Multidisciplinary Team versus a "Phosphate-Counting" App for Serum Phosphate Control: A Randomized Controlled Trial.

Area of Science:

• Nephrology
• Biochemistry
• Digital Health

Background:

• Hyperphosphatemia is common in end-stage kidney disease (ESKD) patients on dialysis due to dietary phosphate intake exceeding removal.
• Current phosphate binder dosing is fixed, potentially not aligning with variable meal phosphate content.
• This mismatch can lead to challenges in managing serum phosphate levels.

Purpose of the Study:

• To evaluate if an app (OkKidney) matching phosphate binder dosage to food phosphate content improves serum phosphate control in ESKD patients.
• To assess if the app reduces calcium carbonate intake compared to standard care.
• To compare the app's efficacy against a multidisciplinary renal team approach.

Main Methods:

• Eighty ESKD patients on peritoneal dialysis were randomized to either standard care (multidisciplinary renal team) or the OkKidney app.
• Serum phosphate was monitored monthly for 3 months.
• Phosphate management was adjusted by the team or the app's algorithm based on lab values.

Main Results:

• At 3 months, serum phosphate levels were similar between the control (1.96 mmol/L) and intervention (1.85 mmol/L) groups (P=0.30).
• The median daily elemental calcium carbonate dose did not differ significantly between groups at study completion (P=0.29).
• The OkKidney app demonstrated comparable serum phosphate control to the standard of care.

Conclusions:

• The OkKidney app provided similar serum phosphate control to the standard multidisciplinary renal team approach.
• The app did not prove superior to standard care in managing hyperphosphatemia in this ESKD cohort.
• Further research may explore optimizing app-based interventions for phosphate management.