Integrating Risk-Based Care for Patients With Chronic Kidney Disease in the Community: Study Protocol for a Cluster...

Area of Science:

• Nephrology
• Primary Care Medicine
• Health Services Research

Background:

• A risk-based model using the Kidney Failure Risk Equation (KFRE) is effective in nephrology care.
• Integrating KFRE into primary care is crucial for managing chronic kidney disease (CKD) as most patients are seen in this setting.
• The study aims to bridge the gap between specialized nephrology care and primary care for CKD management.

Purpose of the Study:

• To develop, implement, and evaluate tools for a risk-based approach to CKD care in primary care.
• To empower both patients and providers with actionable risk information for CKD management.
• To assess the impact of KFRE integration on CKD patient care pathways in primary settings.

Main Methods:

• A multicenter cluster randomized controlled trial involving 32 primary care clinics in Manitoba and Alberta.
• Intervention group clinics received KFRE and decision aids integrated into their Data Presentation Tool (DPT), alongside patient aids and feedback.
• Control clinics followed current CKD management guidelines without active intervention.

Main Results:

• Primary outcomes include the proportion of patients with measured urine albumin-to-creatinine ratio and appropriate ACE inhibitor/ARB treatment.
• Secondary outcomes assess optimal management of diabetes, hypertension, cardiovascular risk, NSAID use, and estimated glomerular filtration rate (eGFR) decline.
• Substudies examine CKD health literacy, physician trust, provider satisfaction, healthcare costs, and referral patterns.

Conclusions:

• The intervention has the potential to significantly improve CKD patient management within Canadian primary care.
• Successful implementation could lead to substantial health and economic benefits.
• Findings may inform future practice guidelines for CKD care in primary settings.