Integrating CKD Into US Primary Care: Bridging the Knowledge and Implementation Gaps

Abstract

Chronic kidney disease (CKD) affects 37 million American adults who experience high rates of cardiovascular events and are at risk of kidney failure and mortality. Routine primary care case finding for CKD with estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) should focus on risk conditions, particularly diabetes, hypertension, and cardiovascular disease, as recommended by clinical practice guidelines. The diagnosis of CKD is associated with many important aspects of care, including patient awareness, patient engagement, and improved implementation of evidence-based interventions. Individualized care that tailors CKD interventions proportional to the adverse outcome risk or the eGFR and uACR heat map is a major challenge for primary CKD care, because the condition is heterogeneous in terms of both the cause and the severity. The coordinated care approach to CKD management is necessary to deploy best practice in chronic disease management that engages the interdisciplinary team. An integrated system supports the timeconstrained primary clinician with CKD registry functions, clinical decision support tools, quality improvement initiatives, and payment model incentives to drive reduction in adverse outcomes and containment of expenditures. A CKD population health strategy can be built to address primary care education and implementation gaps from the perspectives of testing, detection of disease, interventions, and coordinated system-integrated care. Registry function and data monitoring of the burden of CKD, delivery interventions, and outcomes are key features. Implementation of the Race-free 2021 CKD-(Epidemiology Collaboration) EPI eGFR reporting recommendations by engaging local nephrology, administrative, clinical laboratory, and health equity leaders should help drive the population health design strategy and the data assessment.

Designing Interventions Addressing Structural Racism to Reduce Kidney Health Disparities: A Report from a National Institute of Diabetes and Digestive and Kidney Diseases Workshop

“…As new models of kidney care are emerging, they should be intentional about advancing health equity by applying an antiracist lens to payment and delivery system reform, and they should be assessed for their effect on kidney outcomes and equity. Kidney care models can adopt strategies that have been successful in the care of other diseases and should promote access to quality insurance; improved scope of coverage to meet medical and social needs, payment reform to incentivize equity care transformations, and support for safety net institutions 11 , 88 – 90 …”

“…Kidney care models can adopt strategies that have been successful in the care of other diseases and should promote access to quality insurance; improved scope of coverage to meet medical and social needs, payment reform to incentivize equity care transformations, and support for safety net institutions 11 88 – 90 …”

“…Kidney care models can adopt strategies that have been successful in the care of other diseases and should promote access to quality insurance; improved scope of coverage to meet medical and social needs, payment reform to incentivize equity care transformations, and support for safety net institutions. 11,[88][89][90] Opportunities for Funders, Academic Medical Centers, and Health Systems The workshop findings offer important information for funding agencies, academic medical centers and health systems committed to reducing health disparities. Indeed, the National Institutes of Health (NIH) has made a commitment to address structural racism to address health disparities, 91 and they and several other entities have recently released funding announcements focusing on structural racism (Table 4).…”

Usability Testing of the Kidney Score Platform to Enhance Communication About Kidney Disease in Primary Care Settings: Qualitative Think-Aloud Study

“…To bridge the communication gap about kidney disease among patients and health care professionals and increase testing among individuals at risk for CKD, the National Kidney Foundation (NKF) developed the Kidney Score Platform, leveraging the behavior change wheel, a validated framework used to design interventions to incite individual behavior change [ 13 ]. The Kidney Score Platform is a web-based series of tools that includes resources for health care professionals to encourage the use of a population health strategy for CKD management [ 14 ] as well as an interactive, dynamic component for patients to increase their knowledge and self-management. Before embarking on a study of the Kidney Score Platform’s impact on patient-clinician communication about kidney disease and individual awareness of CKD [ 13 ], we sought feedback from clinicians about the provider resources available on the Kidney Score Platform and engaged in usability testing of the patient-facing tool to gather feedback regarding its acceptability and potential use [ 15 ].…”

Machine learning for risk stratification in kidney disease

“…Risk stratification for kidney disease has become globally imperative to improve health equity [1]. Early identification of kidney disease can prove a useful tool for the treatment of perioperative and postoperative acute kidney injury [2,3], as well as chronic kidney disease [4]. However, current measures of kidney function and structure are inadequate especially in the early stages of the disease.…”