kidney health: eat well, live well

Conditions: Chronic Kidney Diseases

Summary: this two-arm, parallel randomized trial study will assess the efficacy of a 6-month (26 weeks) community-based program in reducing kidney injury (as urine albumin to creatinine ratio, uacr), cardiovascular risk (as hemoglobin a1c and blood pressure), mental health (as phq-8) and diet quality (as fruits and vegetables intake and healthy eating index) in community-dwelling, low-income adults diagnosed with early chronic kidney disease (stages 2 or 3 and not on kidney replacement therapies) compared to educational materials and usual care alone.

this study tests a community-based program aimed at supporting adults with early-stage chronic kidney disease to change their eating habits to reduce the likelihood of kidney injury progression. the program components were design to reduce barriers to a) eating healthier, kidney-friendly foods through the direct provision of fruits and vegetables, grocery store e-gift cards, kidney-friendly recipes, and food preparation tips; b) learning about kidney disease and the role of healthy eating in slowing its progression through educational materials; and c) social connection through empathetic relational phone calls and sms texts from a dedicated "health partner". over a period of 6 months (26 weeks), participants randomized to the intervention arm will receive: * kidney-friendly produce (fruits and vegetables) delivered at their preferred location * recipes and tips on food preparation tailored to the produce * grocery store electronic gift cards * educational materials on ckd and disease management * personalized practical and emotional support through a dedicated health partner researchers will see if participation in the program (intervention) reduces markers of kidney injury (albumin:creatinin ratio) and cardiovascular disease risk and improves diet (particularly fruits and vegetables intake) and mental health when compared to usual care (control).

Eligibility criteria:
inclusion criteria: * adult (18 years of age or older) * primary care visit at either one of the three partner clinics from harris health \[smith clinic, harris health outpatient center (located on the lbj campus), or martin luther king jr. health center (mlk)\] and a primary care patient within harris health system * have had at least 1 visit in the past 18 months with prior history in the clinic (i.e., not first visit) * diagnosis of ckd (stage 2, 3a, and 3b) as defined by estimated glomerular filtration rate (egfr) ≥ 30 and \<90 ml/min/1.73 m2 or cdk 1 or undiagnosed with urine albumin creatinine ratio ≥ 30 mg/g * within the past 12 months, the most current serum k+ ≤ 4.6 meq/l * english or spanish speaking * ability to participate in the program at least 6 months * ability to clean, prepare, refrigerate/freeze food products that are given to them * have access to receive sms text messages * location of preferred produce bag delivery within an available delivery zone exclusion criteria: * ckd 4, esrd or on dialysis. * taking certain medications chronically (more than twice a week for 90 days) that may interfere with k+ metabolism (such as non-steroidal anti-inflammatory drugs (nsaids), as self-reported during enrollment screening * taking mineralocorticoid receptor antagonists * taking warfarin * diagnosis of any specific kidney conditions (such as polycystic kidney disease, glomerulonephritis, lupus associated with nephritis, antineutrophil cytoplasmic antibody (anca)-associated vasculitis (aav)) that would contraindicate study participation as determined by physician * medical history of organ transplant that would contraindicate study participation as determined by physician * received immunotherapy for primary or secondary kidney disease within 6 months prior to enrolment * diagnostic of heart failure conditions class iv in the new york heart association (nyha) functional classification * had myocardial infarction, unstable angina, stroke, or transient ischemic attack (tia) within 12 weeks prior to enrolment * had coronary revascularization (pci, cabg) or valvular repair within 12 weeks prior to enrolment * on active hospice care as self-reported during enrollment screening * diagnosis of active malignancy requiring treatment that would contraindicate study participation as determined by physician * has decompensated cirrhosis as determined by physician * cognitive impairment that would contraindicate study participation as self-reported during enrollment screening

Keywords: phone calls telehealth fruits and vegetables produce home delivery grocery vouchers gift cards community-based trial proteinuria diet mental health