Dr Joseph Vassalotti Explains How CKDintercept's Components Can Improve Kidney Care

CKDintercept, the primary care initiative of the National Kidney Foundation, involves multiple strategies aimed at improving the quality of kidney care, explained Joseph Vassalotti, MD, clinical professor at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation.

What is CKDintercept and how do you hope it will improve kidney care?

CKDintercept is the National Kidney Foundation’s primary care initiative. It’s a multipronged effort, which includes simplifying the laboratory tests to make it easier for the primary care clinician to order the estimated GFR [glomerular filtration rate] and the urine albumin to creatinine ratio with Kidney Profile that includes those 2 tests. We’re also harmonizing the way the tests are reported, so that the reporting formats and the formulas used to calculate the estimated GFR are harmonized across the laboratories. And we’re partnering with the laboratory societies and clinical laboratory professionals to implement this work together.

It also includes a quality measure. Unfortunately, we don’t have any quality measures in all of Medicare or Medicaid for chronic kidney disease. Medicare and Medicaid have many quality measures for kidney failure or end-stage renal disease treated with dialysis or transplant, but there’s nothing, so we want to start with the quality measure there. We want to replace the existing medical attention for nephropathy measure that’s in the HEDIS [Healthcare Effectiveness Data and Information Set] program. That’s the commercial insurance acronym for the quality measure program with the simpler quality measure that includes the estimated GFR and the urine albumin to creatinine ratio in the patients with diabetes.

That should drive the testing for kidney disease. At this point, the average American with diabetes gets an estimated GFR 80% to 90% of the time, depending on which data set you looked at, you look at over a year period, but the urine albumin to creatinine ratio in most of the data sets we’ve looked at only is done about 40% of the time. We want to increase the testing of the population with diabetes at risk for kidney disease with this quality measure.

Then there is an educational aspect, and really a lot of this will involve working with primary care clinicians and primary care societies to show how that heat map risk stratification, how the lower estimated GFR and the increase in the albuminuria predict risk and how they actually should guide interventions, like the ones that I mentioned before, ACE [angiotensin-converting enzyme] inhibitors and angiotensin receptor blockers, when to refer to a nephrologist, more intensive cardiovascular risk reduction with statin-based therapy, and others.

The other programs within the CKDintercept include a payment model that we’re working on to innovate care, both in the primary care setting and the nephrology setting, so to incentivize the primary care clinician and the nephrologist for evidence-based interventions which should lead to better outcomes for people living with chronic kidney disease.