Boston—Due to the difficulty in predicting which patients with chronic kidney disease (CKD) will progress to end-stage renal disease (ESRD), current standard of care for patients prior to ESRD is suboptimal. There are prediction tools available, but, according to Jamie Green, MD, and colleagues, they have not been widely implemented into clinical care. The research team worked to (1) develop a CKD registry to identify patients at high risk of progression to ESRD and (2) enroll patients at high risk of disease progression in a clinical program to improve care pre-ESRD. The registry was described during a poster session at the NKF Spring Clinical Meetings in a poster titled Clinical Implementation of a Chronic Kidney Disease (CKD) Registry with Risk Prediction.
The CKD registry was developed as part of a clinical trial conducted at eight nephrology clinics in a large integrated health system in Pennsylvania. Based on electronic health records, patients not on dialysis with CKD stages G3aA3, G3bA2-A3, G4A1-A3, and G5A1-A3 were eligible for inclusion in the registry. Patients remained in the registry until they reached 6-months following initiation of renal replacement therapy.
The validated Kidney Failure Risk Equation used to predict risk was embedded in the registry. Patients were stratified according to risk of progression to kidney failure within 2 years: low, <6%; moderate, 6 to 10%; or high >10%. To optimize care in the transition from CKD to ESRD, patients at high risk were enrolled in a case-manager based clinical program.
During the study period (4/3/2017-4/2/2018), 3696 patients met inclusion criteria. Of those, 57% (n=2097) had CKD stage 3, 38% (n=1393) had CKD stage 4, and 5% (n=204) had CKD stage 5. Mean age of the cohort was 73 years, 55% were female, and 98% were white. At study entry, 77% (n=2386) were identified as low risk of progression to kidney failure within 2 years, 7% (n=259) as moderate risk, and 16% (n=601) as high risk. By the end of 12 months, 31% (n=76/244) of high-risk patients at four sites were enrolled in a clinical program to improve pre-ESRD care.
The researchers said, “A CKD registry with risk prediction can be utilized to identify patients at high risk for progressing to kidney failure and [can] allow targeted interventions to be implemented.”
Source: Green J, Ephraim P, Hill-Briggs F, et al. Clinical implementation of a chronic kidney disease (CKD) registry with risk prediction. Abstract of a poster presented at the National Kidney Foundation 2019 Spring Clinical Meetings, May 8-12, 2019, Boston, Massachusetts.