Chronic kidney disease affects approximately 26 million individuals in the United States and is a progressive disease, with individuals losing kidney function yearly. Low kidney function and decrements in kidney function are both individually associated with cardiovascular risk and progression to the need for renal replacement therapy. Racial and ethnic minorities suffer a disproportional burden of kidney disease and its complications. One of the only proven therapies to slow the progression of chronic kidney disease is control of blood pressure (BP) which is difficult to achieve. We will enroll 350 patients with chronic kidney disease aged 12 and older from pediatric and adult chronic kidney disease clinics in the Bronx, NY, a sample composed primarily of non-Hispanic blacks and Hispanics. The 300 adult participants with uncontrolled hypertension will participate in a randomized clinical trial with 2 arms: 1) usual care with monthly CKD clinic visits, including distribution of educational materials from the National Kidney Disease Education Program (NKDEP), or 2) distribution of educational materials from the NKDEP and monthly group-based visits with other patients with CKD in the CKD clinic to encourage medication adherence, dietary restrictions and physical activity. We hypothesize that participants randomized to 6 months of group-based care will show improvements in our outcome measurements including: 24-hour ambulatory BP monitoring, self-reported medication adherence, quality of life, patient satisfaction and 24-hour urine sodium levels and 7 day physical activity measured by pedometer at baseline and 6 months. The study is powered to detect a 5 mmHg difference in 24-hour mean systolic blood pressure between the intervention and usual care groups. The 50 adolescents recruited into the study will undergo the same educational and peer and provider support in group-based care as the adults. We will compare their 24-hour ambulatory blood pressures, missed appointments and dietary and physical activity adherence at the end of the 6 months to their baseline. This application brings together experts in kidney disease (Drs. Kaskel, Bauer, and Melamed) and behavioral interventions for chronic diseases (Drs. Bauman, Doyle and Litwin) to make a strong team poised to perform this research in an underserved, high-needs patient population.
Kidney disease and hypertension affect millions of Americans and blood pressure control is not optimal in many Americans. This application tests group-based care to educate and empower individuals with high blood pressure to better control their blood pressure through improved medication adherence, increased physical activity and lower sodium intake. If the results show improvements in blood pressure with this low-cost intervention, it could be available for millions of high-risk individuals to improve their health status.
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