Randomized clinical trial of the KH4L self-management program

Chronic kidney disease (CKD) imposes physical, psychological, and social burdens. While self-management is essential in CKD, many existing interventions lack theoretical grounding and patient co-design. The Kidney Health 4 Life (KH4L) program was developed to address these gaps via a modular, online, peer-supported self-management intervention.

This open-label, single-blind, parallel group randomized controlled trial recruited Australian adults with CKD. Participants were randomized 1:1 to receive the KH4L intervention or standard care. The intervention consisted of six self-paced online modules, health coaching, and peer support. The primary outcome was self-management capability. Secondary outcomes included self-efficacy, knowledge, and psychological wellbeing. Outcomes were assessed at baseline, 6 weeks, and 18 weeks post baseline. Linear mixed models were utilized for quantitative outcomes and qualitative feedback was analysed using simple thematic analysis.

Of 394 enrolled, 383 were included in the analysis. There was no significant change in the primary outcome of total self-management scores. However, the intervention group showed significant improvements in problem solving (P = .009), self-efficacy (P = .048), and CKD-related knowledge (P = .017). Mixed results were seen with the psychological outcomes with depression scores improving more in the control group (P = .043) and no improvement in anxiety. Subgroup analyses indicated greater benefits for those accessing CKD-specific modules compared to dialysis-specific content, possibly due to smaller sample size.

KH4L improved some self-management outcomes in people with CKD. The findings highlight the value of tailored, stage-specific digital interventions and suggest theory-informed programs can improve self-efficacy and knowledge. Further research is needed to optimize engagement and ascertain long-term impacts.