Telemedicine in Advanced Chronic Kidney Disease: Efficacy and Safety of the NORA App. A Multicenter Randomized Trial.

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Telemedicine in Advanced Chronic Kidney Disease: Efficacy and Safety of the NORA App. A Multicenter Randomized Trial.

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Co-author 1

Nestor Toapanta Gaibor nestor.toapanta@vallhebron.cat Vall d'Hebron Hospital Nephrology Barcelona Spain -

Co-author 2

David Cano dcano@nora.bio Vall d'Hebron Institut de Recerca Nora Barcelona Spain -

Co-author 3

Carolina Movilla carolina.movilla@hotmail.com Virgen del Rocio Hospital Nephrology Seville Spain -

Co-author 4

Isabel Galán Carrillo isabelgalancarrillo@gmail.com Reina Sofía Hospital Nephrology Murcia Spain -

Co-author 5

Oana Rap orap@csi.cat Sant Joan Despí Hospital Nephrology Barcelona Spain -

Co-author 6

Mariana Rivera Pérez mariana.rivera.sspa@juntadeandalucia.es Virgen Macarena Hospital Nephrology Seville Spain -

Co-author 7

Cristina Guirao cris.nefrologia.to@gmail.com Vall d'Hebron Hospital Nephrology Barcelona Spain -

Co-author 8

Manuel López Mendoza lolopezmen@gmail.com Virgen del Rocio Hospital Nephrology Seville Spain -

Co-author 9

Serena Gatius gatius_serena@hotmail.com Reina Sofía Hospital Nephrology Murcia Spain -

Co-author 10

Alfonso Lara Ruiz alfonso.lara.sspa@juntadeandalucia.es Virgen Macarena Hospital Nephrology Seville Spain -

Co-author 11

Mercedes Salgueira mercedes.salgueira.sspa@juntadeandalucia.es Virgen Macarena Hospital Nephrology Seville Spain -

Co-author 12

Meritxel Ibernon mibernonv@csi.cat Sant Joan Despí Hospital Nephrology Barcelona Spain -

Co-author 13

Maria Jose Soler Romeo mariajose.soler@vallhebron.cat Vall d'Hebron Hospital Nephrology Barcelona Spain *

Co-author 14

Co-author 15

Introduction

Digital health interventions may improve follow-up and adherence in advanced chronic kidney disease (CKD). The NORA App, initially validated in stroke patients, was adapted for nephrology to assess its impact on clinical and patient-reported outcomes.

Methods

We conducted a multicenter, prospective, randomized clinical trial including 100 patients with advanced CKD, allocated 1:1 to the NORA App (n=45) or standard care (n=55) groups. Follow-up lasted 12 months.

Results

Outcomes included mortality, initiation of renal replacement therapy (RRT), hospitalizations (overall and renal-related), and patient-reported well-being (PROMIS_PH, HADS).Results:Overall mortality was 7% (6.7% NORA vs 7.3% control). Seven patients started RRT (8.9% NORA vs 5.5% control). Forty-three hospitalizations occurred in 29 patients, 15 due to renal causes (10 NORA vs 5 control). Median hospital stay was shorter in the NORA group (8 [4–15] vs 12 [5–13] days). At 12 months, NORA users showed improved physical well-being (PROMIS_PH) and lower anxiety (HADS-A), with no difference in depression.

Conclusion

In this multicenter randomized trial, use of the NORA App was associated with improved physical and emotional well-being, shorter hospital stays, and no increase in mortality or RRT initiation. NORA represents a safe and efficient telemonitoring tool to enhance care in advanced CKD.

Kewords