Empowering CKD and Hemodialysis Patients with mHealth: Implementation of the NephroGo App in Europe

Background/Objectives: Chronic kidney disease (CKD) requires intensive dietary and lifestyle management, yet patient engagement and access to tailored education remain limited, particularly outside clinical settings. This study describes the development and implementation of NephroGo, and evaluates its usability, user engagement, and perceived acceptability among patients with CKD. Methods: The app was developed based on clinical and dietary guidelines, incorporating personalized nutrient recommendations, dialysis tracking, and educational content. Technically, it features a Django backend, Flutter mobile frontend, and secure cloud-based hosting. User feedback was collected through one-time interviews (n = 10) and a standardized Mobile App Rating Scale (MARS) survey (n = 32). Longitudinal usage data over four years were also analyzed. Results: Initially, NephroGo was downloaded by 204 users, of whom 93.6% were considered active users based on defined behavioral engagement thresholds. Over a four-year period, the app accumulated a total of 1670 downloads. This study focuses on evaluating user engagement, usability, and perceived acceptability of the NephroGo app over a four-year period. Most users were female (52.3%) and aged 30-65. Stage 5 CKD patients and those undergoing peritoneal dialysis (PD) had the highest engagement. The most-used feature was the personalized nutrition calculator, with sodium being the most frequently exceeded nutrient. The average MARS score was 4.09 ± 0.66, with functionality rated highest (4.27 ± 0.74). App ratings were significantly higher among users referred by physicians (p = 0.039). Conclusions: NephroGo offers a scalable digital tool to support dietary management and health monitoring, with potential to complement standard nephrology care in a resource-conscious manner.