RESUMO
Rationale & Objective: Increased interdialytic weight gain (IDWG) has been associated with increased morbidity and mortality. We evaluated the usefulness and safety of a mobile application (app) that allows patients receiving maintenance hemodialysis to self-monitor their daily fluid intake. Study Design: Within group comparison before or during intervention. Setting & Participants: Patients receiving maintenance hemodialysis with mean IDWG of <4%. Exposure: Participants were trained to use a smartphone-based app, FiApp that allowed them to record fluid intake and compare with individual targeted daily fluid intake determined by the nephrologist. Outcomes: The primary study outcome was the association between IDWG and fluid intake recorded in the FiApp. Secondary outcomes included FiApp safety and usage. Patient interviews were performed at weeks 1 and 4 to collect information regarding FiApp usability and recommendations for app improvements. Analytical Approach: Mean, median, and standard deviation. Results: Eighteen of 25 patients completed the full 4-week study, provided all app data, and completed 2 patient interviews. The mean 4-week IDWG during app use was similar to the baseline mean 4-week IDWG before app use; however, 61% of the participants had a decrease in IDWG when using the app compared with IDWG at baseline. Of the 18 participants who completed the study, only 1 had a mean 4-week IDWG that was 20% higher than that at baseline. The app was used on ≥80% of the days by 13 (72%) of 18 participants, and was used every day in 7 (39%) of 18 participants. The mean relationship between fluid reported in the app and fluid consumed was 40%. Limitations: This safety study recruited patients who had IDWG of <4%. Conclusions: A smartphone-based app can be safely used to help patients receiving maintenance hemodialysis track and control fluid intake. Motivated patients were able to decrease IDWG despite baseline IDWG being <4% of the body weight. Trial Registration: NCT03759847. Plain-Language Summary: Patients receiving maintenance hemodialysis struggle to limit fluid intake. Excess fluid intake can lead to adverse cardiovascular events. We developed a smartphone app to help patients receiving dialysis self-monitor their fluid intake. In this safety study in patients receiving dialysis with an interdialytic weight gain of <4% of the body weight, more than half of the patients were able to decrease their interdialytic fluid intake while using the app, and only 1 patient had an increase in interdialytic weight gain of >20% while using the app. Information gleaned from structured patient interviews will be used to refine this app.
RESUMO
BACKGROUND: Pregnant and breastfeeding women experience great changes in their total body water content and water dynamics. To support the accretion of total body water during pregnancy and compensate for the water lost through breast milk during breastfeeding, increased adequate intakes (AI) for total water have been established by various health authorities. Despite this widespread advice, several studies suggest that pregnant and breastfeeding women do not meet the AI for total water, suggesting the need to raise women's awareness on the importance of adequate water intake, particularly during pregnancy and breastfeeding, as well as to provide them with a simple means of monitoring their hydration on a day-to-day basis. A urine color (UC) scale recently has been validated for hydration monitoring in pregnant and breastfeeding women. SUMMARY: We sought to develop a version of a tool based on the UC scale, using only images or illustrations, which could be understood by users of various nationalities and spoken languages. Pregnant and breastfeeding women (n = 1,275) from Brazil, Mexico, and Poland were shown 3 versions of the tool. Understanding, appreciation, simplicity and intent to use were evaluated using a questionnaire consisting of 26 items. Key Messages: Among the 3 versions tested, one tool emerged as the most highly understood (88% spontaneous understanding) and was highly appreciated by users (mean [SD]: 8.40 [2.20] out of 10). There were no differences between countries. Furthermore, 83% reported being very likely to use the tool daily. These results suggest that a simple tool based on the UC scale will help pregnant and breastfeeding women meet the AI for total water.
