Development of a multimedia-based real-time electronic fluid intake restriction model as a PACER tool to optimize self-monitoring of CKD patients undergoing hemodialysis

Abstract

Background & objective: Chronic kidney disease (CKD) is a major global and national health concern, with an increasing prevalence among the productive-age population. In Riau Province, Indonesia, the growing number of hemodialysis patients underscores the urgent need for effective self-monitoring strategies to control fluid intake. Non-adherence to fluid restriction frequently leads to interdialytic weight gain (IDWG), which can result in serious complications. While pharmacological therapy is often necessary, it may cause adverse effects and does not address behavioral factors contributing to poor fluid control. Conventional educational approaches have shown limited long-term effectiveness, highlighting the need for innovative, technology-based solutions. This study aimed to develop and evaluate a multimedia-based real-time electronic fluid intake restriction model to optimize self-monitoring and adherence among CKD patients undergoing hemodialysis.

Methodology: A Research and Development (R&D) design was implemented at Arifin Achmad Regional Hospital, Riau, Indonesia. The development process included a preliminary needs assessment through interviews and focus group discussions (FGDs), application design, expert validation, limited trials, and large-scale testing using a quasi-experimental one-group pretest–post-test design without a control group. During the intervention phase, patients used the PACER (Productivity And Capacity Evaluation in Research) application for two consecutive weeks, with daily fluid intake logging and automatic IDWG calculation after each dialysis session. Quantitative data were analyzed using paired t-tests, and qualitative data were interpreted through the Colaizzi's method of descriptive data analysis.

Results: Expert validation produced a mean feasibility score of 4.6 (very feasible). Limited trials involving 15 patients indicated high acceptability (mean = 4.3) and usability (mean = 4.2). In a large-scale test (n = 76), the mean fluid balance significantly decreased from 738.08 mL to 665.71 mL (P = 0.001, 95% CI: 3.46–112.28), demonstrating improved compliance and self-monitoring.

Conclusion: The PACER model is a feasible, user-friendly, and effective digital health application that enhances fluid self-monitoring and adherence among CKD patients. It represents an innovative step in Indonesia’s digital health transformation, supporting patient self-efficacy, clinical outcomes, and the integration of smart health technologies into preventive nephrology care in Indonesia.

Abbreviations: CKD: Chronic kidney disease, FDG: focus group discussions, IDWG: interdialytic weight gain,

Keywords: Chronic kidney disease; Hemodialysis; Fluid intake; Patient compliance; Mobile application

Citation: Saputra S, Sandra S, Mardeni, Mahmud AR, Prayoga DH, Nugroho HSW. Development of a multimedia-based real-time electronic fluid intake restriction model as a PACER tool to optimize self-monitoring of CKD patients undergoing hemodialysis. Anaesth. pain intensive care 2025;29(9):1255-62. DOI: 10.35975/apic.v29i9.3062

Received: September 23, 2025; Revised: October 10, 2025; Accepted: October 27, 2025