Capitalizing on Kidney Care’s Shift Toward Early Identification

Kidney Disease Improving Global Outcomes (KDIGO) recently released new, groundbreaking guidance which endorses the strategy of early identification, risk stratification and treatment of chronic kidney disease (CKD) on a global scale. This represents a much-needed sea change in an area of medicine that is struggling, even in highly developed countries. 

CKD is one of the most common chronic diseases in the U.S., but, unlike other chronic conditions, many people living with kidney disease do not know they have it until it becomes extremely serious — their kidneys fail and they need dialysis. In the United States, where 1 in 7 adults has kidney disease, 50 percent of those with more advanced stages of kidney disease don't know they have it. But these guidelines will also have a resounding impact outside the U.S.

Pursuing the approach laid out in this statement will have a profound effect on reducing the inequalities in kidney care worldwide.

Pursuing the approach laid out in this statement will have a profound effect on reducing the inequalities in kidney care worldwide. The authors stated, “the development of a CKD screening program was considered an equity imperative, particularly because socially disadvantaged and other vulnerable populations experience a disproportionate burden of CKD and are the least likely to receive effective treatments to reduce the risk of complications and improve outcomes.” Emphasizing early identification and treatment can help eliminate this disparity.

Transforming our approach to kidney care based on this KDIGO report requires significant infrastructure changes, particularly around supporting primary care providers (PCPs). PCPs know their patients best and are best positioned to identify the disease early, but with many clinical needs to attend to in limited time, diagnosing CKD can be tricky. So, the challenge is to build technology, tools, and guidelines that support PCPs in this difficult task and reduce their burden, rather than adding to their ever-growing list of duties.

Transforming our approach to kidney care based on this KDIGO report requires significant infrastructure changes, particularly around supporting primary care providers (PCPs).

The first step to help PCPs is to identify persons with kidney disease at high risk for complications who need care. Given the wide availability of electronic health records, predictive models could be deployed to identify these persons. Identification alone, however, is not sufficient. These risk identification models must be supplemented by tools and systems that work within the physician's workflow and provide actionable steps to accurately risk stratify and allow the PCP to design a treatment plan that’s right for each patient. There is no one size fits all model in kidney care, and providing PCPs with a comprehensive toolbox allows them to tailor their care appropriately.

We’re seeing more and more evidence that this approach of empowering primary care physicians could work. In a recent AJKD study, my colleagues and I deployed a provider-facing digital clinical decision support tool to improve CKD management in primary care. The tool provided guidance on risk stratification, and it gave the PCP actionable recommendations individualized to their patient. The tool was well received and utilized by most providers when deployed, and use of the tool increased recognition of kidney disease. Making tools like these commonplace will ease the job of PCPs and ensure patients are diagnosed early and treated effectively.

Another important facet of supporting PCPs is providing easier means of patient education and coordinating multidisciplinary care. To ensure the patient’s best possible quality of life, comprehension of their disease and investment in lifestyle modification is paramount. Digital tools that provide peer support, real-time access to providers to ask questions, and coordinate care between pharmacists, nutritionists, and other relevant specialists goes a long way to meeting this goal.

Cricket Health, where I work to implement a new model of kidney care, is at the leading edge of this paradigm shift. We aim to work hand in hand with PCPs to give them the support and resources to identify and risk stratify CKD, coordinate multidisciplinary care, and educate their patients to best manage their disease. Our providers deliver both virtual and in-person care, meeting the needs of their patients wherever they are. We’re also working to realign the industry’s financial incentives to support early disease identification and management rather than lifelong dialysis reliance. 

Kidney care’s transformation won’t happen overnight, but when primary care providers have the tools they need to manage a uniquely difficult disease, we can make tremendous progress in avoiding kidney failure. These tools exist now: the challenge is encouraging their rapid, widespread adoption.