Abstract: SA-OR012

Reducing Health Disparity – PCORI Supported Home Based Kidney Care Approach in Zuni Indians

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Authors

  • Shah, Vallabh O., University of New Mexico Health Science Center, Albuquerque, New Mexico, United States
  • Nelson, Robert G., National Institutes of Health, Phoenix, Arizona, United States
  • Pankratz, V. Shane, University of New Mexico Health Science Center, Albuquerque, New Mexico, United States
  • Ghahate, Donica M., University of New Mexico Health Science Center, Albuquerque, New Mexico, United States
  • Bobelu, Jeanette, University of New Mexico Health Science Center, Albuquerque, New Mexico, United States
Background


To conduct a randomized trial of home based kidney care (HBKC) of patient activation measure (PAM) with lifestyle intervention to reduce risk factors for chronic kidney disease (CKD) in Zuni Indians.

Methods

Randomized families with more than one individual with CKD (1:1) to a usual care (UC) or an HBKC intervention group. After initial lifestyle coaching in both groups, the HBKC received reinforcement of healthy behaviors through alternate weekly home visits by the community health representatives, and with quarterly group sessions. The primary outcome was change in PAM. The secondary outcomes were changes in measures of T2D, CKD, BP, lipid profiles, BMI, Morisky score), KDQOL and diet. Tests for significance were performed using mixed models analysis of variance with a per-household random effect and while adjusting for baseline levels of the variables being examined.

Results

Patients in the HBKC group increased PAM total score by 9.5±26.1 points, compared to a decrease of 0.7±14.0 points in the UC (p=0.04). Similarly, 16.7% more of the HBKC group were in the PAM "activated" group (PAM level >3) at the study’s end, while 12.5% fewer of the UC group were in the PAM “activated” group at the study’s end. In our secondary analyses, progression of multiple risk factors for kidney disease, especially BMI, A1C, and hsCRP, slowed by the HBKC intervention. We also observed greater improvements in QOL in the HBKC group; SF12 mental scores significantly increased in the HBKC compared to the UC (p=0.02), with an average±S.D. point change in the HBKC group of 7.5±11.0 compared to a -0.2±9.0 point change in the control group

Conclusion

A HBKC intervention of continuous patient engagement, a potentially scalable approach to providing care to patients with CKD, was effective in improving PAM levels and in reducing risk factors for CKD.

Funding

  • Other U.S. Government Support