The Case for Disease Management in Chronic Kidney Disease

Abstract

Chronic kidney disease (CKD) is a growing epidemic in the United States and worldwide, with nearly two thirds of CKD patients also having diabetes, hypertension, or both. Morbidity and mortality among patients with CKD are high, as are the costs associated with care, which is highly fragmented. Disease management (DM) programs are designed to coordinate the delivery of care to patients, improve clinical outcomes, and reduce costs along the continuum of care. The goals of DM programs in CKD patients are to fill the gaps in current care by focusing on four key areas: (1) slowing the progression of CKD, (2) identifying and managing the complications of CKD, (3) identifying and managing associated comorbid conditions, and (4) smoothing the transition to renal replacement therapy (RRT). To be successful, this approach requires multidisciplinary collaboration among physicians (eg, primary care physicians, endocrinologists, cardiologists, nephrologists, surgeons) and participating caregivers including nurses, dieticians, social workers, and pharmacists. Patient identification, limited reimbursement, late patient referral, and lack of primary care physician and nephrologist knowledge about the importance and details of CKD management are all barriers that must be overcome for such programs to be successfully implemented. Considering the magnitude of the opportunity, DM applied to CKD is a promising approach to the care of this vulnerable population.

Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis

“…[159][160][161][162][163][164][165][166][167][168][169][170][171][172] Two broad categories of aspirations for care were described:…”

“…The key role of nurses was highlighted as: patient educators, care managers communicating between care providers and support staff, and following up patients to monitor their progression. [166][167][168] Four of the papers suggested that patients should be managed and evaluated in primary care by skilled support staff, with only complex or severe cases referred to specialists or nephrologists in secondary care. 166,168,171,172 Furthermore, they noted the importance of care plans being developed based on evidence-based practice guidelines.…”

“…[166][167][168] Four of the papers suggested that patients should be managed and evaluated in primary care by skilled support staff, with only complex or severe cases referred to specialists or nephrologists in secondary care. 166,168,171,172 Furthermore, they noted the importance of care plans being developed based on evidence-based practice guidelines. Recognition that CKD was a chronic and complex condition was found to be useful in supporting collaboration and education needs.…”

Rise of Pay for Performance

“…Disease management programs, successfully implemented in other disease states, may be well suited to overcome the current fragmentation of care (48). A systematic review that assessed the clinical and economic effects of disease management in patients with chronic diseases found marked improvements in many processes and outcomes of care but no significant reduction in costs (49).…”

Cardiovascular Risk Factors in End-Stage Renal Disease Patients: The Impact of Conventional Dialysis versus Online-Hemodiafiltration

“…The two most common causes of CKD are diabetes and arterial hypertension; glomerulonephritis, nephrolithiasis and polycystic kidney disease are other, less common causes [2].…”