A Novel Health Behavior Intervention to Promote Adherence in End Stage Kidney Disease: INSPIRED Proof of Concept Trial

Daniel Arroyo-Ariza, MD

Massachusetts General Hospital – Fellow

Scientific Abstract

Background:  Despite the known benefits of physical activity, a low phosphorous diet, and medication adherence, a significant proportion of patients with end-stage kidney disease (ESKD) receiving hemodialysis (HD) are not adherent to one or more of these behaviors, thus increasing their risk for poor health outcomes. To address the limitations of existing health behavior programs, we developed INSPIRED (Improving Nutrition, Spirit, and Physical Activity in RenalDisease), a 12-week, phone-delivered intervention to enhance motivation and well-being, using motivational interviewing (MI) and positive psychology (PP) techniques. In this single-arm, proof-of-concept trial, we aimed to assess its feasibility, acceptability, and preliminary efficacy in 10 individuals with ESKD and suboptimal adherence to physical activity, diet, or medications.

Methods: In the INSPIRED program, participants completed weekly, 25-minute phone sessions with a study trainer. Between sessions, participants engaged in PP activities (focused on gratitude, strengths, and meaning) and worked towards goals related to physical activity, diet and/or medications. Feasibility was measured by the number of phone sessions completed, and acceptability was measured by participant ratings of PP and MI utility (using 0-10 Likert scales). We also explored the intervention’s impact on psychological outcomes and health behavior adherence usingvalidated scales and accelerometers.  

Results: Participants completed 78% of sessions and rated the program’s PP and MI components as easy to complete (PP: 8.7 ± 1.5; MI: 8.3 ± 2.0) and subjectively helpful (PP: 8.8 ± 1.2; MI: 8.8 ± 1.6). The intervention led to promising but non-significant improvements in positive affect, depression, anxiety, physical activity, and other adherence outcomes.

Conclusions: The INSPIRED program appears to be feasible and well accepted.  Larger, randomized controlled trials are needed to further examine INSPIRED’s impact on well-being, objectively measured adherence, and health outcomes in patients with ESKD.

Live Zoom Session – March 9th

research Areas


Daniel Arroyo-Ariza, MD, Lauren Harnedy, BA, Juliana Zambrano, MD, Abraham Cohen-Bucay, MD, Jeff C. Huffman, MD, Christopher M. Celano, MD

Principal Investigator

Christopher M. Celano, MD

Affiliated Website