Kidney Week

Abstract: SA-PO0503

Controlling Hypertension Through Education and Coaching in Patients with CKD: Results from the CHECK-D Trial

Session Information

• CKD: Clinical - Therapies, CKM Health, Special Populations, and More
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Bragg-Gresham, Jennifer L., University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States

Jennifer L. Bragg-Gresham, MS, PhD

• Resnicow, Kenneth A., Regents of the University of Minnesota, Minneapolis, Minnesota, United States

Kenneth A. Resnicow, PhD

• Richardson, Caroline, Brown University, Providence, Rhode Island, United States

Caroline Richardson, MD

• Levine, Diane L., Wayne State University School of Medicine, Detroit, Michigan, United States

Diane L. Levine, MD

• Saran, Rajiv, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States

Rajiv Saran, MD, MBBS, MS

• Gillespie, Brenda W., University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States

Brenda W. Gillespie, MS, PhD

• Delacroix, Emerson, University of Michigan School of Social Work, Ann Arbor, Michigan, United States

Emerson Delacroix, MA

• Lin, Ying-Jen, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States

Ying-Jen Lin, PhD

• Fagerlin, Angela, University of Utah Health, Salt Lake City, Utah, United States

Angela Fagerlin, PhD

• Wright Nunes, Julie A., University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States

Julie A. Wright Nunes, MD, MPH

Background

Chronic kidney disease (CKD) affects >30 million Americans and increases cardiovascular risk. Blood pressure (BP) control slows CKD progression and reduces cardiovascular morbidity and mortality, yet <40% of patients with CKD achieve BP targets. We evaluated whether motivational interviewing (MI)-based health coaching added to CKD education improved BP outcomes across diverse primary care settings.

Methods

In a large cluster-randomized trial across 11 academic, urban, and suburban primary care clinics, 307 CKD patients with uncontrolled hypertension received clinician-delivered CKD education alone (control arm) or CKD education plus 12 months of MI-based health coaching (intervention arm). Nine clinics were at the University of Michigan and two at Wayne State University (WSU). Intent-to-treat and as-treated analyses used linear mixed models accounting for clinic clustering, location interaction, demographics, comorbidities, medications, and baseline BP.

Results

A total of 189 participants had baseline and 1-year BP measurements. Mean age was younger in intervention clinics (66 vs. 69 years, p=0.02); 62% were women. Mean baseline eGFR was 43±14 mL/min/1.73m2, and over half had diabetes. More than 60% self-identified as White race, while all WSU participants identified as Black race. Both study arms had significant BP reductions at 12 months (SBP: -5.4 mmHg control, -6.2 mmHg intervention; p<0.01), without significant between-group differences (p=0.77). Interaction analyses suggested heterogeneity by race, with less BP improvement among WSU participants (Figure). COVID-19 affected recruitment, intervention delivery, and target sample size attainment.

Conclusion

Structured CKD education and home BP monitoring improved BP over 12 months in patients with CKD receiving primary care, while MI-based health coaching did not provide incremental benefit. Potential racial differences in treatment response warrant further investigation to guide equitable CKD self-management strategies.

Funding

• NIDDK Support