# NAVIGATE Kidney: A Multi-Level Intervention to Reduce Kidney Health Disparities

> **NIH NIH U01** · UNIVERSITY OF COLORADO DENVER · 2024 · $736,635

## Abstract

PROJECT SUMMARY/ ABSTRACT
Latinx (gender-inclusive term; includes Hispanics, Latino/a) experience a faster progression from chronic
kidney disease (CKD) to kidney failure and face a disproportionate burden of structural racism and
discrimination that contribute to kidney health disparities compared to non-Latinx Whites. Latinx individuals
constitute the racial and ethnic group most likely to start dialysis with a central venous catheter. Compared to
non-Latinx Whites, they are less likely to start recommended kidney replacement therapy (KRT) such as home
dialysis and kidney transplant. Reducing the number of individuals who start KRT with a central venous
catheter is critical because it is associated with a higher risk of fatal infection, non-fatal infection,
hospitalization, and mortality compared to permanent vascular access. The Advancing American Kidney
Health Initiative, a 2019 Presidential executive order, aims to improve access and quality of person-centered
KRT. In response, the Centers for Medicare and Medicaid Services (CMS) launched kidney value-based
payment models to improve patient-centered care; however, these models do not address the structural racism
that operates across socioecological levels faced by racial and ethnic minorities with CKD. Our community-
partnered team assessed how structural racism operates across socioecological levels among Latinx with
kidney disease and in partnership with community, developed and tested NAVIGATE-Kidney, a multi-level,
language and culturally concordant community health worker (CHW) intervention for Latinx on hemodialysis.
We propose to partner with our community steering committees (CSCs) in Colorado and New Mexico to refine,
adapt, and test NAVIGATE-Kidney for Latinx individuals with CKD stage 4/5 (eGFR 15-29 mL/min/1.73m2)
(Aim 1). We will determine the effectiveness of NAVIGATE-Kidney compared to standard care by conducting a
patient-level randomized controlled trial in 448 Latinx with CKD stage 4/5 (Aim 2). Our primary hypothesis is
that intervention participants will have a lower rate of central venous catheter use at KRT start (primary
outcome). Our secondary hypothesis is that intervention participants will have a higher rate of optimal KRT
starts (composite secondary outcome), higher patient activation, and lower decisional conflict (patient-centered
outcomes). To provide the most compelling data that will address structural racism, we will assess contextual
factors and implementation outcomes using the innovative PRISM (Practical Robust Implementation and
Sustainable Model) framework which aligns with parameters that policymakers consider to advance health
equity (Aim 3). We will conduct a comprehensive economic evaluation including a cost-effectiveness analysis
of NAVIGATE-Kidney to inform policy change (Aim 4). All the proposed work will be conducted in partnership
with our community steering committee and patient partners. We will set up CSC structures and procedures to
ensure ...

## Key facts

- **NIH application ID:** 10911360
- **Project number:** 5U01DK137272-02
- **Recipient organization:** UNIVERSITY OF COLORADO DENVER
- **Principal Investigator:** Lilia Cervantes
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $736,635
- **Award type:** 5
- **Project period:** 2023-09-01 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10911360

## Citation

> US National Institutes of Health, RePORTER application 10911360, NAVIGATE Kidney: A Multi-Level Intervention to Reduce Kidney Health Disparities (5U01DK137272-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10911360. Licensed CC0.

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