A randomized trial led by Lilia Cervantes , MD, MSc, professor of hospital medicine at the University of Colorado Anschutz School of Medicine , has found that a culturally tailored intervention helped achieve a modest reduction in interdialytic weight gain among Hispanic and Latino patients with kidney failure who rely on hemodialysis.
The intervention, called Navigate-Kidney, utilizes community health workers (CHWs) to help patients undergoing hemodialysis understand and work through challenges that come with treatment, including socioeconomic factors, particularly food insecurity as well as lack of culturally responsive care, and disparities in access to health insurance and health care.
"I've had a community steering committee for over 10 years composed of patients, caregivers, interdisciplinary clinicians, and members of non-profit organizations focused on kidney disease disparities," says Cervantes, who also directs the Immigrant Health program and works with the Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS). "We've worked through several qualitative and mixed method studies trying to understand the perspectives and preferences, needs, and barriers of Latino patients with kidney failure receiving in-center hemodialysis, their caregivers, and their interdisciplinary nephrology clinicians."
The group eventually landed on Navigate-Kidney, and new research reveals that the tailored and patient-centered approach is proving to be beneficial.
The intervention led by CHWs has four goals: building trust with the patient, offering support toward multi-level social and structural challenges, providing patient-centered education on kidney care, and enhancing self-management.
"What's beautiful about this approach is that a community health worker can provide a very patient-centered approach," Cervantes says.
Meaningful shifts in interdialytic weight gain
Hemodialysis-dependent kidney failure often requires ample support due to the highly-regimented treatment schedule and need for lifestyle changes – both of which can be especially challenging in populations that face higher rates of socioeconomic difficulties, food insecurity, and healthcare disparities.
Nearly two-thirds of Navigate-Kidney patients faced food insecurity, Cervantes says, and the dietary restriction is an important part of managing interdialytic weight gain — how much weight a patient gains between dialysis sessions because of fluid retention.
High interdialytic weight gain can intensify complications and hinder treatment results.
Results from the randomized trial, published in JAMA Internal Medicine , found that six months after the intervention ended, the average interdialytic weight gain was 3.26% among intervention participants and 3.72% among the participants who received the standard care — a difference of 0.46 percentage points in interdialytic weight gain. While a modest improvement, Cervantes says it's meaningful.
"Seeing these results tells us that the group that received the CHW intervention may have experienced an improvement in their understanding of the dietary restriction to reduce their fluid gain between dialysis sessions," she says. "It means that they developed the confidence and the knowledge necessary to understand the different reasons they might increase fluid, and it means that they were able to engage in self-management."
'I still had a lot of life to live'
Beyond the promising results in interdialytic weight gain, Cervantes and her team of researchers also found that participants were thrilled with the CHW model and the support they received.
"I learned that I still had a lot of life left to live, even if it is (with dialysis) and that helps me to feel better," one participant said of their experience, which was published as part of qualitative findings from the Navigate-Kidney trial in JAMA Network Open .
By building relationships through empathy and consistent support, the researchers say CHWs were able to help patients navigate complex health and social systems, provide culturally and linguistically tailored education, and empower them to manage their care.
"The nutritionist told me she gave me a paper to understand my diet but when she (CHW) joined us, it was very different…we went over those papers and how the food is related to symptoms…we talked about what to eat and what is good for me and what isn't good for me," another participant recalled.
A third participant said that doctors had advised against eating salt, but a CWH was able to help tailor their diet and develop new menus and recipes and make that shift manageable.
Now, Cervantes and her team are in the process of finalizing a CHW training program focused on kidney disease that can be adapted to many different populations and settings.
"We are building Navigate-Kidney CHW training programs so that they can be applied to any group, any race and ethnicity, and setting" Cervantes says. "The CHW training will be able to deliver support in a way that is culturally responsive and takes into account lived experience, cultural traditions, perspectives, and beliefs."
