Objective: Home-Based Kidney Care (HBKC) is a pragmatic treatment approach that addresses patient preferences and cultural barriers to healthcare. We previously reported the results of a clinical trial of HBKC vs. usual care in a cohort of Zuni Indians in New Mexico. This study investigated the potential for differential efficacy of HBKC vs. usual care according to type 2 diabetes status of the Zuni Indians who had participated in the trial.
Methods: Participants identified as having evidence of chronic kidney disease were enrolled into the original trial, and were randomized into either HBKC or usual care. Participants were subsequently categorized according to type 2 diabetes status. Linear regression models were used to test for the presence of a differential treatment effect by diabetes status and to estimate treatment effects within those with and without diabetes.
Results: The original study enrolled 63 participants into the HBKC group, and 62 into usual care. Twenty-four (38.1%) participants in the HBKC group and 32 (51.6%) in usual care had diabetes. The test for interaction between diabetes status and treatment arm suggested a significant differential treatment effect by diabetes status (p=0.022). The treatment effect among those with diabetes showed that PAM total scores increased by 16.0 points (95% Confidence Interval [CI]: 8.8 to 23.1) more in the HBKC group than in the usual care group, while changes in PAM total scores were similar in both treatment groups among those without diabetes (treatment effect [95% CI] = -1.4 [-12.4 to 9.6]).
Conclusions: We have previously shown that HBKC is effective in increasing the engagement of Zuni Indians with CKD in their healthcare. This secondary analysis suggests that the effectiveness of this intervention on increasing patient activation is most notable among those CKD patients who also have diabetes.
V. Shah: None. V.S. Pankratz: None. D.M. Ghahate: None. J. Bobelu: None. R. Nelson: None.
Patient-Centered Outcomes Research Institute