PROJECT SUMMARY/ ABSTRACT Compared to non-Latinx White individuals, Latinx individuals (gender-inclusive term; includes Hispanics, Latino/a/e) have 2-times the risk of kidney failure and face a disproportionate burden of structural racism and kidney health disparities. Latinx individuals are less likely to receive pre-dialysis nephrology care compared to non-Latinx White individuals and as a result, are less likely to initiate person-centered kidney replacement therapy (KRT), such as kidney transplantation or home dialysis. Latinx individuals are instead more likely than non-Latinx White individuals to begin KRT with a central venous catheter (CVC), which has a higher risk of mortality (1.4-1.5-fold) and fatal infection (1.5-2-fold) compared to an arteriovenous fistula or graft. Our community-partnered research team developed and tested NAVIGATE-Kidney, a multi-level, language and culturally concordant community health worker (CHW) intervention for Latinx individuals with kidney failure who receive maintenance hemodialysis. We hypothesize that our NAVIGATE-Kidney intervention will reduce the composite primary endpoint, defined as time to transition to KRT and CVC use or death. Our funded parent grant (U01 DK137272-01) allows us to move beyond dialysis center interventions by providing support to Latinx individuals with chronic kidney disease stage 4. As part of the ERASE-KD consortium, the NAVIGATE- Kidney protocol was reviewed by the NIH Office of Disease Prevention (ODP). The NIH ODP stated that this study should be modified to an individually randomized group treatment (IRGT) trial to account for the intraclass correlation (ICC) induced by the nesting of patients within the CHWs; otherwise, the analysis will lead to an inflated type 1 error. The team modified the study design and it is now an IRGT; however, without supplemental funding, we can only account for an ICC of 0. When clustering exists, it is very unlikely that the ICC will be 0. To account for an ICC, we must increase our power by increasing the number of CHWs from 4 to 6. This will allow the team to detect a hazard ratio of 0.50 for a range of ICCs. There is no preliminary data nor literature available to provide a reasonable estimate of the ICC of time to event endpoints of participants with the same CHW for the population of our study. Findings from this IRGT will inform the ICC of future CHW interventions including those interventions that are part of the ERASE-KD consortium. The team will work with the ERASE-KD consortium and the NIH ODP to develop research methods for time-to-event IRGT. This change constitutes an opportunity to advance kidney disease health equity science.