Abstract: PUB051
Closing the Cardiovascular-Kidney-Metabolic (CKM) Counseling Gap: Harm-Reduction Framework Care for Food-Insecure Patients with CKD and Obesity
Session Information
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Author
- Sanon, Julien, Lehigh Valley Health Network, Allentown, Pennsylvania, United States
Background
Food insecurity is independently associated with a 38% higher risk of CKD progression to ESKD after adjustment for demographics, diabetes, hypertension, eGFR, and albuminuria (Banerjee/Crews, AJKD 2017). Over 70% of dietary sodium comes not from the salt shaker but from canned goods, ultra-processed foods (UPFs), and shelf-stable products consumed by necessity. UPFs deliver inorganic potassium additives with near-complete bioavailability, while plant-source potassium (~65% bioavailable, attenuated by fiber and alkali load; Picard, JRN 2019) is paradoxically restricted by legacy counseling. Sodium restriction reduces BP and albuminuria in CKD (Garofalo 2018; McMahon 2013). The gap is translation into a format executable in community nephrology.
Methods
We developed the Modify-Not-Eliminate (MNE) protocol delivered by a board-certified nephrologist and licensed dietitian-nutritionist via two standardized pamphlets: one on CKD/sodium, one on plant-forward nutrition. It is applied to all CKM-criteria patients (CKD with obesity, metabolic syndrome, or T2D), with RD co-management triggered for GLP-1 RA initiation. Pamphlet content is verbally confirmed at follow-up. Components: (1) source-targeted sodium reduction, anchored in the >70% extra-shaker principle and rinsing/draining techniques cutting canned-food sodium by up to 41%; (2) bioavailability-conscious plant substitution, replacing UPF inorganic potassium with whole-food sources, consistent with the plant-dominant low-protein diet (PLADO) and updated KDIGO consensus; (3) modification-rather-than-prohibition language framed around cardiovascular benefit.
Results
Since August 2025, the protocol has been delivered at every encounter, with ~90 CKM-relevant encounters per month. The cohort is predominantly adults with CKD stages 2–4 and obesity, with high comorbid T2D and substantial RAAS-inhibitor and SGLT2-inhibitor exposure under serum potassium monitoring. The framework has been disseminated to ~130–140 dietitians across regional health systems.
Conclusion
The MNE protocol operationalizes sodium and plant-forward potassium evidence into a counseling format executable in food-insecure community nephrology. By targeting UPF-derived sodium and inorganic potassium while reframing plant intake, it addresses a delivery gap in CKM care. It is a scalable bridge to RD care, refined through practice and interprofessional education.
Acknowledgment
I acknowledged that AI was used to edit my abstract, but the concept and content are based on my unique CKD clinic experience. As a result, I take full responsibility for the integrity of the content generated.