Authors' objectives: Chronic kidney disease (CKD) affects just under 100,000 people in Wales. It may worsen over time and people with severe CKD may require dialysis and/or kidney transplant. There is evidence that improvements in diet and increased exercise are beneficial in managing long term health conditions such as CKD and may improve risk factors associated with disease progression. Improving a patient’s understanding of their condition and providing them with guidance and information on how to make good lifestyle changes can have a positive impact on their quality of life. Currently, in Wales, the standard of care is variable and access to rehabilitation or regular support/education provided by healthcare practitioners can be limited. Therefore, digital self-management interventions, such as websites or apps may be beneficial. These are designed to educate patients and provide them with rehabilitation and tools to help them improve their lifestyle and better understand and manage chronic kidney disease. An example of a digital health intervention (DHI) for chronic kidney disease is the Kidney BEAM website, a physical rehabilitation tool which provides live or pre-recorded exercise sessions and education. The aim of the review was to identify and summarise evidence on the clinical and cost effectiveness of digital rehabilitation and self-management interventions for chronic kidney disease.

Authors' results and conclusions: HTW searched for, and identified, digital rehabilitation and self-management technologies for people with chronic kidney disease. This included websites and apps but excluded interventions where contact with healthcare professionals was a key component, or which specifically targeted dialysis-specific outcomes such as infection or adherence. HTW identified six studies across seven publications for inclusion in the clinical effectiveness section. This included one relevant publication on the cost effectiveness of the Kidney BEAM intervention. Seven publications on patient, carer and family considerations were included, plus one shared resource from Kidney Care UK. Three smartphone apps and three websites were evaluated. Two of these websites (Kidney BEAM and My Kidneys and Me) are available in Wales and were evaluated in the only two multicentre randomised controlled trials (RCTs) identified. Kidney BEAM is a physical rehabilitation digital health intervention and My Kidneys and Me is a self-management programme, including physical rehabilitation elements. The remaining studies included one pre-post case series and three pilot/feasibility studies evaluating self-management digital health interventions. One paper was included in the economic review. This study assessed the cost effectiveness of Kidney BEAM in one of the RCTs described above and found Kidney BEAM to be a cost-effective intervention compared to waitlist control at a willingness-to-pay threshold of £20,000 per quality-adjusted life year (QALY) gained. No further economic modelling was conducted by HTW. HTW sought the perspectives and experiences of patients and families by engaging with patient organisations. Resources were shared from these organisations and a survey was co-produced and conducted online. In addition, six qualitative studies on patient experiences were found during the clinical literature review. These insights are reported in the patient, carer and family perspectives section.

Authors' recommendations: The evidence supports the routine adoption of Kidney BEAM, a digital rehabilitation and self-management intervention for people with chronic kidney disease (CKD). Evidence comparing Kidney BEAM to waitlist control showed improvements in peoples’ quality of life, knowledge, skills and confidence related to managing health and healthcare, and physical function. A published cost-effectiveness analysis found Kidney BEAM to be a cost-effective intervention compared to waitlist control. Kidney BEAM should be viewed as an additional tool that may be delivered alongside any programmes currently offered in Wales. Other digital rehabilitation and self-management interventions are available for people with CKD but there was insufficient evidence to demonstrate their clinical and cost effectiveness.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: The Appraisal Panel recommended further research assessing longer term outcomes and whether there are groups of patients within the wider CKD population who may benefit the most from this technology. The Appraisal Panel also noted that identifying those groups of people where there may be less uptake would be useful in order to facilitate adherence.

Project Status: Completed

Year Published: 2025

URL for published report: https://healthtechnology.wales/reports-guidance/digital-interventions-for-chronic-kidney-disease/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk