Nurse-Led Digital Intervention for Sodium Restriction in Chronic Kidney Disease: Mixed Methods Implementation Study.
Yu Shi, Hongmei Peng, Youying Zhang and 5 others
PMID 42476106WHAT IT FOUND
The primary 24-hour urine sodium outcome could not be evaluated: only 24 of 99 completed collection.
The nurse-led app program, combining education, quizzes, peer competition, tasks, feedback and remote monitoring, improved sodium knowledge, but blood pressure and quality of life did not differ.
Key findings
01The planned primary outcome, 24-hour urinary sodium excretion, could not be evaluated because only 24 of 99 participants completed urine collection.
02On the 10-item sodium knowledge questionnaire, the enhanced nurse-led app group scored 8 versus 6 in controls (P = .005).
03Interviews with 23 intervention completers identified urine collection burden, family resistance, digital fatigue and limited long-term support as barriers to sustained sodium restriction.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The primary outcome was uninterpretable because 75.7% of primary outcome data were missing, so the study cannot confirm sodium restriction or kidney outcomes. The design was changed from a registered RCT to an exploratory implementation study after interim review, so it should not be read as a definitive trial. No between-group statistical comparison was done for urinary sodium, even among completers, because of low power and selection bias. Qualitative findings came only from 23 intervention completers, not from people who dropped out, so barriers may be underestimated. The study was single-center, relatively small, and did not analyze outcomes by CKD stage, limiting generalizability. Participants and the delivery nurse were unblinded, and the intervention combined several components, so any effect cannot be attributed to one feature.
Declared interests
Funding was from the Chongqing Technology Innovation and Application Development project and the Chongqing Municipal Science-Technology Bureau and Health Commission. The authors declared no conflicts of interest. The Su Yi app was independently designed by Thinmed Medical Technology.
The easy way to misread this
Do not conclude that this nurse-led app lowers sodium excretion or improves kidney outcomes. The primary 24-hour urine outcome was not tested because only 24 of 99 participants completed collection, and the positive finding was a secondary knowledge score.