Effectiveness of telehealth nutritional therapy in preventing chronic kidney disease among adults with type 2 diabetes and obesity: a real world, retrospective, propensity score matched cohort study

Objective To evaluate the real-world effectiveness and safety of a telehealth-delivered, individualized nutrition therapy (VINT) for the prevention and progression of chronic kidney disease (CKD) among adults with type 2 diabetes and obesity. Design Retrospective, propensity score-matched cohort study using administrative claims data. Setting Komodo Healthcare Map, a longitudinal U.S. claims database containing medical and pharmacy data. Participants 8,391 adults enrolled in the VINT program were matched 1:1 with 8,391 usual-care controls on demographic, clinical, and medication covariates, with up to five years of follow-up. Main outcome measures Primary outcomes were new-onset CKD, CKD stage ≥ 3, and CKD stage ≥ 4. Secondary outcomes included regression or stability among those with baseline CKD and safety outcomes (kidney stones, gout, and acidosis). Cox proportional hazards and Poisson regression models were used to estimate hazard ratios (HRs) and incidence rate ratios (IRRs). Results VINT participation was associated with lower incidence of new-onset CKD (10.8 vs 15.7 per 1,000 person-years; HR 0.67, 95% CI 0.54-0.83; p<0.001), CKD stage ≥ 3 (HR 0.55, 95% CI 0.42-0.72; p<0.001), and CKD stage ≥ 4 (HR 0.34, 95% CI 0.16-0.71; p=0.004). Among participants with baseline CKD, regression or stability occurred in 96.8% of VINT vs 87.6% of controls (p=0.005). There was no increased risk of kidney stones, acidosis, or gout. Conclusions In this large, real-world matched cohort, participation in a telehealth-delivered individualized lifestyle intervention emphasizing carbohydrate restriction was associated with significantly lower CKD incidence and progression, without increased adverse renal outcomes.