKD are highly helpful for preventing adverse health outcomes. Disease progression prediction and the development of prevention strategies tailored to high-risk populations are necessary to reduce the prevalence of CKD. Additionally, balancing the strict dietary restrictions in CKD with preserving the quality of life and addressing the psychological well-being of patients are important considerations. By overcoming these obstacles, digital technologies can play a significant role in improving disease management. Digital solutions have the potential to address the unmet needs in CKD care. Personalized and individualized care plans, medication adherence tools, and dietary management features can enhance CKD management and improve patient outcomes. However, there are challenges to overcome, including gaps in personalized care, integration with healthcare systems, data privacy concerns, and limited availability.

In conclusion, a comprehensive approach is needed to address the challenges and unmet needs of CKD patients. Digital solutions, when properly developed and integrated, have the potential to fill the gaps in CKD care and improve patient outcomes, ultimately enhancing the quality of life for individuals living with CKD.

Introduction:

Chronic kidney disease (CKD) is a significant global health issue with a high prevalence.CKD has emerged as one of the leading causes of mortality worldwide, and It’s one of the non-communicable diseases that have shown an increase in associated deaths over the past 2 decades.CKD is more prevalent in older individuals, women, racial minorities, and in people experiencing diabetes mellitus and hypertension. [1]

The global all-age CKD prevalence has increased by nearly 30% since 1990, with current prevalence estimates giving an approximate range between 8% and 16%. [2] CKD often develops as a result of underlying conditions, most commonly type 2 diabetes and hypertension.[3] Patients with CKD have an increased risk of adverse renal and cardiovascular morbidity, as well as increased all-cause mortality [4] As such, CKD is associated with significant healthcare expenditure.

Some of the challenges people with CKD endure are 

  • Over 70% of CKD patients have at least one comorbidity, with hypertension and diabetes mellitus being the most common. This complicates the management of CKD.[5]
  • Complications from Kidney Failure such as anemia, metabolic acidosis, and electrolyte disorders, make CKD care more complex.[6]
  • There are variations in CKD care models amongst systems, this can lead to inconsistent care and outcomes for patients

Treatments for CKD generally include Medications for hypertension, Medications to control diabetes, Anemia management, Dietary modifications, Fluid Management, Dialysis and Kidney Transplantations.

Detection and Diagnosis of CKD in patients:

There are five stages of chronic kidney disease as shown in the table below.[7]

Five stages of Chronic Kidney Disease

Symptoms for CKD[8]

Fatigue and Weakness:

Feeling tired or weak is a common symptom of CKD, which can be attributed to the buildup of waste products in the body.

Changes in urination:

CKD can affect the frequency, color, and volume of urine. Some common changes include increased urination (especially at night), foamy urine, blood in the urine, or decreased urine output.

Fluid Retention:

As the kidneys fail to remove excess fluid from the body, individuals with CKD may experience swelling in the legs, ankles, feet, or face. They may also have sudden weight gain due to fluid retention.

Shortness of breath:

Fluid accumulation in the lungs can lead to shortness of breath or difficulty breathing.

Persistent itching:

The buildup of waste products in the blood can cause severe itching, often affecting the legs and back.

Loss of Appetite and Weight loss:

Individuals with CKD may experience a decreased appetite, leading to unintentional weight loss.

Muscle cramps and Twitches:

Electrolyte imbalances, such as low levels of calcium or potassium, can lead to muscle cramps, twitches, or weakness

Nausea and vomiting:

CKD can affect the digestive system, causing nausea, vomiting, and a metallic taste in the mouth

Trouble concentrating and cognitive changes:

CKD can affect brain function and lead to difficulty concentrating, memory problems, and overall cognitive changes.

Comorbidities for CKD patients [9] 

CKD is often associated with a number of comorbidities, which can significantly impact the health and quality of life of patients. These comorbidities include:

Hypertension:

Hypertension is a common comorbidity in CKD patients, with an average prevalence of 66.4%. CKD combined with other cardiovascular risk factors accelerates atherosclerosis and increases stroke risk in the predialysis stages. Medial calcifications, which occur frequently in patients with CKD, are associated with abnormal cushioning function of blood vessels and increased arterial stiffness.

Diabetes:

Diabetes is another prevalent comorbidity, with an average prevalence of 33.2%. CKD is often associated with hypertension and high atrial pressure, as well as activation of the renin-angiotensin-aldosterone system (RAAS). Angiotensin II can promote atrial fibrosis, increase atrial pressure, and modulate ion channels, all of which are involved in structural and electrical remodeling of the atria, thus resulting in AF.

Hyperlipidemia:

Hyperlipidemia is present in an average of 11.4% of CKD patients. Patients with proteinuria, a hallmark of CKD, have a 71% greater risk of stroke compared to those without, as proteinuria is strongly associated with hypertension and other cardiovascular risk factors.

Cerebrovascular disease:

Cerebrovascular disease is a significant concern for CKD patients, with an average prevalence of 6.2%. CKD affects both brain structure and function, leading to a higher risk of both ischemic and hemorrhagic strokes. CKD significantly worsens stroke outcomes, and patients with stage 3-5 CKD have worse survival prognosis, greater neurological deficit following ischemic zone, and poor functional outcomes following stroke.  

Multimorbidity is more common among CKD populations. Research shows that a high degree of comorbidity was associated with poorer outcomes, such as all-cause mortality, hospitalization, and increased length of hospital stay.

Unmet Patient needs:

CKD patients often grapple with a multitude of health challenges that extend beyond their primary diagnosis. The presence of comorbidities such as hypertension, diabetes, hyperlipidemia,and CVD can significantly compound these challenges, leading to a host of unmet patient needs, Here’s how:

Improved Symptom Management:

The high symptom burden experienced by CKD patients, such as excessive tiredness, sleep disturbance, and pain in the bones and joints, can be exacerbated by comorbidities like hypertension, diabetes, and cerebrovascular disease. The management of these symptoms is often inadequate, leading to an unmet need for better symptom management strategies.

Systematic Symptom Assessment:

The presence of multiple comorbidities in CKD patients makes symptom assessment more complex. There is a need for more systematic approaches to symptom assessment that take into account the various comorbidities that CKD patients may have.

Addressing Mental Health & social support:

Comorbidities such as cerebrovascular disease can lead to cognitive impairment and emotional dysfunction, highlighting the need for better mental health and social support for CKD patients

Better Treatment Options:

The presence of comorbidities like hypertension, diabetes, and hyperlipidemia can complicate the treatment of CKD. Current renoprotective pharmacotherapies are only partially effective, and there is a need for continued research to find new agents with new mechanisms of action that may lead to more effective therapy for patients with CKD and its comorbidities

Early Detection and Diagnosis:

Before the disease reaches an advanced stage, CKD frequently advances silently with few obvious signs. Better methods are required to detect CKD at an earlier stage, enabling prompt treatment and care to halt the disease’s progression. Besides, CKD is often diagnosed too late, making it hard to prevent adverse health outcomes for patients. Yet the disease can be slowed or even averted if diagnosed early.

Disease Progression Prediction:

Predicting the rate of disease progression is quite a challenging  factor.More precise methods and biomarkers might be helpful for determining a person’s risk of a sudden drop in kidney function. 

Prevention Strategies:

Although several CKD risk factors, such as diabetes and hypertension, are well known, there are still limited effective preventative measures available. Particularly in high-risk populations, there is a need for tailored preventative measures that can lower the prevalence of CKD.

Quality of life:

The strict dietary restrictions in CKD can affect the quality of life of patients.A difficulty that needs to be addressed is the way to balance the nutritional requirements of CKD with preserving quality of life and psychological well-being.

Risk Stratification and Predictive Models:

CKD is a heterogeneous condition with varying rates of disease progression and outcomes. Developing accurate risk stratification models and predictive algorithms could help identify high-risk individuals, guide treatment decisions, and optimize resource allocation in CKD management. These unmet needs highlight the importance of a comprehensive approach to the care of CKD patients that not only addresses the kidney disease itself but also its associated comorbidities.

Wellthy Therapeutics Digital Solutions for CKD Care

Despite the availability of numerous digital apps for kidney disease management, significant gaps persist. These include a lack of personalized care, poor integration with healthcare systems, absence of real-time feedback, and inadequate lifestyle interventions. User experience often falls short, impacting engagement. Other challenges include data privacy concerns, limited availability, lack of clinical validation, and regulatory hurdles, all limiting their adoption and effectiveness.

Wellthy Therapeutics can help here by creating a comprehensive SaMD solution to address the unmet needs of CKD patients by:

  • Personalization and Individualized Care:

Wellthy Therapeutics can leverage its digital platform to provide personalized care plans tailored to individual patients. By considering factors such as the patient’s disease stage, underlying causes,  and preferences, the SaMD can offer a highly individualized approach to CKD management.

  • Comorbidity management:

Comorbidity management in CKD requires a multidisciplinary approach. Regular monitoring, patient education, Lifestyle Modification Support, and patient education are essential to effectively manage comorbidities and optimize patient outcomes in chronic kidney disease. Effectively managing these comorbid conditions is essential to improve patient outcomes, slow disease progression, and enhance the overall quality of life. 

  • Medication adherence:

Tools for medication adherence can be incorporated into digital solutions, such as notifications, tracking, and reminder systems. These characteristics make it easier for patients to take their prescriptions as directed, which is essential for treating CKD and avoiding problems.

Dietary Management and Nutrition Tracking:  Patients with CKD can track their nutritional intake, including salt, potassium, phosphorus, and fluid intake, using digital tools and mobile applications. To assist patients in selecting foods that adhere to their particular dietary restrictions, these solutions can offer personalized recommendations

Conclusion:

Addressing the complex challenges and unfulfilled needs of patients with chronic kidney disease (CKD) requires a comprehensive, tailored approach that embraces patient-centricity. Given the various issues faced by CKD patients, such as symptom management, concurrent conditions, and quality of life, the need for solutions that deliver customized care and empower patients is pressing.

Digital health interventions like the ones provided by Wellthy Therapeutics offer promising avenues to meet these needs. By delivering personalized care, facilitating comorbidity management, and offering tools for medication adherence, these digital solutions create an empowering platform for enhanced patient self-management. Moreover, they enable dietary and nutrition tracking, a crucial aspect for CKD patients, and cater to the demand for a holistic approach to manage multiple facets of the disease concurrently.

Yet, the full potential of these tools can only be unlocked if we ensure they are seamlessly integrated into healthcare systems and receive wide acceptance from both patients and healthcare professionals. Therefore, it becomes imperative that we address and overcome barriers such as data privacy, limited availability, and regulatory challenges.

In conclusion, the use of digital solutions presents an exciting opportunity to redefine CKD care. By bridging existing gaps in CKD management and augmenting traditional healthcare services, digital interventions could substantially improve patient outcomes, enhance the quality of life for individuals living with CKD, and foster more effective, patient-centered healthcare strategies amidst this global health predicament.

References : 

  1. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011) Apr. 2022;12(1):7-11. doi: 10.1016/j.kisu.2021.11.003, PMID 35529086.
  2. Global, regional, and national burden of chronic kidney disease. 1990-2017: a systematic analysis for the Global Burden of Disease Study;2017.
  3. Tangri N, Chadban S, Cabrera C, Retat L, Sánchez JJG. Projecting the epidemiological and economic impact of chronic kidney disease using patient-level microsimulation modelling: rationale and methods of inside CKDNavdeep, 1. Adv Ther. 2023;40(1):265-81. doi: 10.1007/s12325-022-02353-5, PMID 36307575.
  4. Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular disease in chronic kidney disease: pathophysiological insights and therapeutic options. Circulation. 2021 Mar 16;143(11):1157-72. doi: 10.1161/CIRCULATIONAHA.120.050686. PMID 33720773, PMCID PMC796916.
  5. Cha J, Han D. Health-related quality of life based on comorbidities among patients with end-stage renal disease. Osong Public Health Res Perspect. 2020 Aug;11(4):194-200. doi: 10.24171/j.phrp.2020.11.4.08, PMID 32864310, PMCID PMC7442444.
  6. Arif H. Complications of chronic kidney disease: electrolyte and acid-base disorders. In: McCauley J, Hamrahian SM, Maarouf OH, editors. Approaches to chronic kidney disease. Cham: Springer; 2022. doi: 10.1007/978-3-030-83082-3_12.
  7.  Stages of CKD – Healthline
  8. .Chronic kidney disease – Symptoms and causes – Mayo Clinic
  9. MacRae C, Mercer SW, Guthrie B, Henderson D. Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care. Br J Gen Pract. 2021 Feb 25;71(704):e243-9. doi: 10.3399/bjgp20X714125, PMID 33558333, PMCID PMC7888754.
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