Facilitating Improvements in Kidney Health Using a Smartphone App Counseling Program in Patients With Diabetes

Patients with diabetes and stage 1-3a CKD receive instructions on downloading and using
MyFitnessPal on their smartphone or computer to log meal data daily, weekly website
educational materials, and weekly telephone visits with a dietician for 8 weeks. Patients
receive a follow-up phone call from the dietitian and 5 and 11 months for further support and
counseling, and are also invited to attend a local dietitian-led grocery tour. This pilot
study examines the feasibility of dietary app-supported tele-counseling in the treatment of
patients with stage 1-3a chronic kidney disease (CKD) and diabetes.

Main outcomes include sodium intake assessed by 24 hour urine collection as well as other
dietary measures related to kidney disease (sodium/potassium ratio, Healthy Eating Index
score, 24-hour urine phosphorus, estimated net endogenous acid production) and health
measures (24-hour ambulatory blood pressure, weight, albumin/creatinine ratio)

Inclusion Criteria:

- Age > 21 years

- Diabetes diagnosis (Type I or Type II)

- Last urine albumin/creatinine ratio (ACR) within the past two years > 30 mg/g

- Last outpatient estimated glomerular filtration rate (eGFR) within the past year > 45
ml/min/1.73m2

- Last outpatient systolic blood pressure (SBP) within the past year < 160 mmHg

- Last outpatient diastolic blood pressure (DBP) within the past year <100 mmHg

- Preceding eGFR decline rate less than -2 ml/min/1.73m2/y

- At least 2 outpatient eGFR measurements in electronic health record, separated by at
least 2 years

- Agreeable to change diet (decrease sodium and red/processed meat intake, increase
fruit and vegetable intake)

- Access to smartphone or computer

Exclusion Criteria:

- Inability to understand English

- Myocardial infarction, stroke, or atherosclerotic cardiovascular disease procedure
within 6 months.

- Current treatment for malignancy

- Planned bariatric surgery

- Pregnancy or planning to become pregnant within next 2 years

- Self-reported average consumption of > 14 alcoholic beverages per week

- Psychiatric hospitalization in past year

- Unstable angina

- Urine ACR > 2500 mg/g

- Last potassium > 5.0 mg/dL

- Hypoglycemia episode in past 1 month (glucose < 70 mg/dL)

- Principal investigator discretion (i.e. concerns about safety, compliance)