Can Early CKD Be Transitioned Back to Primary Care Providers (PCPs)?

Background: Chronic Kidney Disease (CKD) affects nearly 37 million U.S. adults. The increasing prevalence of CKD challenges nephrology practices, which struggle to meet the demand for specialized care. Transitioning early-stage CKD patients back to PCPs (with guidance on when to refer back) may allow nephrology clinics to focus on new patient care. Methods: A retrospective chart review was conducted using electronic health records (EHR) of 90 randomly selected patients from an advanced practice provider's (APP’s) panel (Figure 1). Eligibility criteria for transition back to PCPs included CKD Stage Grade 3a (G3a) or lower with albuminuria (UACR) < 300mg/g on a spot sample and blood pressure under fair control (< 160/90 mmHg). Exclusion criteria included any of the following: CKD stage G3b – G5, unstable creatinine, UACR (> 300mg/g), electrolyte abnormalities, metabolic acidosis, uncontrolled hypertension, microscopic hematuria, glomerulonephritis, or need for anemia management. Results: Out of 90 randomly selected patients, 34 (37.7%) were potentially eligible to return to their PCP for further management. Of these, 5 patients with CKD Stage G3a and UACR < 300mg/g were excluded due to electrolyte abnormalities (hyponatremia, n=3), unstable creatinine levels (n=2), and microscopic hematuria (n=1). The remaining 29 patients (32.2%) will be transitioned back to their PCP’s with (1) specific parameters for return to nephrology clinic and (2) a guide developed by the nephrology division to assist with CKD management. Conclusion: In this study, approximately one third of nephrology clinic patients were deemed appropriate to transition back to PCPs. This practice has the potential to reduce load in CKD clinics, freeing up resources for those at higher risk of cardiovascular events and progression to ESKD. Future work will involve reviewing the entire panel of patients and tracking outcomes in patients transitioned to PCPs.