# Community Health Worker Support for Hispanic and Latino Individuals Receiving Hemodialysis: The Navigate-Kidney Randomized Clinical Trial

## TL;DR

A study found that community health workers helped reduce weight gain between dialysis sessions for Hispanic and Latino patients with kidney failure.

## Contribution

The study introduces a culturally tailored community health worker intervention to improve outcomes for Hispanic and Latino hemodialysis patients.

## Key findings

- The CHW intervention modestly reduced interdialytic weight gain compared to standard care.
- Fewer shortened dialysis sessions were observed in the CHW group.
- Patient activation improved significantly with the CHW intervention.

## Abstract

This randomized clinical trial evaluates if community health worker support reduces interdialytic weight gain among Hispanic and Latino individuals receiving hemodialysis.

Does providing a community health worker (CHW)–based intervention for dietary education and self-efficacy improve interdialytic weight gain (IDWG) among Hispanic and Latino individuals with hemodialysis-dependent kidney failure?

In this randomized clinical trial that included 139 patients at 5 dialysis centers in Denver, Colorado, from 2020 to 2022, a CHW intervention modestly reduced IDWG compared to standard care. There were fewer shortened dialysis sessions with the intervention and greater improvement in patient activation.

Providing CHW support for Hispanic and Latino individuals receiving hemodialysis is a practical and meaningful approach to improving patient outcomes, including lowering IDWG.

Hispanic and Latino individuals with hemodialysis-dependent kidney failure experience social barriers that may increase their risk for volume-related complications, including fluid accumulation between dialysis sessions or interdialytic weight gain (IDWG). Higher IDWG contributes to cardiovascular complications, hospitalizations, and poor quality of life. Minimizing IDWG is prioritized by patients, clinicians, and payers; yet, high IDWG remains common despite dietary education.

To determine if community health worker (CHW) support reduces IDWG among Hispanic and Latino individuals receiving hemodialysis.

This parallel group, unblinded, multicenter, community-partnered, randomized clinical trial was conducted at 5 dialysis centers in Denver, Colorado, between November 2020 and August 2022. Self-identified Latino or Hispanic adults receiving in-center hemodialysis were eligible. Data were analyzed from August 2024 to July 2025.

Participants were randomized 1:1 to the Navigate-Kidney intervention or standard care. In Navigate-Kidney, CHWs followed a framework-driven, patient-centered protocol to support patient social needs and provide health navigation and culturally responsive kidney care education, including dietary modification and fluid restriction education. CHWs met participants biweekly for at least 6 visits. Standard care had no trial-driven culturally responsive components.

The primary outcome was change in IDWG from 90 days prior to intervention to 180 days postintervention, calculated as a percentage of estimated dry weight. Secondary outcomes included missed and shortened dialysis sessions, health care utilization, and patient activation. Between-group IDWG differences were estimated with piecewise linear mixed models.

Of 139 participants (mean [SD] age, 56.8 [12.9] years; 68 [49%] female), 68 were randomly assigned to Navigate-Kidney and 71 to standard care. Postintervention trends in percentage of estimated dry weight differed between Navigate-Kidney and standard care, which corresponded to a difference between groups of −0.46 percentage points (95% CI, −0.78 to −0.14 percentage points) in IDWG after 180 days of follow-up (P = .01). Mean IDWG was 3.26% (95% CI, 2.83%-3.68%) and 3.72% (95% CI, 3.30%-4.14%) in Navigate-Kidney and standard care, respectively. There were fewer shortened dialysis sessions with Navigate-Kidney vs SC (median [IQR], 0.1 [−1.2 to 1.1] vs 0.6 [−0.5 to 1.8]; P = .02), as well as greater improvement in the Patient Activation Measure (median [IQR], 1.8 [−2.2 to 5.2] points vs −2.2 [−7.4 to 2.5] points; P = .005).

In this randomized clinical trial, a culturally tailored CHW intervention modestly lowered IDWG and improved dialysis adherence and patient activation among Hispanic and Latino patients with hemodialysis-dependent kidney failure.

ClinicalTrials.gov Identifier: NCT03978806