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CKD Outcomes Improve for Black Adults When DASH Diet Is Combined With Coaching, Assistance

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A study presented at Kidney Week 2022 investigated the effects of combining diet coaching and financial support in black adults with high blood pressure and advanced chronic kidney disease.

Some efforts to promote healthy diets for vulnerable populations with chronic kidney disease (CKD) include dietary guidance and financial assistance.Research published in Kidney Week 2022 We looked at the combined effects of both, adding dietary advice to interventions for black adults with hypertension and advanced CKD, and including money for groceries.

Black adults have higher rates of hypertension and advanced CKD in the United States, and potential reasons for these disparities may include lack of access to healthy foods. gaps in knowledge about healthy diets.

diet to stop high blood pressure, or dashwhich emphasizes a heart-healthy diet that is low in sodium and rich in potassium and other nutrients.

Diedre C. Crews, MD, ScM, FASN, Deputy Director and Professor of Medicine at the Johns Hopkins Center for Health Equity, Diedre C. Crews, said the hypothesis of the two-step trial was a significant 20% reduction in urinary albumin excretion. and improved blood pressure. This study included her 150 black adults with a urinary albumin/creatinine ratio (ACR) of 30 and less than 1000 mg/g and an estimated glomerular filtration rate (eGFR) of 30 ml/min/1.73 m and above. was2.

The average age of participants was 61 years. 37% were male and 44% had diabetes. Mean systolic blood pressure was 129 mmHg and eGFR was 75 ml/min/1.73 m2.

Most (64%) were taking renin-angiotensin-aldosterone system (RAAS) blockers and 26% were food insecure.

Participants were randomized 1:1 into two groups. A ‘voluntary’ group followed the DASH diet for 4 months and was provided with a $30 weekly gift card to spend on groceries (S-DASH group). The Dietitian Led Coaching Group (C-DASH) delivered $30 worth of “5 Plus” food to their homes and had weekly phone calls with their coaches. 5 plus means 5 servings of fruits and vegetables plus nuts and beans totaling 17,000 milligrams of potassium each week.

In both groups, the weekly meal allowance stopped between 5 and 12 months, but the coaching group continued with phone calls, albeit at longer intervals.

The survey was conducted from February 2018 to August 2021. After COVID-19 restrictions were put in place, 142 of the 150 participants remained in the study. common (44% compared to 29% in the C-DASH group).

The crew presented 4-month results that were analyzed using mixed-effects regression. The primary outcome was percent change in urinary ACR.

Overall, the C-DASH group showed a reduction in urinary albumin/creatinine ratio (UACR) that was not statistically different from the S-DASH group. However, in the subgroup with particularly high UACR, the C-DASH group had a 73.3% decrease in UACR and the S-DASH group had a 20.5% increase.

The C-DASH group had statistically significant increases in potassium and fruit and vegetable consumption over the non-coached group.P. = .09). Hyperkalemia (>5.5 mEq/L) she developed in 1 her C-DASH participant and no S-DASH participants.

“Our next step is to expand our program to support more populations disproportionately affected by kidney disease,” Cruz said.

reference

Five plus butts and beans for Crews DC, Dalcin AT, Carson KA and other kidney researchers. A dietary intervention trial in hypertensive black adults with CKD. Presented at: Kidney Week 2022; November 3-6, 2022. Orlando, Florida. Abstract FR-OR64.

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