Veteran Centered Meal Intervention in Chronic Kidney Disease

This pilot randomized clinical trial will evaluate the feasibility, acceptability, and preliminary effects of medically tailored meals among Veterans with chronic kidney disease. Approximately 100 Veterans with stage 3b or 4 chronic kidney disease and elevated systolic blood pressure will be enrolled and randomized 1:1 to receive medically tailored meals or usual care during an initial 3-month intervention period. Participants initially assigned to usual care will subsequently receive medically tailored meals during a 3-month crossover period. All participants will be followed for 6 months. The medically tailored meal intervention will provide prepared meals designed to support dietary recommendations for chronic kidney disease and cardiovascular health. The study will assess intervention feasibility and acceptability, including recruitment, adherence, retention, completion of study assessments, and participant experiences with the meals. Clinical outcomes will include systolic blood pressure, kidney function and injury measures, cardiometabolic laboratory markers, and vascular function. Dietary intake and diet quality will be assessed using 24-hour dietary recalls. Patient-reported and behavioral outcomes will include kidney disease-related quality of life, general health and well-being, treatment burden, and measures related to dietary behavior and self-management. Healthcare utilization and medication use will also be evaluated. Assessments will generally occur at baseline, 3 months, and 6 months.