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

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.