A pragmatic randomized controlled trial of a CKD specific telemonitoring platform to minimize adverse outcomes in high risk CKD patients.

The COVID-19 pandemic has changed the way patients with chronic kidney disease (CKD) are cared for in Canada. Since CKD patients are at high risk of getting very sick from COVID19, they are being cared for with "virtual visits", with telephone or video conference calls. While this helps prevent spread of the virus it makes taking care of kidney problems more difficult. CKD patients need careful monitoring of kidney function, blood pressure and weight; of how they feel; and they need education about their kidney disease, diet, and choices for dialysis or kidney transplant. Simple phone or video calls is not enough for proper care.. Additional home monitoring is needed to improve virtual care for CKD patients. We developed a home monitoring kit called VIEWER which is designed for CKD patients and includes an iPad, a blood pressure monitor, a weigh scale, a finger-tip oxygen monitor, and a motion tracker (like a FitBit). All of these devices talk wirelessly (by Bluetooth) to the iPad. The VIEWER app guides patients through a daily home assessment. The app helps patients do a symptom questionnaire once a week to monitor how they are feeling. Patients can see all their information, and can text, call, or video the health team through the iPad. The health care team can see all this information to help assess changes and to guide treatments. To test if VIEWER improves care, we will do a type of study called a randomized clinical trial (RCT). We will ask 340 patient volunteers with low kidney function (<15%) to take part. Half the patient volunteers will use the VIEWER for 6 months, and half will continue with usual care in the clinic. A computer will randomly choose (like a computer coin flip) which patients are assigned to each group. We think VIEWER will reduce how often patients visit the emergency room, are admitted to hospital, or need emergency dialysis. If the trial results are positive, we will work to make VIEWER available to more people with CKD.