Home-Based Kidney Care in Native American's of New Mexico (HBKC)
Chronic Kidney Diseases
About this trial
This is an interventional health services research trial for Chronic Kidney Diseases focused on measuring Diabetes, American Indians, Disparity, microalbuminuria, Telemedicine, Community health representative (CHR), Patient Activation Measure (PAM), Home base kidney care
Eligibility Criteria
Inclusion Criteria:
- (1) live in a household with 1 participant
- (2) age 21 to 80 years
- (3) negative pregnancy test in women of child-bearing potential
- (4) diagnosed diabetics or HbA1c >7
- (5) BMI >27 kg/m2 and UACR of >/= 30
Exclusion Criteria:
- (1) life expectancy < 1 year
- (2) pregnancy or absence of reliable birth control in women of child-bearing potential
- (3) malignancy except non-melanoma skin cancer
- (4) blind
- (5) ESRD and on dialysis
- (6) kidney transplant recipient
- (7) unwilling or unable to give informed consent.
Sites / Locations
- University of New Mexico
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Usual Care / Delayed Intervention
Home-Based Kidney Care Intervention
Participants randomized to the control group will receive usual care by their provider for 12 months. They will also attend one group class taught by CHRs in which they will learn basic information about diabetes prevention. DI participants will receive publicly-available literature that reinforces the information given in class, and they will have no other contact with study staff aside from during study data collection visits at baseline and 12 months. After 12 months of usual care, patients will enter into the delayed intervention where they will complete 12 months of Home-Based Kidney Care (HBKC).
All subjects randomized to the HBKC arm will be visited by a CHR in their home at least every two weeks for the duration of the 12 month intervention. Each visit will last 30 minutes to one hour and participant preference will be incorporated into the HBKC intervention arm by allowing participants to prioritize the order in which curriculum topic areas will be emphasized by the CHRs. Topics from currently available NIDDK and IHS kidney education materials will include: (1) Kidney 101, (2) weight management, (3) exercise, (4) healthy eating, (5) medication management, (6) coping with stress, (7) risk factor management (i.e.- blood pressure, hyperlipidemia), (8) alcohol and substance abuse, (9) smoking cessation, and related health concerns.