Effectiveness of Telehealth Low-Carbohydrate Intervention in Preventing Chronic Kidney Disease: A Real-World, Retrospective, Matched Cohort Study.

Abstract

Background: Lifestyle interventions targeting metabolic health may influence chronic kidney disease (CKD) risk, particularly among adults with type 2 diabetes and obesity. We evaluated real-world associations between a telehealth-delivered, individualized nutrition therapy program (VINT) and CKD incidence and progression compared with usual care.

Methods: We conducted a retrospective, propensity score-matched cohort study using the Komodo Healthcare Map, a longitudinal U.S. administrative claims database. Adults enrolled in a telehealth-delivered nutrition therapy emphasising carbohydrate reduction, VINT (n = 11 077) were matched 1:1 to usual-care controls on demographic, clinical, and medication covariates, over 5 years of follow-up. Primary outcomes were new-onset CKD, CKD stage ≥ 3, and CKD stage ≥ 4. Secondary outcomes included renal safety events. Cox proportional hazards and Poisson regression models were used to estimate hazard ratios (HRs) and incidence rate ratios (IRRs).

Results: VINT participation was associated with a lower incidence of new-onset CKD (10.1 vs. 15.6 per 1000 person-years; HR 0.64, 95% CI 0.53-0.77; p < 0.001), CKD stage ≥ 3 (HR 0.57, 95% CI 0.45-0.73; p < 0.001), and CKD stage ≥ 4 (HR 0.38, 95% CI 0.18-0.79; p = 0.009). No increased risk of kidney stones, metabolic acidosis, diabetic ketoacidosis, or gout was observed in VINT compared with the UC group.

Conclusions: In this large, real-world matched cohort, participation in a telehealth-delivered nutrition therapy emphasising carbohydrate reduction was associated with lower CKD incidence and progression without increased renal adverse events. These findings suggest that individualized nutrition therapy may be a safe and scalable approach to CKD prevention and management in adults with metabolic disease, warranting further prospective investigation.