July 22, 2019
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CKD management program in primary care demonstrates positive results

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While the implementation of a nurse-led program to manage chronic kidney disease in a primary care setting did not slow disease progression, it did improve quality of care and help patients achieve target blood pressures, according to a published study.

“Many clinicians in primary care remain uncomfortable with the concept of CKD and find this area of patient management challenging, difficult and of debatable benefit,” Rupert W. Major, PhD, of the department of nephrology at University Hospitals of Leicester National Health Service Trust in the United Kingdom, and colleagues wrote. “Although most patients with CKD are managed in the primary care setting, the evidence base for CKD care in general practice is scant, and it is not clear whether specific CKD management programs can alter outcomes in primary care.”

To determine the impact of such a program, researchers conducted the Primary-Secondary Care Partnership to Improve Outcomes in Chronic Kidney Disease study, which was a cluster randomized trial of 46 primary care general practices (23,357 total patients with CKD stages 3 to 5).

A software program, designed specifically for the study, was used to provide practices with patient-related demographic (eg, age, ethnicity, past medical history, smoking history, BMI and CKD-relevant medication history) and biomedical data (eg, blood pressure records, blood biochemistry and hematology results and urine results related to proteinuria). The program was run at the start of the study and at 6-month intervals.

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“Although most patients with CKD are managed in the primary care setting, the evidence base for CKD care in general practice is scant, and it is not clear whether specific CKD management programs can alter outcomes in primary care.”
Source: Adobe Stock

Practices were assigned to either intervention or control. Both groups had access to the software, but the intervention included a CKD nurse practitioner to support a clinical lead (a doctor or nurse) in both interpreting the data file and developing guideline-based patient-level CKD management interventions.

The primary outcome of the study was the mean change in eGFR from baseline to 42 months (measured at 6-month intervals). Secondary outcomes included number of patients coded for CKD, mean BP, number of patients achieving BP targets and proteinuria measurement.

Researchers found that, at 42 months, decline in eGFR was similar between the control and intervention groups (-2 vs. -2.29). Regarding BP, researchers observed that more patients in the intervention group consistently achieved their targets throughout the study period than did those in the control group.

Greater improvements in CKD- and proteinuria-related coding were also seen in the intervention group vs. usual care.

“This study is the largest study to evaluate the outcomes of nurse practitioner-led targeted CKD management in primary care,” the researchers wrote. “The results indicate that the intervention did not protect renal function but it did have a significant positive and potentially cost-effective benefit on several important process measures and quality indicators of CKD care.” – by Melissa J. Webb

Disclosures: Major reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.