Kidney transplants for end-stage renal disease (ESRD) patients generally result in longer survival times compared with dialysis. However, the different treatment options (dialysis vs live/deceased donor transplantation) and the corresponding prognoses are often not personalized or not discussed, which can have major implications on disease outcomes. Patzer et al from Emory University have developed a free medical app and web-based clinical decision aid for clinicians to use with their newly diagnosed ESRD patients called iChoose Kidney.
iChoose Kidney is an easy-to-use patient-tailored tool using population-based data to generate risk predictions at the time of diagnosis. The medical calculator only requires simple parameters including the patient’s age, race, ethnicity, sex, time on dialysis, three comorbidities, and an indicator for low serum albumin to generate predictions on (1) the likelihood of the patient to live longer with a transplant or dialysis, (2) the difference in life expectancy between receiving a transplant compared with dialysis, and (3) the benefits of receiving a deceased versus living donor organ transplant.
The iChoose Kidney app gives the risk estimates for 1 and 3 years. The results are presented in a patient-friendly manner, with easy-to-understand numbers, language, and visuals. The results can also be emailed to the patient directly from the tool.
Emory University is a reputable institution known for its quality research and developments in public health tools using reliable sources. Recently Emory produced the app Surgical Anatomy of the Liver — a medical app we reviewed favorably.
The risk estimates of the iChoose Kidney medical app are based on data from the United States Renal Data System (USRDS) between 2005 and 2011. Data from 663,860 dialysis patients and 57,479 transplant patients was used, and model predictions on half of the sample were validated with actual disease outcomes from the remaining dialysis and transplant cohorts. A multidisciplinary team of clinicians, a behavioral scientist, an epidemiologist, ESRD patients and family members, and a medical illustrator was put together to develop the tool to ensure that it is representative, useful, and user-friendly.
Overall, this nephrology app is important for ERSD patients to gain a better idea of what to expect upon diagnosis, and for clinicians to present a tailored prognosis and treatment options to their patients. The tool facilitates clinician-patient communication that can result in better patient outcomes, both in terms of years lived and quality of life. Because a large sample was used to generate the risk predictions, the risk estimates should be generalizable to individual patients in at least the United States, provided that the databases are updated over time with new data.
The clinical effectiveness of iChoose Kidney is being studied with a multicenter randomized controlled trial (NCT02235571). Tools to help with shared-decision making are not limited to kidney diseases, but other medical areas such as point-of-care, substance abuse, and obesity.
Every patient with the diagnosis of ESRD should utilize this tool with their nephrologist. Emory should be applauded on making a great clinical tool that promotes evidence based practice and patient education.
Patient Education for Patients with Kidney Disease
By Emory University