More than 1 in 7 U.S. adults have chronic kidney disease (CKD). An estimated 25% of persons with CKD in the U.S. are food insecure, meaning they don’t have consistent access to enough food for an active, healthy lifestyle, and they are 38% more likely to develop kidney failure than food secure individuals with CKD. In addition to medication, evidence-based treatment to prevent CKD progression includes following a healthy diet. However, people with CKD report difficulty adhering to dietary guidance because of the high cost of healthy foods. Food Is Medicine approaches, and specifically produce prescriptions, provide patients with free or subsidized fruits and vegetables to facilitate disease management. Produce prescriptions have shown improved outcomes for people with diabetes and cardiovascular disease, but little research has examined these interventions in populations with CKD.

We conducted an RCT where people with CKD and food insecurity (n=100), recruited from patients at ambulatory clinics at an academic center, were randomized to either a control (usual care) or intervention group, which received twice monthly produce prescription vouchers ($40-60) for 6 months to purchase fruits and vegetables at local stores. Food and nutrition insecurity and diet quality were assessed at baseline, 3, and 6 months. We will compare 3- and 6-month outcomes in the 2 study groups using Generalized Estimating Equations.

In preliminary findings, the prevalence of food (78.0% to 63.3%, p=0.11) and nutrition (38.0% to 18.4%, p<0.05) insecurity decreased at 3 months compared to baseline in the intervention group, but not the control group (food: 56.0% to 56.3%, p=0.98; nutrition 30.0% to 31.3%, p=0.89). Study follow-up is complete and full analytic results are forthcoming. The findings we present will serve as critical early data on the efficacy of produce prescriptions within CKD populations and will inform the design of future patient-centered interventions to address social needs.