Results Summary

What was the research about?

In chronic kidney disease, or CKD, the kidneys don’t work well to remove waste from the blood. CKD can lead to kidney failure and even death. American Indian people have high rates of CKD.

Behaviors to manage health and health care may slow the progress of CKD. Increasing patients’ activation, or their knowledge, skills, and confidence about these behaviors, may be one way to improve kidney health.

In this study, the research team compared two approaches to increase patient activation and improve kidney health among American Indian adults with or at risk for CKD:

  • CKD education at home plus usual care. Community health representatives, or CHRs, met with patients at home or by phone two times per month. Topics discussed in meetings included staying active, making healthy food choices, problem solving, and weight loss. CHRs also held group sessions every three months to build peer support. In these sessions, people did social activities, like cooking traditional food or playing bingo. Patients also received usual care.
  • Usual care alone. Patients received usual care at one of four Indian Health Service or tribally operated health clinics in New Mexico. They also attended a class on diabetes taught by CHRs.

What were the results?

The research team surveyed patients at the start of the study and again 6 and 12 months later. But many of the surveys took place during the COVID-19 pandemic, so only 26 percent of the patients completed all three surveys.

For patients who completed either the 6- or the 12-month survey, those who received CKD education plus usual care and patients who received usual care alone didn’t differ in how much patient activation and kidney health improved.

Compared with patients who received usual care alone, patients who received CKD education plus usual care were:

  • Four times more likely to complete the 6-month survey
  • Three times more likely to complete all the surveys

Who was in the study?

The study included 186 American Indian people ages 21–80 who had or were at risk for CKD caused by type 2 diabetes. The average age was 57, and 57 percent were women. Patients in the study could be part of the same household.

What did the research team do?

The research team assigned households by chance to receive CKD education plus usual care or usual care alone. Besides completing surveys, patients who remained in the study had tests to monitor diabetes and kidney health.

Patients with CKD caused by diabetes, tribal leaders, doctors, and staff from the Indian Health Service provided input on the study.

What were the limits of the study?

Due to social distancing during the pandemic, patients received CKD education online or in print instead of at home. Fewer people completed the study, so it was hard to find differences between approaches.

Future studies could continue to explore ways to provide CKD education to American Indian people with and at risk for CKD.

How can people use the results?

Clinics can use these results when considering how to support American Indian patients in managing their CKD.

Final Research Report

This project's final research report is expected to be available by July 2024.

Peer-Review Summary

The Peer-Review Summary for this project will be posted here soon.

Conflict of Interest Disclosures

Project Information

Vallabh O. Shah, PhD
Kevin English, DrPh; Vernon S Pankratz, PhD; Mark Unruh, MD
University of New Mexico Health Sciences Center
Home-Based Chronic Kidney Disease (CKD) Care in Native Americans of New Mexico: A Disruptive Innovation

Key Dates

July 2016
July 2023

Study Registration Information


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Last updated: December 20, 2023