Experiences of participants of a dietary intervention trial for African Americans with hypertension and CKD

Background: African Americans are disproportionately affected by hypertension (HTN) and CKD and evidence suggests dietary modifications towards a more Dietary Approaches to Stop Hypertension (DASH)-accordant diet could improve outcomes for this population. We aimed to explicate barriers and facilitators of healthy eating, and the perceived benefits of the intervention among completed participants of a dietary intervention trial for African Americans with HTN and CKD. Participants were randomized to one of two groups: 1) Self-Shopping DASH (S-DASH) diet group with $30/week grocery allowance for 4 mo. but no specific guidance on purchases, followed by no food allowance for 8 mo.;or 2) Coaching DASH (C-DASH) diet advice group with a $30/week food allowance and assistance in purchasing foods for 4 mo., followed by intermittent coaching without food allowance for 8 mo. Methods: We performed a content analysis of transcripts from semi-structured interviews with participants who completed the trial (13 C-DASH;12 S-DASH were randomly selected). Thematic analyses followed 5 stages: 1) reading and rereading all transcripts and utilizing audio recordings as needed for clarity;2) three coders reading two of the same transcripts, coding them, and comparing codes which were then used to create the initial coding framework;3) defining codes, coding additional transcripts, discussing/ revising the coding framework;4) formulating initial themes and 5) diagramming relationships among initial themes to merge overlapping themes. Results: Participants were a mean age of 62 ± 9.3 years, 36% were male. Key themes included healthy diet facilitators (food tracking, motivation, social support, and perception of healthy foods);barriers (transportation, past eating habits, stress and COVID mitigation);and impact of the trial on knowledge and health. Conclusions: Participants of a dietary intervention trial for African Americans with HTN and CKD identified several facilitators and barriers to healthy eating that could inform future efforts to address disease burden in this population.

Telemedicine in the care of kidney transplant recipients with COVID-19

Introduction: Kidney transplant (KT) recipients with COVID-19 symptoms are bringing challenges to providers given the risk of COVID-19 exposure to health care workers, patients, and the public. Case Description: Three KT recipients with COVID-19 were managed using telemedicine via synchronous video visits integrated with an electronic medical records system, from home to inpatient settings (Figure 1-2). Patient 1 is a 53-year-old male s/p KT in 2012;Patient 2 is a 56-year-old female s/p KT in 2019;and Patient 3 is a 53-yearold female s/p simultaneous liver-kidney transplant in 2014. Patients 1 and 3 had followup COVID-19 NAT testing: Patient 1 converted to be negative at 24 & 28 days, whereas Patient 2 converted to be negative at 45 & 48 days. Discussion: Telemedicine helped assess, diagnose, triage, and treat patients with COVID-19 while avoiding an ER or outpatient clinic visit. We highlight the value of telemedicine in the maintenance of uninterrupted follow-up care for immunosupressed patients with prolong viral shedding.