Key result
A pharmacist-delivered telehealth intervention significantly slowed eGFR decline among African Americans (difference 1.5 mL/min/1.73 m²; 95% CI 0.04-3.02) but not non-African Americans (Pint=0.005).
Why the study?
African Americans face higher risks of diabetes, chronic kidney disease, and uncontrolled hypertension, but differences by race in response to telehealth interventions targeting kidney function decline were unknown.
Does a multifactorial telehealth intervention improve eGFR decline in primary care patients with diabetic kidney disease?
RCT (n=281)
randomized
Does a multifactorial telehealth intervention improve eGFR decline in primary care patients with diabetic kidney disease?
A pharmacist-delivered telehealth intervention for diabetic kidney disease showed differential effects by race, slowing eGFR decline in African Americans but not in non-African Americans.
Answers are grounded in this paper and cite their sources.
Supports pharmacist telehealth to slow eGFR decline in African Americans; extends evidence for race-specific CKD interventions.
BACKGROUND: African Americans are significantly more likely than non-African Americans to have diabetes, chronic kidney disease, and uncontrolled hypertension, increasing their risk for kidney function decline. OBJECTIVE: The objective of this study was to compare how African Americans and non-African Americans with diabetes responded to a multifactorial telehealth intervention designed to slow kidney function decline. RESEARCH DESIGN: Secondary analysis of a randomized trial. Primary care patients (N=281, 56% African American) were allocated to either: (1) a multifactorial, pharmacist-delivered phone-based telehealth intervention focused on behavioral and medication management of diabetic kidney disease; or (2) an education control. MEASURES: The primary study outcome was change in estimated glomerular filtration rate (eGFR). Linear mixed models were used to explore the moderating effect of race on the relationship between study arm and eGFR decline over time; the mean annual rate of eGFR decline was estimated by race and study arm. RESULTS: Findings demonstrated a differential intervention effect on kidney function over time by race (Pinteraction=0.005). Among African Americans, the intervention arm had significantly greater preservation of eGFR over time than the control arm (difference in the annual rate of eGFR decline=1.5 mL/min/1.73 m; 95% confidence interval: 0.04, 3.02). For non-African Americans, the intervention arm had a faster decline in eGFR over time than the control arm (difference in the annual rate of eGFR decline=-1.7 mL/min/1.73 m; 95% confidence interval: -3.3, -0.02). CONCLUSION: A multifactorial, pharmacist-delivered telehealth intervention for diabetic kidney disease may be more effective for slowing eGFR decline among African Americans than non-African Americans.
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Kobe et al. (2020) conducted an RCT in diabetic kidney disease (n=281). multifactorial, pharmacist-delivered phone-based telehealth intervention vs. education control was evaluated on change in estimated glomerular filtration rate (eGFR) (MD 1.5, 95% CI 0.04, 3.02, p=0.005). A pharmacist-delivered telehealth intervention significantly slowed eGFR decline among African Americans (difference 1.5 mL/min/1.73 m²; 95% CI 0.04-3.02) but not non-African Americans (Pint=0.005).
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