10 Questions about the Link Between Chronic Kidney Disease and Nutrition

March is National Kidney Awareness Month . At NourishedRx , we’re proud of the supportive role we play in helping underserved people with chronic kidney disease (CKD) improve their health and live their best lives.

More common, debilitating, and deadly than many realize, CKD needs to be better understood so that it can be better prevented and managed. Specifically, CKD is a disease that is greatly exacerbated by diet, lifestyle and life condition factors, so there’s a lot that can be done to slow its advance, improve the health and quality of life of those living with the disease, and (ideally) prevent it in the first place.

1. ? How big is the problem???

Over 37 million Americans have CKD. In 2019, treatment costs for Medicare beneficiaries with CKD was $87.2 billion with an additional $37.3 billion needed for those with end-stage renal disease (ESRD).?

2. ? Why is CKD called a silent killer?

CKD presents no symptoms until the disease reaches its later stages. For that reason, 90 percent of people with CKD are unaware that their kidneys are damaged or failing until their condition becomes life-threatening. This increases the likelihood of lifelong dialysis, transplant, and end-stage renal disease (ESRD) which has an average life expectancy of 5 years.

3. ? How can CKD be detected earlier?

Regular urine and blood tests can detect early kidney damage, and help providers treat and educate patients on the best ways (including diet and lifestyle changes) to slow or stop the progress of the disease.

4. ? Why doesn’t that happen?

Best practices for screening and testing are still evolving though experts agree that early diagnosis would have a big impact on outcomes and costs. But less than 40% of diabetes patients are screened for kidney disease despite the propensity that people with diabetes have to develop CKD. Those numbers are particularly low for Black Americans and socio-economically disadvantaged populations, who are often challenged by other health equity gaps like access to quality food which make them more likely to develop CKD in the first place. And even when testing is available, vulnerable populations often lack the resources or support to access clinical treatment or adopt healthier diets and lifestyles.

As the disease progresses, that treatment becomes even more 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.

5. ? Who gets CKD?

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. 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.

6. ? Why does nutrition matter?

25 percent of people with advanced CKD are also food insecure . People living in food deserts or otherwise challenged by poor diet and food insecurity are more likely to develop diabetes and high blood pressure. Better nutrition can reduce costs associated with CKD, diabetes, and heart disease by $27 to $48 billion.

7. ? Do food-as-medicine programs help?

Yes! For people lacking access to nutritious food or the resources, support, or health to obtain nutritious food and prepare nutritious meals, food-as-medicine programs can be a huge difference maker. Such services can offer CKD patients the nutrition they need to slow the progression of their disease, significantly reducing the likelihood of more intensive and costly care.?

8. ? What makes a food-as-medicine program successful??

In our experience, it’s critical to tailor food-as-medicine programs to the personal and cultural tastes of the recipient. People won’t eat food they don’t like or can’t have for cultural reasons, and they won’t feel enthusiastic about adopting healthier eating habits when that food is not delicious or enjoyable. Because of our personalized meals and grocery deliveries, our participants are excited to get their food delivery every week.

9. ? Is it possible to sustain the impact of such programs?

Our wellness support associates and registered dietitians engage closely with program participants as individuals with specific needs, challenges, gifts, and preferences. Through this personalized support, we help participants develop habits and skills that make them more independent and self-sufficient. We also spend a lot of time educating participants on food choices and preparation. We help them learn to read nutrition labels, make healthier choices at the grocery store, and cook food in ways that enhance nutritional benefit.?

10. How does food-as-medicine care overlap with clinical care?

Food is a powerful doorway to trust, engagement, and connection. Our wellness support associates learn a lot about our participants’ health and social care needs. And we’re able to communicate those needs or care gaps to the health plan or health system. For example, many food-insecure members are forced to decide between paying for medicine or paying for food. Because our wellness support associates have gained trust, they can learn whether the participant is taking their medications or not and help let the plan or health system 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.

Targeted Nutrition Making a Difference

Given the devastating impact of CKD on people’s lives, and the cost to the healthcare system, we’re excited about the potential of targeted food-as-medicine programs.?

At NourishedRx we work with members with Stage 3, Stage 4 or Stage 5 CKD who may be at risk of food insecurity. Our data-driven technology platform helps us tailor food solutions to individual needs and preferences, then deliver food, meal kits, groceries, or produce bundles.?

Depending on their health and functional status, participants 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. To align with their clinical condition, we make sure they receive 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.?

We also engage participants 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. We also monitor health throughout the program to evaluate the impact on clinical and cost outcomes. Once we connect, enrollment numbers are high. Trust grows rapidly, and out of that trust comes engagement.

Healthier nutrition can aid in preventing CKD and slowing the progression of the disease once it’s been detected. And a supportive approach can also help equip people with tools, knowhow, and resources, to take better care of themselves while avoiding unnecessary trips to the emergency department and more costly care.?

With National Kidney Awareness Month as the catalyst, let’s help more people with CKD lead better lives this year.