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Addressing CKD in Primary Care

The National Kidney Disease Education Program (NKDEP), an initiative of the National Institutes of Health, aims to improve early detection of chronic kidney disease (CKD), facilitate the identification of patients at greatest risk for progression to kidney failure, promote evidence-based interventions to slow progression of CKD, and support the coordination of Federal responses to CKD.

Central to NKDEP's approach is the concept that CKD should be identified and addressed in the primary care setting, and that managing CKD prior to referral can improve patient outcomes. CKD has long been perceived as a "specialist disease," and primary care providers (PCPs) have tended to defer treatment prior to subspecialty referral, missing opportunities for early treatment. Yet many of the therapeutic interventions for CKD are similar to those required for optimal diabetes care (e.g., control of glucose, blood pressure, and lipids) and other key interventions can be integrated into primary care (e.g., screening for co-morbidities, nutrition counseling).

To support the delivery of CKD care prior to referral—thereby helping to improve patient outcomes—NKDEP provides a variety of information, tools, and resources that educate PCPs and other health professionals. These include the Quick Reference on UACR and GFR, a clinical reference sheet that explains the two key tests (urine albumin-to-creatinine ratio, or UACR, and GFR) used to diagnose and monitor CKD, and two free CME webinars—"Improving Outcomes in Chronic Kidney Disease" and "Nutritional Management of Chronic Kidney Disease"—accredited by the American Academy of Family Physicians. Both webinars and the Quick Reference on UACR and GFR reference sheet can be accessed at www.nkdep.nih.gov.

Patient education is also a key intervention in CKD care. Educators play an important role in educating their patients about the risk for CKD, the importance of testing, and risk reduction steps they can take. Through education, they can also begin to prepare their patients for the possibility of kidney failure and treatment. To support patient education, NKDEP has developed the following resources for providers:

• Explaining Your Kidney Test Results: A Tear-off Pad for Clinical Use that helps providers explain GFR and UACR test results and CKD basics to patients. The pad has been adapted into Spanish, Chinese, and Vietnamese.
• Patient education concepts and suggested talking points on four key topics: CKD and risk, testing, treatment, and kidney failure.
• Short educational web videos for health professionals that model ways to answer common patient questions (in English and Spanish) on a wide series of topics related to CKD and kidney failure. Diet plays a critical role in CKD management. NKDEP has developed a suite of materials to help general practice registered dietitians (RDs) provide effective medical nutrition therapy (MNT) to CKD patients who are not on dialysis. The purpose of MNT for CKD is to maintain good nutritional status, slow progression, and treat complications. These free, downloadable, and reproducible materials are designed to distill key information about CKD and diet for RDs and patients, and can be found on NKDEP's website: www.nkdep.nih.gov/identify-manage/ckd-nutrition.shtml.

NKDEP has also created a variety of free, easy-to-read educational materials for the general public, African Americans, and Spanish-speakers. These include brochures and fact sheets for those at risk for and living with kidney disease. NKDEP's Kidney Connection campaign encourages African Americans to "make the kidney connection" between diabetes, high blood pressure, and kidney disease; and get tested for kidney disease. All patient education materials are available for order and download at www.nkdep.nih.gov/resources.shtml.

NKDEP hopes that by providing these science-based, free materials and resources, primary care providers will feel more confident in educating and managing their CKD patients to help slow the progression of CKD- with the ultimate goal of delay or preventing kidney failure. All materials are available on NKDEP's website: www.nkdep.nih.gov.