Empowered CKD Management Protocol

Through the past six months at the University of Texas Health Science Center in San Antonio, Texas, Dr. Richard Gibney and the Empowered Kidney Care team have published a first draft of their official empowered CKD Management Protocol.

Already, the first six month’s results are inspiring, demonstrating a promising start to a complete empowered kidney care program.

The document is the latest step in a steady shift from end stage renal disease (ESRD) to early-stage chronic kidney disease (CKD). By moving “upstream,” we can help preserve kidney function and prevent patients from having to go on dialysis.

Identify and communicate kidney function with patient and provider

A study by the United States Renal Data Systems (USRDS) found that 92% of CKD 1-3 patients are UNAWARE that they have kidney disease. Another recent study by the National Kidney Foundation (NKF) found that 80% of patients with CKD do not receive appropriate testing.

These studies reinforce the fact that CKD management must begin with awareness. The first step requires medical teams to identify and investigate potential loss of kidney function. From there, they must identify and clearly communicate the appropriate CKD level (CKD 1-5) with the patient.

Move “upstream” to preserve kidney function for CKD stage 1-3

By the time many patients visit a nephrologist, their kidney function has already declined to the point where it’s too late. Providers must instead move upstream to address the underlying risk factors for kidney disease.

1. Hypertension (high blood pressure)
2. Diabetes (blood sugar)
3. Obesity

Once identified, these issues may be controlled with proper medication and lifestyle changes. A number of newer medications, including SGLT-2 inhibitors provide excellent CKD management benefits across the board, helping to preserve kidney function and heart health.

Empower patients

When it comes to chronic disease like CKD, patients are the most important member of the healthcare team. Their understanding and participation are critical to preserving kidney function.

As empowered healthcare providers walk alongside each patient, they can assign three simple but effective “homework” items:

1. Bring personal health data (a list of blood sugar, blood pressure, and weight) to every office visit
2. Bring medication bottles to office visit (improves communication and educates patient if they need to modify dose)
3. Bring a “patient advocate” to provide support and love (frequently wife or daughter)

For more on patient empowerment, make sure to review and download our Empowered CKD Checklist.

Collaborate and communicate with healthcare team

Poor communication between medical professionals commonly results in confusion and missed opportunities for CKD management.

An empowered kidney care program ensures consistent messaging between doctors and patients (align PCP, diabetes, cardiac, renal). Beyond doctors and nurses, the team can also expand to include dietary specialist, social worker, and pharmacist support.

Manage high-risk medications for CKD patients

Many patients and healthcare providers are unaware that common medications can have detrimental effects on kidney health. Drugs like NSAIDs (Ibuprofen) should be avoided or have their dose modified.

If you are unsure about the content, purpose, or safety of a patient’s medications, there are several helpful online resources available including the Epocrates app.