Group-Based Care in Adults and Adolescents With Hypertension and CKD: A Feasibility Study

Abstract

Rationale & Objective Group-based care provides an opportunity to increase patient access to providers without increasing physician time and is effective in the management of chronic diseases in the general population. This model of care has not been investigated in chronic kidney disease (CKD). Study Design Randomized controlled trial in adults (n = 50); observational study in adolescents (n = 10). Setting & Participants Adults and adolescents with CKD and hypertension in the Bronx, NY. Intervention Group-based care (monthly sessions over 6 months) versus usual care in adults. All adolescents received group-based care and were analyzed separately. Outcomes Participant attendance and satisfaction with group-based care were used to evaluate intervention feasibility. The primary clinical outcome was change in mean 24-hour ambulatory blood pressure. Secondary outcomes included physical activity, medication adherence, quality of life, and sodium intake as assessed by 24-hour urinary sodium excretion and food frequency questionnaires. Results Among adults randomly assigned to group-based care, attendance was high (77% of participants attended ≥3 sessions) and most reported higher satisfaction. Mean 24-hour ambulatory systolic blood pressure decreased by −4.2 (95% CI, −13.3 to 5.8) mm Hg in group-based care patients compared with usual care at 6 months but this was not statistically significant. Similarly, we did not detect significant differences in health-related behaviors (such as medication adherence, sodium intake, and physical activity) or quality-of-life measures between the 2 groups. Among the adolescents, attendance was very poor; self-reported satisfaction, although high, did not change from baseline compared with the 6-month follow-up. Limitations Small study size, missing data. Conclusions Group-based care is feasible and acceptable among adults with hypertension and CKD. However, a larger trial is needed to determine the effect on blood pressure and health-related behaviors. Patient participation may limit the effectiveness of group-based care models in adolescents. Funding National Institutes of Health R34 DK102174. Trial registration https://clinicaltrials.gov/show/NCT02467894 .

Lifestyle Interventions, Kidney Disease Progression, and Quality of Life: A Systematic Review and Meta-analysis

“…Nonsignificant improvements were reported in 90 domains across 14 studies. 28 , 29 , 30 , 35 , 36 , 39 , 42 , 44 , 45 , 47 , 54 , 58 , 78 , 79 , 88 , 90 No difference in QoL between intervention and control arms were reported for 3 domains across 3 studies, 47 , 49 , 58 whereas nonsignificant reductions in QoL after lifestyle interventions, compared with those of control, were reported in 17 domains across 10 studies. 36 , 43 , 44 , 45 , 47 , 49 , 54 , 58 , 78 , 79 , 88 No studies reported statistically significant reductions in QoL after lifestyle interventions, compared with those of the control.…”

“…Dietary interventions were investigated in 24 studies, 46 , 47 , 48 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 with exercise interventions used in 23 studies. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 Eleven studies assessed interventions involving multiple components (eg, both diet and exercise), 16 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , ...…”

“…The effect of lifestyle interventions on QoL were investigated in 20 studies. Quality of life was assessed using a range of tools, including the 36-item short form survey, 16 , 17 , 28 , 29 , 30 , 35 , 36 , 43 , 44 , 47 , 75 , 88 Kidney Disease Quality of Life Short Form questionnaire, 38 , 43 , 44 , 45 , 47 , 49 , 90 12-item short form survey, 41 , 54 , 79 World Health Organization Quality of Life-BREF, 74 , 78 Assessment of Quality of Life questionnaire, 58 EuroQoL 5-dimensional, 36 Kidney Disease Quality of Life 36-item survey, 41 RAND 36-Item Short Form Health Survey, 39 and Veterans RAND-12 42 ( Item S14 ).…”

Physical activity and the ‘pediatric inactivity triad’ in children living with chronic kidney disease: a narrative review

“…In Johns et al .’s study, 31 10 adolescents (median age 18.0 years) underwent monthly group-based care sessions over 6 months. Sessions involved self-care activities (e.g.…”

“…Furthermore, there have been limited efforts to implement interventions to increase physical activity behaviour, and those that have tried have had seemingly negligible effects. 30 , 31 In this context, it is important to note that drivers of inactivity are likely different across disease sub-groups (e.g. in KTx recipients, barriers include fear of injury, while in those on dialysis, a lack of time may be a greater hindrance), and these should be accounted for in the promotion of physical activity behaviour.…”