Table 2.

Potential interventions to address structural racism in kidney disease populations proposed during workshop breakout sessions

Structural Target(s)	Intervention(s)	Target Population	Design	Outcomes	Potential Facilitators	Potential Challenges
Harmful effects of adverse SDoH (e.g., food insecurity, housing insecurity, access to care, transportation) specific to community contexts, needs, assets and preferences	Train the trainer program to equip CHWs to provide: • CKD, DM, and HTN screening • Culturally and language concordant, trusted health education • Motivational interviewing, patient activation, patient-centered goal setting • Telehealth visits • Partnership with CBOs to address social risks	Minoritized/marginalized populations with or at high risk for CKD	Stepped wedge RCT, which allows all participants to potentially benefit from the intervention, in line with preferences of many communities	• Patients screened for social risks • Connection to care as needed • Knowledge and awareness of CKD in community participants • Patient activation and self-efficacy • Community resilience	• Collaboration with community members and existing community sites • Train-the-trainer approach may help with sustainability	• Some states require clinician(s) be on site for CHW-led interventions • Ensuring sustainability • Reimbursement may require certification of CHWs • Ensuring education and training is paired with resources • Stepped wedge RCT designs are statistically complex
Health care access barriers for children with CKD (e.g., transportation, lack of parental work leave policies, difficult to navigate health care systems)	Pediatric transitions of care program providing: • Outreach and support by a patient navigator/social worker/CHW/promotora • Structured training for outreach providers • Mobile technology to enhance adherence • Mobile van for home visits	Pediatric (aged <26 years) patients with CKD and their families from minoritized or low-income non-Hispanic White populations	Cluster randomized (by neighborhood), stepped wedged RCT	• Kidney biomarkers (e.g., eGFR, UACR) • CKD risk-factor control • Adherence • Quality of life • Trust • Mental health symptoms (depression/anxiety) • Navigator fidelity	• Community-engaged approach • Sustainability potential via novel payment models • Health care system policy changes • Employer policy changes for adults with children who need chronic disease care	• Study timeline • Ensuring sustainability • Stepped wedge RCT designs are statistically complex
Social needs identified by clinical screening and patient goal setting	Tailored, virtual team care involving: • Navigator to identify and screen for social risks using EHR tools • Quarterly care team goal-setting discussions (including patient, family, caregivers) • Culturally and linguistically tailored referrals to CBOs to address social risks • Nurse and pharmacist to discuss medical concerns, medications and care coordination • Quarterly reports in EHR available to medical team	Primary care and emergency department patients and caregivers with unrecognized CKD or at high risk of CKD identified from the EHR	Three-arm patient-level RCT, stratified by primary care or emergency department: 1. Usual care 2. Navigator only 3. Navigator + goal setting + CBO referrals + nurse and pharmacist	Primary: • Quality of life • Clinical outcomes: eGFR, UACR, BP • Patient activation • Trust • Engagement in goal setting • Satisfaction • General distress • Caregiver burnout Secondary: • Nephrology and PCP burnout • Equity in outcomes by SES, race/ethnicity • Implementation: Costs and resource use, patient and caregiver engagement, medication changes, provider views of quarterly reports	• Patient-centered approach • Health system and community involvement	• Staffing costs, especially for clinicians • Less physician oversight may result in less buy-in • Cluster RCTs require uniformity in intervention delivery
Food apartheid/food deserts, predatory food marketing (e.g., by media), and barriers to nutrition education	Multilevel food and nutrition program Community food environment • Incentivize (e.g., tax credit) food suppliers/retailers to provide affordable access to healthy foods • Incentivize stores and major producers to implement culturally and literacy tailored kidney-friendly labeling Health system • EHR alert to identify people living in a food swamp or desert • Referral to a kidney dietitian trained in structural competency and equity Individual • Education, coaching, and nutritional support to individuals and families	Individuals with early CKD and poorly controlled CKD risk factors	Cluster RCT with randomization at two levels of intervention: 1. Community level, 50% of communities receive healthy, appropriately labeled foods 2. Individual level, 50% of participants receive nutritional education and health care interventions	Community level: • Changes in food availability • Pricing of kidney health-promoting items • Availability of kidney-friendly labeled items Individual level: • CKD progression to kidney failure • eGFR decline • Albuminuria • Control of risk factors (e.g., DM)	• Community engaged approach • Partnerships with local businesses to improve sustainability and enhance community health education	• Data integration challenges • Local sociopolitical environment
Resource deprivation/financial resource strain for pregnant people from marginalized communities	Food, housing and income support to pregnant people to mitigate multigenerational trauma: • Unrestricted income supplements • Housing vouchers • Provision of healthy food to whole family	Pregnant individuals and their children who reside in structurally disadvantaged communities	Multilevel RCT comparing 1–5 years of intervention versus usual care over 10–30 years of follow-up	At birth: weight, visceral adiposity, insulin sensitivity, cortisol levels, lipids, glucose, nephron number Longitudinally: • eGFR decline • Albuminuria • BP • A1C • Obesity • Allostatic load • Experiences of discrimination • Patient activation • Trust in health care • Maternal food health literacy • Familial dietary patterns • Quality of life, stress • Anxiety • Collaboration with community • Demonstrated effect of targeting income and wealth		• Need for improved data integration • Duration of follow-up and related costs • Ability to measure CKD effect versus effect on CKD risk factors

CHW, community health worker; DM, diabetes mellitus; HTN, hypertension; CBO, community-based organization; RCT, randomized controlled trial; PCP, primary care provider; EHR, electronic health record; SES, socioeconomic status; UACR, urine albumin-creatinine ratio.