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

ObjectiveTo 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. DesignRetrospective, propensity score-matched cohort study using administrative claims data. SettingKomodo Healthcare Map, a longitudinal U.S. claims database containing medical, and pharmacy data Participants8,391 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 measuresPrimary outcomes were new-onset CKD, CKD stage [&ge;]3, and CKD stage [&ge;]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). ResultsVINT 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 [&ge;]3 (HR 0.55, 95% CI 0.42-0.72; p<0.001), and CKD stage [&ge;]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 versus 87.6% of controls (p=0.005). There was no increased risk of kidney stones, acidosis, or gout. ConclusionsIn 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. What is already known on this topicO_LIAdults with type 2 diabetes and obesity are at high risk of chronic kidney disease (CKD) and kidney-related complications. C_LIO_LICurrent drug therapies, while beneficial, leave substantial residual risk and are often limited by cost, access, and adherence. C_LIO_LIScalable lifestyle-based approaches that can be delivered remotely are urgently needed to prevent CKD onset and progression. C_LI What this study addsO_LIIn a large real-world matched cohort, a telehealth-delivered individualized nutrition therapy program was linked to a 33% lower risk of new-onset CKD and up to a 66% lower risk of advanced CKD (stage 4 and beyond). C_LIO_LIAmong participants with existing CKD, disease regression or stability occurred in nearly 97%, compared with 88% of controls. C_LIO_LIThe intervention was safe, with no increased risk of kidney stones, acidosis, or gout. C_LI