Over 37 million Americans have chronic kidney disease (CKD). Since the disease presents no symptoms until its later stages, 90 percent of those people are unaware that their kidneys are damaged or failing, and possibly leading them toward end-stage renal disease (ESRD), lifelong dialysis, transplant, and an avoidable death.
Early and regular testing can help detect CKD, allowing patients to receive treatment and adopt lifestyle changes before the disease progresses. But such testing is not always accessible in underserved populations already experiencing health disparities and socio-economic circumstances that make them more likely to develop CKD in the first place. What’s more, those populations often lack the resources and know-how to adopt healthier lifestyles.
A powerful answer to this conundrum is a better diet, delivered through a food-as-medicine program. Such services can offer CKD patients the nutrition they need to slow or stop the progression of their disease, significantly reducing the likelihood of more intensive and costly care. And they can serve as conduits of trust, engagement, and valuable insights for providers and health plans, enabling better overall care and healthier lives.
Recognizing the need for this service, we’re implementing a program to deliver nutritious food to people with CKD at risk of food insecurity. We see great opportunities to improve health and reduce costs for CKD populations across the country.
The Silent Killer
Chronic kidney disease is one of a number of severe health conditions labeled silent killers because patients exhibit no symptoms until the illness becomes life-threatening or life-ending. Regular urine and blood tests can detect early kidney damage, and help providers treat and educate patients on the best ways to slow or stop the progress of the disease. The earlier that providers and health plans can identify and engage with CKD patients, the better.
But when CKD is not detected or when patients fail to take steps to slow or stop the progression of the disease, treatment becomes increasingly complex, costly, and difficult to access. There are less than 10,000 nephrologists in the U.S. for 37 million people with CKD. Dialysis is expensive for payers and patients alike. More than 90,000 people in the U.S. are waiting for a kidney transplant.
Risk factors for CKD include age (people over 60), race/ethnicity (35% of people in the U.S. with CKD are African American), a history of smoking, a family history of kidney disease, and obesity. But the primary precursors to CKD are diabetes and high blood pressure. One-third of adults with diabetes and one-fifth of adults with high blood pressure also develop CKD. Some patients with CKD have both diabetes and high blood pressure.
People living in food deserts or otherwise challenged by poor diet and food insecurity are more likely to develop diabetes and high blood pressure, and 25 percent of people with advanced CKD are also food insecure. Those CKD patients are also more likely to develop end-stage renal disease which has an average life expectancy of 5 years.
Healthier nutrition can aid in preventing CKD and slowing the progression of the disease once it’s been detected. That’s where we come in.
At NourishedRx, we make high-quality nutritious food accessible to the people who need it most. With our data-driven technology platform, we tailor food solutions to individual needs and preferences, then deliver food, meal kits, groceries, or produce bundles. Our team of wellness support associates and registered dietitians guide and engage program participants with personalized support, throughout their health journey.
Members eligible for this program have Stage 3 or Stage 4 CKD and are at risk of food insecurity. Participants’ health will be monitored throughout the program to evaluate the impact on clinical and cost outcomes.
Depending on their health and functional status, participants will get prepared meals and meal kits for the first 6 weeks, then grocery deliveries for the next 10 weeks, and additional support for the final 8 weeks. We’ll engage those people through our weekly food deliveries and help them with referrals to community resources and nutrition education while providing the health plan with any actionable insights we uncover.
To address their CKD, we’ll provide participants with a balanced diet focused on nutrient-dense foods, including fruits and vegetables, less refined sugar and carbohydrates, and proper amounts of protein, sodium, potassium, and phosphorus. But we also know that food has to hit the mark with each member. As our lead dietitian Megan McFadden notes, “It’s very important that members receive food that appeals to them and is aligned with their cultural cuisine preferences. We’re not going to drive health benefits from providing food members don’t like, won’t eat, or will throw away.”
One interesting aspect of such programs is how enthusiastically members interact with us. Once we connect, enrollment numbers are high. They’re excited to get their food delivery every week. They love to give us feedback, especially when a meal is particularly delicious. Trust grows rapidly, and out of that trust comes engagement.
Our registered dietitians and wellness support associates are in consistent contact with members during the course of each program to support them and help them develop skills that make them more independent and self-sufficient. So, we spend a lot of time educating them on food choices and preparation. We show them how to read nutrition labels and make healthier choices at the grocery store. We want members to leave our program with lasting benefits.
And we find that we learn a lot about our members’ health that we can communicate to the health plan through actionable insights. For example, knowing that many food-insecure members are forced to decide between paying for medicine or paying for food, we might ask whether they’re actually taking their medications and let the plan know. This can be game-changing information since people who are food insecure don’t often see their doctors on a regular basis or engage openly with their health plan case managers.
Our clinical advisor, Dr. Roger London, emphasizes how important this work is for health plans and care teams. “Megan and her team act as a trust bridge while providing valuable services and expertise. They’re effectively an extension of the medical practice, helping to enhance coordination and adherence with a difficult-to-reach population. And they’re helping the health plan document other comorbid conditions like hypertension, diabetes, heart failure, and so on, to make sure people are getting all the care they need.”
The goal is to help the member be as healthy as possible and equip them with tools to take better care of themselves. But it also helps them avoid unnecessary trips to the emergency department. And slowing or stopping the progression of CKD reduces the likelihood that they’ll develop ESRD, begin dialysis, or become a candidate for transplant – all costly and intense interventions that everyone would like to avoid. On a national level, it’s estimated that better nutrition can reduce costs associated with CKD, diabetes, and heart disease by $27 to $48 billion.
March is National Kidney Awareness Month. As it comes to a close, it’s important that we all carry with us greater awareness of this silent killer. At NourishedRx, we’re proud of the supportive role that we’re able to play in helping underserved people with CKD improve their health and live their best lives.