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. 2019 Aug 30;1(5):242-252.
doi: 10.1016/j.xkme.2019.07.004. eCollection 2019 Sep-Oct.

Interventions to Improve Blood Pressure Control Among Socioeconomically Disadvantaged Patients With CKD: Kidney Awareness Registry and Education Pilot Randomized Controlled Trial

Delphine S Tuot  1   2   3 , Anna D Rubinsky  3   4 , Alexandra Velasquez  1 , Charles E McCulloch  5 , Dean Schillinger  2   6 , Margaret A Handley  2   5   6 , Chi-Yuan Hsu  1   3 , Neil R Powe  2   6
Affiliations

Interventions to Improve Blood Pressure Control Among Socioeconomically Disadvantaged Patients With CKD: Kidney Awareness Registry and Education Pilot Randomized Controlled Trial

Delphine S Tuot et al. Kidney Med. .

Abstract

Rationale & objective: Sustainable interventions that enhance chronic kidney disease (CKD) management are not often studied in safety-net primary care, in which populations bear a disproportionate burden of disease and experience translational gaps between research and practice. We tested the feasibility of implementing and the impact of 2 technology-enhanced interventions designed to enhance CKD care delivery.

Study design: A 2×2 randomized controlled pilot trial.

Setting & participants: Primary care provider teams (n = 6) and 137 patients with CKD aged 18 to 75 years from 2 safety-net primary care clinics, 2013 to 2015.

Interventions: Primary care provider teams were randomly assigned to access a CKD registry with point-of-care notifications and quarterly feedback or a usual-care registry for 12 months. Patients within provider teams were randomly assigned to participate in a CKD self-management support program or usual care for 12 months.

Outcomes: We examined recruitment, randomization, and participation in each intervention. We also examined the impact of each intervention and their combination on change in systolic blood pressure (SBP), albuminuria, and patient self-reported behavioral measures after 12 months.

Results: Among potentially eligible patients identified using the electronic health record, 24% were eligible for study participation, of whom 35% (n = 137) were enrolled. Mean age was 55 years, 41% were non-English speaking, and 93% were of racial/ethnic minority. Mean baseline estimated glomerular filtration rate was 70.5 (SD = 30.3) mL/min/1.73 m2; mean baseline SBP was 131 (SD = 21.8) mm Hg. Nearly 90% of clinicians reported that the CKD registry influenced their CKD management. More than 95% of patients randomly assigned to CKD self-management support engaged regularly with the intervention. Estimated changes in SBP over 1 year were nonstatistically different in each of the 3 intervention groups compared with usual care: (usual care: 0.5 [95% CI, -5.2 to 6.3] mm Hg; CKD registry only: -5.4 [95% CI, -12.2 to 1.4] mm Hg; CKD self-management support only: -6.4 [95% CI, -13.7 to 1.0] mm Hg; and CKD registry plus CKD self-management support: -0.5 [-5.5 to 4.5] mm Hg), though differences were larger among those with baseline SBPs > 140/90 mm Hg. Decreases in albuminuria were similarly nonstatistically different in each of the intervention groups compared with usual care. No differences were observed in patient self-reported behaviors.

Limitations: Single health system.

Conclusions: Patient and provider interventions to improve CKD care are feasible to implement in low-income settings with promising results among those with uncontrolled blood pressure.

Funding: National Institute of Diabetes and Digestive and Kidney Diseases.

Trial registration: ClinicalTrials.gov, number: NCT01530958.

Keywords: Chronic kidney disease; blood pressure; chronic care model; randomized controlled trial; registry; self-management support.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Study design. Academic clinic: May 2013 to November 2014; community clinic: January 2014 to August 2015. Abbreviations: CKD, chronic kidney disease; CKD-SMS, chronic kidney disease self-management support; PCP, primary care provider.
Figure 2
Figure 2
Consolidated Standards of Reporting Trials (CONSORT) diagram. Abbreviations: CKD, chronic kidney disease; CKD-SMS, chronic kidney disease self-management support; ESRD, end-stage renal disease; PCP, primary care provider; rec, recommends.
Figure 3
Figure 3
Call completion of automated telephone self-management modules.
Figure 4
Figure 4
(A) Estimated mean systolic blood pressure (SBP) and 95% confidence interval (CI) at baseline and 1 year for each Kidney Awareness Registry and Education (KARE) group. (B) Estimated mean 1-year change and 95% CI in SBP by baseline SBP control for each KARE group. Abbreviations: CKD, chronic kidney disease; SMS, self-management support.
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Comment in

  • Eliminating Missed Opportunities for CKD Care.
    Kramer H, Markossian T. Kramer H, et al. Kidney Med. 2019 Sep 12;1(5):229-231. doi: 10.1016/j.xkme.2019.07.008. eCollection 2019 Sep-Oct. Kidney Med. 2019. PMID: 32734938 Free PMC article. No abstract available.

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