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Kidney Week

Abstract: FR-PO259

Estimating the Effectiveness of Home-Based Kidney Care in Persons with Diabetes Using Propensity Scores

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

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

Home-based kidney care (HBKC) is a pragmatic approach incorporating the healthcare preferences of individuals to address cultural barriers to standard kidney care. We carried out a 12-month randomized clinical trial (RCT) of HBKC in 72 American Indians, identified as having CKD with diabetes.

Methods

Participants were randomized to receive usual care (UC) or HBKC. After initial lifestyle coaching, the HBKC group received frequent additional reinforcement by CHWs about adherence to medicines, diet and exercise, self-monitoring, and coping strategies for living with stress. The primary outcome was the change from baseline to 12-months in the patient activation measure (PAM). Secondary outcomes included BMI, A1C, hsCRP, and KDQOL measures. Outcomes were compared between study groups using linear models with generalized estimating equations to account for household clustering and propensity scores to account for the fact that we did not randomize specifically for those with diabetes.

Results

Accounting for imbalances in group membership at baseline by applying propensity weights, the estimated average change in the difference in PAM scores was 15.6 points higher in HBKC compared to the UC while also adjusting for baseline PAM scores (Figure 1). When PAM score was categorized into PAM levels, we observed that participants in HBKC were 8.4 times more likely to be activated compared to the UC while adjusting for baseline PAM scores. Body mass index declined by 1.2 kg/m2 (P=0.02) and hsCRP protein by 2.7-fold (P<0.001) more in HBKC group compared to UC. There was a modest decline in A1C by 0.8 % (P=0.14) in HBKC group relative to UC.

Conclusion


A home-based kidney care intervention improves the activation of participants in their own health care. It may also reduce risk factors for poor diabetes outcomes in a rural disadvantaged population.

Funding

  • Other U.S. Government Support