Simple Tools Increase CKD Diagnosis and Referral in Primary Care Settings

William E. Haley, M.D.

New York, NY (January 7, 2015) – Simple clinical tools can promote coordination of care between primary care practitioners (PCPs) and nephrologists resulting in improved documentation, diagnosis and referral of patients with chronic kidney disease (CKD), according to a new study in the January issue of the National Kidney Foundation's American Journal of Kidney Diseases.

"CKD is common and costly, both in terms of dollars and quality of life, and is mostly preventable," said William Haley, M.D., the lead researcher with the Division of Nephrology and Hypertension at Mayo Clinic in Jacksonville, Florida. "Emerging evidence from a number of sources suggests that early interventions and improved care coordination between primary care practitioners (PCPs) and nephrologists results in better outcomes for patients. Practically everyone believes that coordination of care is important, but sadly, it is usually not happening."

Researchers noted that the care of CKD patients has historically been suboptimal, highly variable, fragmented, and inefficient, rife with duplication of services and tests.

According to Dr. Haley and organizations like the National Kidney Foundation, it is critical that PCPs take an active role in detecting and managing early kidney disease. It is estimated that 26 million people have CKD and many more are at risk to develop CKD due to diabetes, hypertension, or being over 60 years old. It is therefore essential that detection and prevention start with the PCP and as kidney disease progresses it becomes valuable to have the patient co-managed by their PCP and nephrologist.

This study conducted at five nephrology clinics and their referring PCP practices in Philadelphia and Chicago evaluated whether implementation of a set of standardized clinical management and communication tools could improve identification and management of CKD including care coordination between PCP and nephrology practices. The study introduced a CKD Screening and Referral protocol, and select specifically tailored tools from the Advanced CKD Patient Management Toolkit developed by the Renal Physicians Association into the PCP practice which resulted in improved processes for CKD identification, referral to nephrologists, communication, and execution of co-management plans. Overall GFR documentation by PCPs increased from 82% to 99% and the rate referral of patients with CKD stage 4 to a nephrologist increased.

Post-intervention interviews with PCPs indicated an increased awareness of CKD risk factors, the need to track high-risk patients, and the importance of early referral. Final nephrologist interviews revealed heightened attention to communication and co-management with PCPs and increased levels of satisfaction among all parties.

"PCPs have a very heavy workload and play a critical role in the identification and management of CKD, so any improvements in care processes can have a significant impact on their ability to provide quality care for CKD patients", said Tom Manley, Scientific Activities Director at the National Kidney Foundation. "We hope that the concepts and communication tools successfully used in this study can be expanded across other healthcare organizations."

The study also highlighted some of the friction that can exist between PCPs and nephrologists, and illustrated how simple tools can begin to address these underlying issues.

"We heard from PCPs about the time burden of screening and managing multiple conditions, and a perception of a lack of respect from specialists -- a feeling of being relegated to do work that specialists choose not to do," said Dr. Haley. "Simply bringing nephrologists and PCPs together and beginning the conversation about CKD care and common goals for patients had a dramatic impact in changing these perceptions and improving care."

Kidney Facts from the National Kidney Foundation

  • 1 in 3 American adults is currently at risk for developing kidney disease.
  • Major risk factors for kidney disease include diabetes, high blood pressure, family history of kidney failure and being age 60 or older.
  • Kidney disease kills more Americans than breast or prostate cancer.
  • Because kidney disease often has no symptoms, it can go undetected until it is very advanced.
  • Early detection and treatment can slow or prevent the progression of kidney disease.
  • Those at risk should have simple blood and urine tests to check if their kidneys are working properly.

The National Kidney Foundation (NKF) is the leading organization in the U.S. dedicated to the awareness, prevention and treatment of kidney disease for hundreds of thousands of healthcare professionals, millions of patients and their families, and tens of millions of Americans at risk. For more information, visit