TOPLINE

A nurse-led digital sodium-restriction program was associated with improvements in sodium-related knowledge in patients with chronic kidney disease (CKD), but its effect on sodium intake could not be fully evaluated because of a low completion rate for urine collections, researchers found.

METHODOLOGY

• Researchers enrolled 99 patients with CKD stages I-V in a randomized controlled trial at a tertiary hospital in China between June and August 2022. Participants were randomly assigned to either an enhanced digital intervention group (n = 46; median age, 44 years) or a minimal digital control group (n = 53; median age, 48 years).
• The intervention group received a 4-week nurse-led digital sodium-restriction program delivered through the Su Yi mobile app, with components including structured education, gamified learning modules, quizzes, peer competition, and personalized feedback, whereas the control group received a single educational session and access to static educational content.
• The primary outcome was 24-hour urinary sodium excretion at 3 months. Secondary outcomes included sodium knowledge, assessed with a validated questionnaire; blood pressure; quality of life; and laboratory measures.
• Semi-structured interviews were conducted with 23 participants who completed the intervention. The study was revised from a randomized controlled trial to a mixed-methods implementation study after only 24.2% of participants completed the primary outcome assessment.

TAKEAWAY

• Participants in the enhanced digital intervention group had a greater improvement in sodium knowledge than those in the minimal digital control group (median score, 8 vs 6; P = .005).
• Only 24.2% (n = 24) of participants completed the 24-hour urinary sodium assessment. Among the 24 completers, median sodium excretion appeared lower in the intervention group; however, statistical testing was not performed because of low power and selection bias.
• No significant between-group differences were observed in blood pressure, quality of life, or other physiologic measures at 3 months.
• Qualitative interviews suggested that initial enthusiasm and gains in self-management were difficult to sustain because of digital fatigue, family resistance, and a poor fit with everyday life.

IN PRACTICE

“This study provides critical insights into implementation barriers and informs the development of future person-centered digital tools. Digital health interventions may be improved via technical enhancements and better adaptation to patients’ daily lives,” the authors of the study wrote.

SOURCE

The study was led by Yu Shi, PhD, Department of Nephrology, Chongqing Key Laboratory of Prevention and Treatment of Kidney Disease, Second Affiliated Hospital (Xinqiao Hospital), Army Medical University (Third Military Medical University), Chongqing, China. It was published online on July 20, 2026, in JMIR Nursing.

LIMITATIONS

The low completion rate for 24-hour urine collection resulted in substantial missing data for the primary outcome, limiting reliable evaluation of the intervention’s efficacy. The qualitative analysis included only participants who completed the intervention, introducing potential selection bias. In addition, the study had a single-center design and small sample size and lacked subgroup analyses by CKD stage, possibly limiting the generalizability of the findings.

DISCLOSURES

The study was supported by the Chongqing Technology Innovation and Application Development Key Research and Development Project and jointly funded by the Chongqing Municipal Science and Technology Bureau and Health Commission. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.