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Integrating CKD Into US Primary Care: Bridging the Knowledge and Implementation Gaps
Joseph A Vassalotti1,2, Suelyn C Boucree3
1Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
Chronic kidney disease (CKD) affects millions, increasing cardiovascular risks. A coordinated care approach with integrated systems and population health strategies is vital for effective CKD management and reducing adverse outcomes.
Area of Science:
- Nephrology
- Public Health
- Health Systems Management
Background:
- Chronic kidney disease (CKD) impacts 37 million US adults, leading to high cardiovascular event rates, kidney failure, and mortality.
- Primary care screening for CKD using estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) should target high-risk conditions like diabetes, hypertension, and cardiovascular disease.
- CKD diagnosis necessitates improvements in patient awareness, engagement, and evidence-based intervention implementation.
Purpose of the Study:
- To outline a comprehensive CKD population health strategy for primary care.
- To address challenges in individualized CKD care due to disease heterogeneity.
- To emphasize the need for coordinated, interdisciplinary care and integrated health systems for optimal CKD management.
Main Methods:
- Focus on primary care case finding using eGFR and uACR for at-risk populations.
- Advocating for a coordinated care model involving interdisciplinary teams.
- Implementing integrated systems with registry functions, clinical decision support, and quality improvement initiatives.
- Adopting the Race-free 2021 CKD-EPI eGFR reporting recommendations.
Main Results:
- Integrated systems can support primary clinicians with essential CKD management tools.
- A population health strategy can bridge primary care education and implementation gaps.
- Registry functions and data monitoring are crucial for understanding CKD burden and intervention effectiveness.
- Collaboration with nephrology, laboratory, and health equity leaders is key for population health design.
Conclusions:
- A coordinated, system-integrated approach is essential for effective CKD management in primary care.
- Population health strategies, supported by integrated systems and data monitoring, can improve CKD outcomes.
- Implementing updated eGFR reporting recommendations is vital for advancing CKD population health efforts.
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 time-constrained 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.
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