Fostering Self-Empowerment in CKD Patients Through Food Choice Mapping

Fostering Self-Empowerment in Kidney Disease Patients Through Food Choice Mapping: A Pilot Study

This project aims to develop mapping of food choices available for chronic kidney disease (CKD) patients when dining out in Singapore. Following the mapping, a mobile application will be developed based on renal dining out food map mobile application (RENDOFOMAP) and trialed on patients with CKD. The specific aims of the project include:

1. Mapping out food choices suitable for patients with CKD when dining out in Singapore which will eventually be translated into a mobile application incorporating simple AI functionality.
2. To evaluate the impact of using RENDOFOMAP on self-empowerment, quality of life, nutritional status, and serum biochemistry in patients with CKD.
3. To evaluate the acceptability and user experience of RENDOFOMAP

Participants with CKD will use the newly developed mobile application to find out if there is improvement in self-empowerment, quality of life, nutritional status, and serum biochemistry.

Study Overview

• Status: Recruiting
• Conditions: CKD; Chronic Kidney Disease (Stages 3b-5)
• Intervention / Treatment: Other: Mobile application empowerment approach

Detailed Description

Diet is integral in CKD management; however, it is not sustainable for patients in the long term if there is solely emphasis on food restrictions without providing knowledge on modifying food choices to allow enjoyment. Thus, a strategic nutritional education approach needs to be adopted to maximise cost-effectiveness.

Patients' self-empowerment is gaining recognition as a means to optimise hospital resource utilisation, reduce healthcare costs, and decrease patients' dependency on medical services. This is particularly relevant for patients with chronic kidney disease (CKD), who are required to adhere to a disease management regimen that often conflicts with their pre-diagnosis lives and priorities.

In recent years, mobile applications have emerged as a popular platform for delivering nutrition education programs. Research indicates that mobile applications designed to engage patients and promote self-management of CKD show promise in improving adherence to dietary restrictions related to sodium, potassium, phosphorus, protein, calories, and fluid intake. Some of these applications offer a range of features but will still need to be reviewed by dietitians during face-to-face consultations. This in-depth approach, while beneficial, may not fully optimise time efficiency for dietitians.

Thus, there is an impetus to create an improved mobile application for CKD nutritional management to allow patients to individualise food choices, on top of charting food intake in the form of food diary. Patients can be trained to use the application during dietetics session which can eventually help reduce time spent for each session thereby improving dietitians' workload.

The proposed application will also incorporate some preliminary Artificial Intelligence (AI) to offer personalised food choices for patients. This feature is expected to further enhance the user-friendliness and convenience of the application, thereby promoting its usage and empowerment among CKD patients.

• Study Type: Observational
• Enrollment (Estimated): 30

Contacts and Locations

• Study Contact: Name: Gary Tung Lin Chiah, MSc, BSc, RD; Phone Number: +6565925769; Email: gary.chiah@singaporetech.edu.sg

Study Locations

• Singapore
  • Singapore, Singapore, 828608
    • Recruiting
    • Singapore Institute of Technology
    • Contact: Tung Lin Gary Chiah; Phone Number: +6597533317; Email: gary.chiah@singaporetech.edu.sg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Participants will be recruited from inpatient and outpatient setting in a tertiary hospital

Description

Inclusion Criteria:

• Are fluent in English. This is necessary to ensure clear communication and understanding of study procedures and materials.
• Adequate proficiency in using smartphone i.e. downloading app, taking photo, completing e-forms within the mobile applications. This is essential for participants to effectively use the mobile application being tested.
• Diagnosed with CKD Stage 3B-5. This targets the specific patient population that the study aims to benefit.

Exclusion Criteria:

• Only fluent in languages other than English. This could hinder effective communication and understanding of the study.
• Diagnosis of cognitive deficit or neurological disorder. These conditions could impair the ability to follow study procedures or provide reliable data.
• Uncontrolled diabetes (HbA1c>8.5%). This condition could introduce additional health risks and confound study results.
• Recent hypoglycemic episodes. This could pose a safety risk during the study.
• Newly initiated on dialysis or planning for dialysis within the next 6 months. These patients may have rapidly changing health conditions that could affect study outcomes.
• Decompensated liver cirrhosis. This condition could complicate the interpretation of study results.
• Pregnant and lactating. These conditions could introduce additional variables that affect study outcomes.
• Inability to provide consent. This ensures that all participants can legally and ethically participate in the study

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Physical Health-Related Quality of Life	Physical Health-Related Quality of Life At baseline and Week 12-16, physical health-related quality of life will be assessed using the 12-Item Short Form Health Survey (SF-12). The Physical Component Summary (PCS) score ranges from 5 to 20, with lower scores indicating better health-related quality of life and higher scores indicating poorer health-related quality of life.	Baseline to the end of study at 12-16 weeks
Mental Health-Related Quality of Life	At baseline and Week 12-16, mental health-related quality of life will be assessed using the 12-Item Short Form Health Survey (SF-12). The Mental Component Summary (MCS) score ranges from 12 to 45, with lower scores indicating better health-related quality of life and higher scores indicating poorer health-related quality of life.	Baseline to the end of study at 12-16 weeks
Modified Nutrition-related Empowerment Scale	At baseline and Week 12-16, nutrition-related empowerment will be assessed using a modified version of the Korean Health Empowerment Scale (K-HES). The scale consists of 8 items scored from 1 (Strongly Disagree) to 5 (Strongly Agree). Item scores are summed to generate a total score ranging from 8 to 40, with higher scores indicating greater nutrition-related empowerment and self-management capacity.	Baseline to the end of study at 12-16 weeks
Ease of Adherence to Diet Plan When Eating Out	Participants will rate the ease of adhering to their prescribed diet plan when eating out using a 5-point scale ranging from 1 (very difficult) to 5 (very easy). Higher scores indicate greater ease of dietary adherence.	Baseline to the end of study at 12-16 weeks
Food Diary Completion Rate	Participant engagement with the nEAT mobile application will be assessed by the proportion of scheduled food diary entries completed during the intervention period. Food diary completion rate (%) = (Number of completed food diary entries ÷ Total number of scheduled food diary entries) × 100. A food diary entry is considered completed when the participant records the required dietary information for the scheduled eating occasion within the nEAT mobile application	Baseline to the end of study at 12-16 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Body Weight Change	Body weight will be measured at baseline and Week 12-16 using a calibrated weighing scale. Weight will be reported in kilograms (kg). Body weight change (kg) = Body weight at Week 12-16 - Body weight at baseline. Negative values indicate a reduction in body weight (weight loss), positive values indicate an increase in body weight (weight gain), and a value of 0 indicates no change in body weight.	Baseline to the end of study at 12-16 weeks
Percentage Weight Change	Percentage weight change over the preceding 6 months will be calculated from self-reported and/or documented body weight records. Weight change will be reported as a percentage (%).	Baseline to the end of study at 12-16 weeks
Body Mass Index (BMI)	Body mass index (BMI) will be calculated as weight (kg) divided by height squared (m²), expressed as kg/m². BMI Asian categories are Underweight: Less than 18.5 kg/m² Normal range: 18.5 to 22.9 kg/m² Overweight (At risk): 23.0 to 24.9 kg/m² Obese (Class I): 25.0 to 29.9 kg/m² Obese (Class II): ≥ 30.0 kg/m²	Baseline to the end of study at 12-16 weeks
Nutritional Status [Subjective Global Assessment (SGA)}	Nutritional status will be assessed using the Subjective Global Assessment (SGA), incorporating recent weight loss, dietary intake, gastrointestinal symptoms, functional status, muscle wasting, fat wasting, oedema, and overall nutritional status. Overall subjective scores range from 1 to 7, where 1-2 indicates severely malnourished, 3-5 moderately malnourished and 6-7 indicates being well nourished.	Baseline to the end of study at 12-16 weeks
Ease of Adherence to Diet Plan When Eating at Home	Participants will rate the ease of adhering to their prescribed diet plan when eating at home before and after using nEAT mobile application using a 5-point scale ranging from 1 (very difficult) to 5 (very easy). Higher scores indicate greater ease of dietary adherence.	Baseline to the end of study at 12-16 weeks
Energy Intake Relative to Estimated Requirements	Energy intake will be assessed using 24-hour dietary recalls completed at baseline and end of study at 12-16 weeks. Individual energy requirements will be estimated using the Harris-Benedict equation based on age (years), weight (kg), and height (cm), and used to establish personalized energy targets. Energy intake will be expressed as a percentage of the estimated energy requirement (%), calculated as actual energy intake divided by estimated energy requirement × 100. Values closer to 100% indicate greater adherence to prescribed energy targets.	Baseline to the end of study at 12-16 weeks
Protein Intake Relative to Estimated Requirements	Protein intake will be assessed using 24-hour dietary recalls completed at baseline and end of study at 12-16 weeks. Individual actual protein requirements will be estimated using the factor 0.8g/kg x weight (kg), and used to establish personalized energy targets. Protein intake will be expressed as a percentage of the estimated protein requirement (%), calculated as actual protein intake divided by estimated protein requirement × 100. Values closer to 100% indicate greater adherence to prescribed energy targets.	Baseline to the end of study at 12-16 weeks
Sodium Intake Relative to Estimated Requirements	Sodium intake will be assessed using 24-hour dietary recalls completed at baseline and end of study at 12-16 weeks. Individual sodium allowance will limited to 2000mg per person . Energy intake will be expressed as a percentage of the sodium allowance (%), calculated as actual sodium intake divided by estimated sodium allowance × 100. Values closer to 100% indicate greater adherence to prescribed sodium targets.	Baseline to the end of study at 12-16 weeks
Phosphorus Intake Relative to Estimated Requirements	Phosphorus intake will be assessed using 24-hour dietary recalls completed at baseline and end of study at 12-16 weeks. Individual phosphorus allowances will be personalised and estimated proportionally to protein intake. Phosphorus intake will be expressed as a percentage of the estimated phosphorus allowance (%), calculated as actual phosphorus intake divided by estimated phosphorus allowance × 100. Values closer to 100% indicate greater adherence to prescribed phosphorus targets.	Baseline to the end of study at 12-16 weeks
Potassium Intake Relative to Estimated Requirements	Potassium intake will be assessed using 24-hour dietary recalls completed at baseline and end of study at 12-16 weeks. Individual potassium allowance will calculated at 39mg/kg per person, however, will be personalised based on the chronic kidney stage and serum biochemistry potassium. Potassium intake will be expressed as a percentage of the individualised potassium allowance (%), calculated as actual sodium intake divided by estimated potassium allowance × 100. Values closer to 100% indicate greater adherence to prescribed potassium targets.	Baseline to the end of study at 12-16 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Estimated Glomerular Filtration Rate (eGFR)	Estimated glomerular filtration rate (eGFR), a laboratory-based measure of kidney function, will be assessed at baseline and at the end of the study (12-16 weeks). eGFR will be reported in millilitres per minute per 1.73 m² (mL/min/1.73 m²). The outcome measure will be the change in eGFR from baseline to study completion. Lower eGFR values compared to baseline indicate poorer kidney function.	Baseline to the end of study at 12-16 weeks
Change in Serum Creatinine	Renal function will be assessed by measuring serum creatinine concentration and reported in micromoles per litre (µmol/L) at baseline and end of study at 12-16 weeks. Higher values from baseline indicate poorer or declining kidney function. Reference value, male: 54 - 101; female: 37 - 75 µmol/L	Baseline to the end of study at 12-16 weeks
Serum Potassium Concentration	Serum potassium concentration will be measured and reported in millimoles per litre (mmol/L). Reference value: 3.6 - 5.0 mmol/L. Higher value from baseline signifies worsening of hyperkalemia	Baseline to the end of study at 12-16 weeks
Change in Serum Albumin	Nutritional status will be assessed using serum albumin concentration and reported in grams per litre (g/L) at baseline and end of study at 12-16 weeks. Higher values indicate better nutritional status compared to baseline. Reference value: 40 - 51 g/L	Baseline to the end of study at 12-16 weeks
CKD-Related Hospital Admissions Compared Against Compliance to 24-hour Diet Recall	Hospital admissions related to chronic kidney disease or its complications occurring during the study period will be recorded and reported as the total number of admissions in comparison to the stratification of24-hour Diet Recall.	End of study at 12-16 weeks

Collaborators and Investigators

• Sponsor: Singapore Institute of Technology
• Collaborators: Singapore General Hospital; Sengkang General Hospital
• Investigators: Principal Investigator: Gary Tung Lin Chiah, MSc, BSc, RD, Singapore Institute of Technology

Study record dates

Study Major Dates

• Study Start (Actual): April 15, 2026
• Primary Completion (Estimated): January 16, 2027
• Study Completion (Estimated): August 16, 2027

Study Registration Dates

• First Submitted: July 19, 2026
• First Submitted That Met QC Criteria: September 2, 2026
• First Posted (Actual): September 4, 2026

Study Record Updates

• Last Update Posted (Actual): September 4, 2026
• Last Update Submitted That Met QC Criteria: September 2, 2026
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: artificial intelligence; nutrition app; renal nutrition
• Additional Relevant MeSH Terms: Urogenital Diseases; Pathologic Processes; Male Urogenital Diseases; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Chronic Disease; Disease Attributes; Renal Insufficiency; Pathological Conditions, Signs and Symptoms; Renal Insufficiency, Chronic
• Other Study ID Numbers: RECAS-0658; IG (S) 1/2024 - 1021 (Other Identifier: Singapore Institute of Technology)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No