Healthy kidneys are essential for keeping people alive as they filter out toxins and excess fluids. If someone’s kidneys fail completely, then they require either a new kidney (a transplant) or for their blood to be filtered (dialysis).

We believe we can offer the best possible care for a particular patient by tailoring it to their specific needs and personal characteristics (personalised care). The ability to measure physical activity in patients with renal disease at home could be used to better personalise the care given to patients with kidney failure. At Cambridge University Hospitals NHS Foundation Trust, we have started measuring the physical function and activity levels of patients with kidney failure, who either already require dialysis or may need dialysis in the near future. We are currently doing this in several ways including measuring how strong their hand grip is, assessing their walking speed and asking questions about how difficult they find certain activities. In the future, we think this additional information about a patient’s function will allow us to target treatments to help improve functional ability and potentially identify any problems earlier.

However, these measurements are time-consuming and require the patient clinic visits to the hospital to be longer. Not all patients need to have these measurements taken regularly if they have good physical function. Physical activity is currently measured by a self-report questionnaire, which can be hard for patients to complete and accurately estimate their activity levels. For this reason, we were keen to see if we can get a better measurement of levels of physical activity at home and from this measurement identify patients who need to have physical function tests in the hospital.

In this study we asked patients to wear an activity monitor (called an accelerometer) on their wrist at home for a week doing their usual activities. Patients were asked to wear the monitor continuously on their wrist for 7 days and given instructions to take home about the monitor. At the end of 7-days, they were asked to complete a questionnaire on how they found wearing the monitor and return the monitor back to the dialysis centre at their next appointment or in a pre-paid envelope. Overall, 40 patients were asked to participate; 20 patients receiving dialysis and 20 patients who may need dialysis in the future.

A high proportion of participants agreed that the monitor was comfortable and was easy to wear for 7-days. Most participants reported instructions on wearing the device and returning the device were straightforward. Almost all the participants wore the monitor each day with the majority wearing it for 24-hours a day. When we compared the information from the accelerometer against the measurements of physical function and activity in the clinic, we found that the physical activity measurement from the device was related to the clinic measurements. Now we have demonstrated that the device can be successfully used by patients in their own homes, we will research further whether this remote monitoring could be used to identify patients who may be at risk of becoming frail and need extra support.

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Publications

W-Ward study publications on the MRC Epidemiology Unit publications database.