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

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.