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

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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.

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