Veteran Kidney Dietary Adherence Associations with Kidney-Related Outcomes and Patient Perspectives, Experiences, and Perceptions with Diet and Medically Tailored Meals (KDA-MTM study)

Va Eastern Colorado Health Care System, Aurora CO

Investigators

Abstract

Veterans experience high prevalence rates of chronic kidney disease (CKD) with notably accelerated progression to end-stage kidney disease is. Veterans who have CKD and other comorbidities exhibit higher mortality rates than the general U.S. population. CKD is frequently either caused by or associated with hypertension, and diabetes. Lifestyle changes, such as diet, may assist in preventing, delaying, or limiting the severity of hypertension, diabetes, and/or kidney disease. Medically tailored meals (MTMs) represent an emerging and innovative approach at the intersection of healthcare and nutrition for managing chronic diseases such as CKD. MTMs are aligned with national nutritional standards and recommendations, specifically addressing the unique dietary needs of individuals. This holistic approach encompasses a multifaceted strategy that goes beyond addressing clinical nutrition, outcomes, and reducing healthcare costs to confronting broader issues like Veteran well-being or food insecurity. This is particularly relevant in the context of CKD, where consistent adherence to dietary guidelines often proves challenging and restrictive. Veterans with CKD may also face unique, service-related, challenges to healthy eating behaviors in addition to these complex dietary considerations. Before diet or MTM interventions can be developed for Veterans, preliminary associations with clinical outcomes need to be examined and Veteran-centered patient perspectives need to be understood. The long-term goal of this line of research is to implement sustainable, novel dietary interventions in the context of chronic, nutritionally sensitive, illnesses that are personalized for Veterans. This encompasses examining the evidence behind CKD dietary guidelines and the potential for liberalizing these restrictions, aiming for a balance between clinical needs and quality of life through greater dietary flexibility. The initial steps toward the long-term goal are proposed with this study, in three aims, using an observational cohort, cross-sectional cohort, and a multi-methods design: (1) score and describe kidney diet quality and adherence in Veteran patients with CKD in a nationally representative dataset, (2) determine the relationship of diet with clinical biomarkers and measures in these Veterans with CKD, (3a) understand patient perspectives and experiences with dietary habits, eating behaviors, and kidney diets, (3b) understand barriers and facilitators to kidney diet MTMs, as well as perceived meal effectiveness and acceptability, among Veterans with CKD. The quantitative aspects (Aims 1 and 2) of this research proposal will provide evidence on how Veterans align or deviate from nutritional recommendations globally and how diet quality relates to clinical outcomes for potential effects sizes and calculating statistical power for a future clinical trial. The qualitative Aim 3 will provide a greater understanding of Veterans dietary and nutrition practices and perspectives in the context of kidney disease, the home-environment, and the greater external-community setting, as well as MTM access and perceived benefits of MTMs. This CDA-1 proposal is supported by infrastructure and resources from the Denver Center of Innovation (COIN) and Merit awards led by the mentoring team. The data gathered from this study will inform the development of a dietary or MTM intervention trial (future CDA-2 study) for Veterans with CKD. During the award period, the candidate will take full advantage of the allocated research time to develop clinical, research, and professional skills essential for a future role as a VA independent investigator. Specifically, the candidate will enhance their skills in both quantitative and qualitative research methodologies, focus on research tailored to the health of Veterans, and refine their abilities in scientific communication, including dissemination of their findings.