Improving CKD Detection and Care in a High-Risk, Underserved Population
The initial steps of the study will include screening of electronic medical records for detection of patients with chronic kidney disease as defined by eGFR less than 60 ml/min/1.73 m2 or by the presence of albuminuria and/or proteinuria. Next step will be notification of primary care providers of identification of their patients for possible enrollment in the study. Once approval from the primary care physician/nephrologist is obtained, subjects will be notified and asked for permission to participate in the study. Study consents will be obtained from patients. Patients will be asked to participate in Aim 2 for CKD management and/or Aim 3 for preparation for renal replacement therapy based upon their eGFR and associated medical conditions.
Electronic medical records of patients followed in the Parkland Health [AND]amp; Hospital System will constitute the pool of information that will be potentially reviewed for detection of participating subjects and for the comparisons after completion of the study.
There are several outcome measures in this study. Each specific aims focuses on clinically relevant outcomes.
The main outcome measurement for specific Aim 1 will be the number of patients newly detected with CKD. There will be comparison of patients detected by PIECES (based on eGFR criteria, albuminuria, or proteinuria) as compared to patients previously identified with CKD as evidenced in their medical records by problem lists, ICD-9 or prior referral to renal clinic).
The main outcome measurement in specific Aim 2 is blood pressure control as defined by blood pressure less than 130/80mmHg for patients with proteinuria and less than 140/90 for patients without proteinuria. The proportion of blood pressures within recommended target during the one year duration of the study as well as blood pressures at one year will be carefully monitored. We will compare outcomes for the group of patients monitored by PIECES with control patients with CKD matched with regard to age decade, race/ethnicity but not in the collaborative primary care-nephrology care model and not monitored by PIECES. Secondary outcomes will include use of ACEI/ARBs, treatment with the statins, and changes in eGFR.
The main outcome measurement for specific Aim 3a is the proportion of patients monitored by PIECES with eGFR [AND]amp;lt; 25ml/min/1.73m2 or identified for referral for preparation for transplantation (living donor or deceased donor) who are ready for listing prior to dialysis. The outcome will be compared to a control group of patients with eGFR [AND]amp;lt; 25ml/min/1.73m2 followed in PHHS and matched in regard to age decade, race/ethnicity, but not monitored by PIECES.
The main outcome measurement for specific Aim 3b is the proportion of patients monitored by PIECES who initiate dialysis with a temporary central venous catheter. The outcome will be compared with a control group of patients with eGFR [AND]amp;lt; 25ml/min/1.73m2 followed in PHHS and matched with regard to age decade, race/ethnicity, but not monitored by PIECES.
1. Adults 18 years and older
2. CKD as defined by eGFR < 60 ml/min/m2 and or presence of proteinuria and/or albuminuria.