Alongside efforts to develop new strategies for the early diagnosis and delayed progression of chronic kidney disease (CKD), it remains critical to implement existing interventions effectively. Since the patients who might benefit are asymptomatic and undiagnosed, the tasks of early diagnosis and intervention naturally belong to the primary care practitioners (PCPs) who are in regular contact with these asyet undiagnosed patients. 1,2 Despite PCPs' familiarity with preventive measures, such as smoking cessation, blood pressure control, and diabetes control, both time constraints and the need to stay up to date with current CKD guidelines and manage competing clinical priorities often pose challenges in achieving optimal CKD outcomes. 3 This requires collaboration between specialists and PCPs, which has worked at small scale 4 but, to our knowledge, not been tried systemwide. 5 The Kidney Coordinated Health Management Partnership (Kidney CHAMP) randomized clinical trial (RCT) in this issue 6 aimed to test a scalable intervention to reduce the risk of a decline in kidney function by delivering the specialist knowledge and judgments of a nephrology team to the primary care setting. Using an algorithm based on routine tests reported in electronic health records (EHRs), the intervention identified high-risk patients (4% or greater 5-year predicted risk of end-stage kidney disease, rapid rates of decline in estimated glomerular filtration rate [eGFR], or eGFR of 15 to 29 mL/min/1.73 m 2 ) without prior nephrology consultation. Nephrologists confirmed diagnoses through (remote) EHR review and provided consultation reports, while pharmacists offered personalized prescription recommendations. However, the responsibility for implementing this guidance (change care or prescriptions, refer for kidney education, or seek further nephrology support) was left to the PCP. The trial compared this multifaceted intervention with usual care across 98 primary practices and 1596 high-risk patients with CKD. The consultation interventions by the nephrologists and pharmacists were reliably delivered in the intervention group (more than 97%) but the referral for nurse education was not and so was changed to automatic referral with nurse-initiated contact. The failure of the Kidney CHAMP intervention to reduce decline in kidney function is disappointing, but there is lots to learn from this excellent RCT of a bold intervention.The Kidney CHAMP RCT 6 is an exemplary use of an EHR system to facilitate eligible patient identification, recruitment, risk assessment, and collection of outcome data to deliver and evaluate a CKD intervention. The intervention was validated in principle: health systems with an EHR shared between specialists and PCPs can reliably automate the identification of high-risk patients and bring specialist skills to the primary care setting, in the form of individually tailored prompts to action delivered directly to the PCP. But we believe
