Dr Joseph Vassalotti Describes Ways to Empower Primary Care Clinicians to Treat Kidney Disease

Educating primary care clinicians on how to manage chronic kidney disease (CKD) in the primary care setting can help avoid referrals for nephrology consults that aren’t needed, said Joseph Vassalotti, MD, clinical professor at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation.

Transcript

What are the differing responsibilities of primary care clinicians and nephrologists in managing CKD?

I think that’s a challenging question to answer because those practice patterns are really being defined locally, and I think that’s a real important area for further investigation. What I would say is that we want the primary care clinician to know that there’s a difference between making a diagnosis of kidney disease and the need to refer for a nephrology consult, that most of the chronic kidney disease particularly that occurs with diabetes and hypertension, can be managed in the primary care setting. And we want to help empower them to do that, with respect to control for those conditions, with ACE [angiotensin-converting enzyme] inhibitors and angiotensin receptor blockers that are informed by the urine albumin to creatinine ratio test with understanding when to refer for nephrology, with understanding the import and the impact of medical nutrition therapy for diabetes and hypertension, with understanding medication management that’s informed by the estimated GFR [glomerular filtration rate] level at lower levels of estimated GFR, some medications need to be dose adjusted, others may need to be avoided.