Transforming CKD Care Through Shared Learning and Collective Action: Hennepin Healthcare Improves CKD Testing and Diagnosis Rates Among High-Risk Patients

Chronic kidney disease is a complex population health crisis requiring coordinated action and a multidisciplinary approach to improve health outcomes. Hennepin Healthcare (HHS), an integrated healthcare delivery system in Minneapolis, Minnesota, partnered with NKF to increase appropriately documented CKD diagnoses and to improve CKD screening rates among adults with diabetes and hypertension, who are at highest risk for kidney disease.

Using NKF’s CKD Learning Collaborative curriculum, leaders from nephrology, primary care and ambulatory quality/ population health at HHS identified process improvements, electronic health record (EHR) updates, and clinician education opportunities to improve CKD outcomes. These improvements included: 

• Adapting and integrating a CKD care algorithm into the HHS Practice Standards page.
• Adding a CKD testing prompt in the EHR, prompting clinicians to order annual urine albumin creatinine ratio (uACR) tests for patients with diabetes or hypertension. uACR is one of the two tests needed to screen for CKD and often the earliest indicator of kidney disease.
• Launching a 4-part CKD-focused Primary Care Education Series, to reinforce evidence based CKD care and highlight available clinical decision support (CDS) tools. 

Following the learning collaborative deployment, positive impacts include: 

• More than 20% increase in rates of uACR testing among patients with diabetes or 
  hypertension---from 33.2% to 40.1%.
• Nearly 33% increase in complete CKD screening (uACR + eGFR) among patients with hypertension--- from 26.8% to 35.6%.
• 534 additional patients with a documented CKD diagnosis, a 10.8% increase. Maximizing opportunities for these individuals to slow disease progression and reduce cardiovascular risk through medication optimization, disease education, and lifestyle management.
   

Hennepin Healthcare is committed to making CKD screening and proper diagnosis a standard of practice across all care teams. To further diffuse change in 2026, the team expanded engagement in primary care residency programs and hosted additional educational sessions for clinicians. Looking ahead, the team will evaluate ongoing utilization of existing CDS tools and explore additional modifications among other strategies to improve CKD care outcomes. 

This project was led by HHS staff members, A. Katherine Hust, MD, MPH, FACP, Danielle Haselby, DO, Karen Grewe, CPHQ, and Lynn Cases, MHI, CPHQ, who worked alongside NKF Population Health Partnership Director Megan Schultz, MPH. Special thanks to Muhammad Reza Chadhry, MD, Rida Shaikh, DO, and Deepon Sarkar, MD, for their contributions to the project as well.