Randomised clinical trial of the kidney health 4 life (KH4L) self-management program

Abstract Background Chronic kidney disease imposes physical, psychological and social burdens. While self-management is essential in CKD, many existing interventions lack theoretical grounding and patient co-design. The Kidney Health 4 Life (KH4L) program was developed to address these gaps via a modular, online, peer supported self-management intervention. Methods This open label, single blind, parallel group randomised controlled trial recruited Australian adults with CKD. Participants were randomised 1:1 to receive the KH4 L intervention or standard care. The intervention consisted of six self-paced online modules, health coaching, and peer support. The primary outcome was self-management capability. Secondary outcomes included self-efficacy, knowledge, and psychological wellbeing. Outcomes were assessed at baseline, 6 weeks, and 18 weeks post baseline. Linear mixed models were utilised for quantitative outcomes and qualitative feedback was analysed using simple thematic analysis. Results Of 394 enrolled, 383 were included in the analysis. There was with no significant changes in the primary outcome of total self-management scores. However, The intervention group showed significant improvements in problem solving (P = 0.009), self-efficacy (P = 0.048) and CKD related knowledge (P = 0.017). Mixed results were seen with the psychological outcomes with depression scores improving more in the control group (P = 0.043) and no improvement in anxiety. Subgroup analyses indicated greater benefits for those accessing CKD specific modules compared to dialysis specific content, possibly due to smaller sample size. Conclusions KH4 L improved some self-management outcomes in people with CKD. The findings highlight the value of tailored, stage specific digital interventions and suggest theory informed programs can improve self-efficacy and knowledge. Further research is needed to optimise engagement and ascertain long term impacts.