Our nation is aging, not always gracefully, and there is a large burden of CKD to manage. 13% of US adults have CKD stages 1-5 with less than 0.5% having stage 4-5 CKD (USRDS 2015 ADR, partially based on NHANES data). Most of the work in managing CKD will not take place in a nephrology office. Exploring this data further (which is well worth your time) unfortunately also reveals that: < 10% of patients with stage 3 CKD know they have CKD; < 50% of patients with diabetes (without known CKD) receive yearly albuminuria screenings; and around 50% of patients with CKD are not at their target blood pressure or A1c. Furthermore, one US multicenter, observational study (ADD-CKD, Szczech et al. PLOS One, 2014, 9: e110535) noted that of over 9,000 patients with diabetes, over 50% had CKD yet barely 10% of patients were identified as having CKD in their medical records. Without actively recognizing and managing CKD, patients may miss out on core treatment (RAASi, hypertension control, etc.).
So, if there is room to improve the care of patients with early CKD within the primary care setting; how can we, as specialists, help our colleagues.
To help with these concerns the NKF is developing a primary care initiative called CKDintercept. This is designed to provide “knowledge and tools to alter chronic kidney disease (CKD) outcomes, improve patient’s quality of life, and have an impact on CKD healthcare spending nationwide.” This developing program will involve education (of providers and patients) as well as systems based approaches to improving CKD care.
The first educational program, on the detection and management of CKD in the primary care setting, is now being rolled out. The program, called CKDinform Early Detection and Prevention, is designed to “improve CKD diagnosis and create a culture of kidney preservation and protection in busy primary care settings.”
The program consists of three PowerPoint based educational modules, designed to be presented by nephrologists or primary care leaders to members of the primary care team (including physicians, mid-level providers, pharmacists, diabetes educators, etc.).
The content within the three modules covers item such as:
- The epidemiology and financial impact of CKD.
- Risk factors for CKD, indications for screening, and diagnosis of CKD.
- Guidelines for nephrology referral.
- Medication safety in CKD.
- Treatments to reduce CKD progression.
- A basic review of renal replacement therapy including transplantation.
The presentations can be used together within a larger symposium or individually within faculty meetings or Grand Rounds. The NKF has also created additional educational resources (such as a CKD risk assessment tool or CKD management algorithm) which can be given to participants. Presenters are allowed to adjust the presentation as they see fit however there are “core-slides” the NKF has identified for each of the three presentations. Importantly, CME/CE credit can be given to participants if these “core-slides” are used and there is not another CME system in place.
This program offers nephrologists resources to help educate their primary care colleagues and potentially improve the care of the patients they see, and more importantly those they may never see. Further information on how to access and utilize the materials, as well as contact info for the NKF, is provided at the links above.
Post by Robert Rope- Nephrology Fellow- Stanford
Reviewed by NKF