Using CKDintercept to Build Interdisciplinary Kidney Care

In this National Kidney Foundation (NKF) panel, moderator Andrew Bzowyckyj, PharmD, BCPS, CDCES, senior scientific director and learning consultant at NKF, talks with 3 clinicians from different practice settings:

• Michelle Estrella, MD, a nephrologist, professor of medicine at the University of California, San Francisco, and renal section chief at the San Francisco VA Medical Center;
• Venita Schandorf, DNP, ARNP, a board-certified family nurse practitioner at MultiCare Covington Family Practice in Washington State’s Puget Sound area;
• and Mark Loafman, MD, MPH, a family medicine physician and systems chair for family and community medicine at Cook County Health in Chicago, Illinois.

The panelists discuss what successful real-world implementation of the NKF CKDintercept initiative looks like and the roles that primary care, nephrology, and other members of the care team play in getting it started.

Loafman noted that primary care visits of 15 to 20 minutes leave little room for comprehensive kidney care and recommended using value-based care arrangements to identify a small group of patients for whom early intervention would show a return on investment, then expanding from there. Clinical pharmacists can be added through partnerships such as training programs with schools of pharmacy, and behavioral health specialists and dietitians can be brought in the same way.

Estrella said CKDintercept breaks an otherwise overwhelming process into specific steps, including engaging stakeholders and showing health system leadership the potential cost savings. She described the goal as coordinated, patient-centered care across nephrology and primary care, with nurse practitioners, clinical pharmacists, and nurses taking on tasks such as standing orders for urine albumin-to-creatinine ratio testing. Schandorf highlighted the initiative’s toolkits for individual clinicians and its laboratory engagement resources. She also described a cardiovascular-kidney-metabolic clinic in development at her organization, where internal medicine physicians and advanced practice providers will manage high-cost patients with publicly funded insurance who have overlapping cardiovascular, metabolic, and kidney conditions, escalating care to cardiology and nephrology as needed.

Loafman stressed the need to create urgency around reaching treatment goals rather than simply completing screenings. Drawing on his faculty experience with a Health Resources and Services Administration clinical pharmacy services collaborative, he recommended setting a 6-month window to bring at-risk patients to goal. He noted that approximately 50% to 60% of primary care patients are not managed to goal, not because clinicians lack knowledge but because systems are not set up to support it. Pairing that measure with a business case for cost savings can win leadership support for building a team and expanding the program.

Bzowyckyj closed by noting that CKDintercept is not “one-size-fits-all” and that practices can start at whichever stage they are in, from screening to intervening to reaching goals. He highlighted the discussed “prescribe and persuade” approach, saying the persuasion part often gets lost.

Learn more about the National Kidney Foundation at kidney.org and at this link.