Effectiveness of a Home-Based Kidney Care and Education Intervention Among American Indian (AI) Communities

Background: To evaluate the effectiveness of home-based kidney care (HBKC) and educational interventions in improving patient activation and health outcomes among American Indians with or at risk for chronic kidney disease (CKD). Methods: Two RCT assessed interventions designed to enhance patient engagement in CKD management. The first study, conducted among AIs with CKD, compared HBKC + lifestyle coaching with usual care (UC). The second study extended the intervention to four additional AI communities in New Mexico. In first study, 125 participants with CKD were randomized into HBKC or UC groups. HBKC included lifestyle coaching, reinforcement on medication adherence, diet, exercise, self-monitoring, and coping strategies. The primary outcome was the 12-month change in Patient Activation Measure (PAM), with secondary outcomes including body mass index (BMI), A1c, and high-sensitivity C-reactive protein (hsCRP). The second study included 186 individuals with CKD received home-based CKD education plus UC. Same outcomes were included as in the first study along with the study retention rates at 6 and 12 months. Results: The first study demonstrated a significant improvement in PAM scores for the HBKC group, with an 8.6-point greater increase than the UC group (p = .023). Secondary outcomes also improved, with significant reductions in BMI (p = .007), A1c (p = .022), and hsCRP (p < .001). In the second study, due to disruptions from the COVID-19 pandemic, there were no significant differences between intervention and control groups in patient activation or clinical markers. However, participants receiving CKD education plus UC were significantly more likely to complete study assessments at six months (OR: 4.0, p < .001) and at one year (OR: 2.9, p = .004), suggesting high participant engagement and interest in family-based CKD education. Conclusion: The HBKC intervention demonstrated significant improvements in patient activation and clinical risk factors for CKD in the Zuni study. While the second study faced pandemic-related challenges, its findings indicate that American Indian families are receptive to home-based CKD education and that such interventions may enhance participant retention. The replication efforts highlight the potential for the HBKC model to be adapted and implemented in other communities, supporting its portability as a a scalable approach to CKD care. Funding: Government Support – Non-U.S.