Development of a Primary Care Cardio-Kidney Risk Navigator for Clinical Decision Support

Background/Objectives: Chronic kidney disease (CKD) and cardiovascular disease (CVD) confer a substantial, interrelated health burden. CKD markedly increases cardiovascular risk and premature mortality, while CVD accelerates kidney disease progression. Despite the availability of simple diagnostic tests and validated CVD risk tools, CKD screening remains inconsistent, kidney measures are under-integrated into CVD risk stratification, and guideline-recommended screening is variably adopted due to system-, clinician-, and patient-level barriers. This initiative aimed to develop a consensus-based, practical algorithm to integrate CKD screening into CVD risk management. Methods: A structured Delphi process was used to develop an evidence-informed, consensus-based screening algorithm. In Phase 1, a multidisciplinary expert panel completed iterative surveys to identify and prioritize key screening components and achieve preliminary consensus. Participants received a landscape assessment summarizing current practices, evidence, and implementation gaps. A roundtable discussion reviewed clinical guidelines, published evidence, and survey findings, informing the development of an initial algorithm draft. In Phase 2, a follow-up roundtable refined the algorithm, assessed feasibility within real-world clinical workflows, and confirmed consensus on priority elements. Agreement was finalized through structured group discussion and survey-based validation. Results: Panel discussions identified optimal CKD screening triggers, key gaps in current practice, and opportunities to promote earlier identification of at-risk patients. Refinement during the second roundtable resulted in consensus on algorithm structure, content, and applicability across settings. The final algorithm reflects a streamlined, implementation-focused approach to support consistent and earlier identification of at-risk patients. Conclusions: The algorithm, labeled the Primary Care Cardio-Kidney Risk Navigator, provides a practical, flexible framework that integrates and operationalizes existing guideline recommendations into a unified, workflow-oriented approach for primary care that supports consistent real-world implementation. It supports earlier identification, referral, and prevention strategies for at-risk populations and can be implemented within electronic health records or as a standalone clinical decision support tool.