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Lifestyle Interventions Delivered by eHealth in Chronic Kidney Disease: A Scoping Review

Ffion Curtis, James O. Burton, Ayesha Butt, Harsimran K. Dhaliwal, Matthew M.P. Graham-Brown, Courtney J. Lightfoot, Rishika Rawat, Alice C. Smith, Thomas J. Wilkinson, Daniel S. March

A method of overcoming barriers associated with implementing lifestyle interventions in CKD may be through the use of eHealth technologies. The aim of this review was to provide an up-to-date overview of the literature on this topic. Four bibliographical databases, two trial registers, and one database for conference proceedings were searched from inception to August 2023. 

Studies were eligible if they reported a lifestyle intervention using eHealth technologies. A narrative synthesis of the findings from the included studies structured around the type of eHealth intervention was presented. Where a sufficient number of studies overlapped in terms of the type of intervention and outcome measure these were brought together in a direction of effect plot.

For individuals living with chronic kidney disease (CKD), having a healthy lifestyle (e.g. being physically active, consuming a healthy diet, and not smoking) can slow disease progression and reduce both cardiovascular risk and all-cause mortality [1–3]. For these reasons adopting a healthy lifestyle is recommended by clinical practice guidelines for this population [4–6]. 

These recommendations are supported by recent randomised controlled trial (RCT) data showing that a 36-month lifestyle intervention doubled the number of individuals with CKD who were able to meet physical activity guidelines [7]. Despite this evidence, there are no interventions to promote a healthy lifestyle embedded as part of normal clinical care for individuals living with CKD.

Materials and Methods
A scoping review was chosen as there has been a growth in eHealth interventions since the COVID-19 pandemic, therefore we wished to provide an overview from the existing literature on the mode and effect of delivery of these technologies in the lifestyle context within the CKD population.

There was one study in Korean [23], which contributed only limited information [24] (S2 Table). Seven trial registrations were excluded from the narrative synthesis as they did not contain enough information (S2 Table). Two articles [25, 26] reported the same study but in different journals, and a further trial was published as two reports in the same journal.

This is the first review that has aimed to scope the available literature to understand the type of eHealth interventions that have been employed to deliver lifestyle interventions in the CKD population. The majority were mobile applications which included both dietary and physical activity components. There was also a number of interventions that used SMS messages, videoconferencing, virtual reality and web-based platforms to deliver lifestyle interventions. There was considerable heterogeneity with regards to the study outcomes reported. 

These eHealth interventions appeared acceptable and feasible to participants with some tentative evidence that mobile applications may have an effect on blood pressure, intradialytic weight gain, potassium and sodium, although these effects were not observed in all included reports and are therefore far from definitive.

The use of eHealth interventions will only grow and there is likely be a move towards new technologies (such as artificial intelligence and virtual reality). However, currently there is insufficient evidence to make recommendations for specific lifestyle eHealth interventions to be implemented into clinical care in the CKD populations. Properly powered RCTs which not only demonstrate efficacy, but also address barriers to implementation are needed to enhance widespread adoption.

Citation: Curtis F, Burton JO, Butt A, Dhaliwal HK, Graham-Brown MM, Lightfoot CJ, et al. (2024) Lifestyle interventions delivered by eHealth in chronic kidney disease: A scoping review. PLoS ONE 19(1): e0297107.

Editor: Henry H.L. Wu, Kolling Institute of Medical Research, The University of Sydney, AUSTRALIA
Received: September 11, 2023; Accepted: December 22, 2023; Published: January 24, 2024

Copyright: © 2024 Curtis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist