Case Study | eConsults Improve Diagnosis and Treatment of Chronic Kidney Disease

Chronic kidney disease (CKD), characterized by damage to the kidneys over a period of three months or more, affects approximately 37 million Americans. Today, 1 in 3 adults are at risk of developing CKD. The disease progresses through five stages, but often symptoms do not appear until CKD has advanced to dangerous phases. Left untreated, kidney disease can result in kidney failure requiring dialysis or transplantation. As diabetes and hypertension, the two leading causes of kidney disease, grow in prevalence, CKD diagnoses are increasingly common.¹ 

Primary care providers (PCPs) are at the forefront of CKD screening and care. While PCPs are best poised to identify high risk patients and intervene early, they face demands for their time and resources. PCPs can be more empowered and efficient when treating CKD patients when given access to virtual nephrologists. Through eConsults, primary care teams can share patient information with a nephrologist and obtain expert support with risk stratification, clinical decision making, and long-term care coordination. Consequently, eConsults expand primary care clinical capacity for CKD patients. 

Rising Kidney Disease Risk: Early Detection and Clinical Decision Support

eConsults can enable earlier detection and management of CKD through data analysis and risk stratification. Without requiring an immediate in-person specialist visit, eConsults facilitate timely specialist review of patient data, such as relevant lab results and medical history to identify at-risk patients. 

Primary care teams can leverage eConsults for clinical decision support based on each patient’s unique risk profile. When a patient meets predefined risk criteria for CKD, including elevated blood pressure, a history of diabetes, or abnormal lab results, the PCP can initiate an eConsult with a nephrologist for early intervention strategies. These might include recommendations designed to prevent or delay CKD progression, such as additional diagnostic testing, diet and lifestyle changes, or adjustments to medications. 

eConsults offer flexibility and real-time feedback, allowing PCPs to obtain specialist input on a case-by-case basis. Alternatively, eConsults can support a cohort-based care model to efficiently identify and support at-risk populations. PCPs can systematically submit eConsults for groups of patients who meet CKD risk criteria by implementing a programmatic strategy. This type of proactive risk stratification can ensure that high-risk patients receive timely expert input, ultimately slowing CKD progression and improving long-term outcomes.

Chronic Kidney Disease (CKD) Fast facts

• 1 in 7 Americans are estimated to have CKD. 

• 90% of those living with CKD don’t know they have it.
• Diabetes is the most common cause of kidney disease, and both diabetes and hypertension cause or contribute to 2 of 3 new cases of kidney failure.²

Diagnosing Kidney Disease and Slowing Progression

Partnering with a virtual nephrologist through eConsults enables PCPs to interpret biomarker tests for more timely, evidence-based diagnostics. PCPs can submit patient data such as blood pressure, blood sugar, urine albumin-to-creatinine ratio (uACR), and estimated glomerular filtration rate (eGFR) to a nephrologist for analysis. With specialist guidance, PCPs can more confidently identify early-stage CKD, even when symptoms are subtle or ambiguous. This collaborative approach can lead to early, personalized interventions. 

The support of a virtual nephrologist extends beyond diagnosis. eConsults can provide expert treatment guidance and ensure that PCPs stay up-to-date with current therapeutic recommendations. Over time, ongoing eConsults can allow PCPs to make proactive treatment modifications to mitigate disease progression as a patient’s condition evolves.

Coordinated specialty care is particularly important for patients with comorbid conditions. Nephrologists, endocrinologists, cardiologists, and dietitians can collaborate to optimize treatment, monitor disease progression, and ensure integrative medication management. This collaborative, multidisciplinary strategy can enhance care quality, improve patient outcomes, and delay the need for advanced interventions. In cases of end-stage renal disease (ESRD), eConsults are instrumental in preparing patients for dialysis and transplantation procedures, ensuring that all critical decisions are made promptly and with input from a team of experts. 

Enhancing CKD Care: The Dual Benefits for Providers and Patients

The use of eConsults to aid in diagnosis and treatment of CKD alleviates burdens on the healthcare system by saving time and reducing costs for both practitioners and patients. eConsults facilitate faster clinical decisions by enabling PCPs to consult with nephrologists virtually. eConsults can help further educate PCPs on conditions and improve on their differentials to come to an accurate diagnosis. This efficiency reduces healthcare costs by minimizing unnecessary referrals, optimizing specialists’ time, and preventing the overuse of specialty care resources. As a result, eConsults ensure that face-to-face appointments are reserved for the patients who need them most, maximizing the availability of specialists for complex or urgent cases. 

CKD disproportionately affects populations facing barriers to care, including elderly patients, individuals from rural and underserved populations, and minority groups. Financial constraints, lack of insurance, lack of transportation, and mobility limitations reduce opportunities for care, limit time with practitioners, and hinder preventive strategies to slow disease progression. Moreover, limited access to good nutrition and chronic stress can accelerate kidney damage.^2-3 eConsults provide timely access to specialist care without the financial and logistical challenges associated with an in-person appointment. As a result, remote specialist guidance enables early intervention and personalized treatment strategies that account for patients’ unique needs.

Finally, eConsults empower primary care teams to serve as the central point of contact for CKD patients, fostering stronger patient relationships and enhanced patient monitoring. eConsults also educate primary care practitioners, particularly new providers, on CKD risk factors, screening guidelines, and best practices for managing early-stage CKD patients. Primary care teams become more confident, informed, and better equipped to deliver consistent, high-quality patient outcomes.

Real eConsult Cases that Avoided an Unneeded Referral

Click on each case to view the eConsult full transcript.

Stage 4 CKD with Comorbidities eConsult Case

PCP seeks advice for treatment of 55-year-old male stage 4 CKD with several comorbid conditions. View the case

Sleep Management Guidance eConsult Case

Specialist provides sleep management guidance for homebound female CKD patient experiencing dialysis. View the case 

Pharmacology & Lifestyle Recommendations eConsult Case

Specialist offers pharmacology and lifestyle recommendations for 56 year-old, uninsured male with DM, HTN & worsening kidney function. View the case

Hyponatremia & Stage 3 CKD eConsult Case

PCP obtains guidance for management of an 85-year-old female with hyponatremia and stage 3 CKD, including lab work and medication management. View the case

eConsults Provide Better Care for Kidney Disease

Kidney disease is a complex and growing public health concern that demands a comprehensive approach to diagnosis and treatment. Early detection, combined with close collaboration between specialists and primary care providers, is essential to slowing CKD progression. eConsults with nephrologists and other specialists empower PCPs with tools for risk stratification, early diagnosis, and informed clinical decision making. By facilitating coordinated and integrated care plans tailored to a patient’s unique risk factors and access challenges, eConsults enhance the quality of care for those managing chronic kidney disease.

Citations:

(1) National Kidney Foundation. Social Determinants of Health. https://www.kidney.org/kidney-topics/social-determinants-health-and-chronic-kidney-disease

(2) National Kidney Foundation. Chronic Kidney Disease. 

https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd#diagnosis

(3) Duke University School of Medicine. A Rising Tide of Kidney Disease in Rural Communities. https://medschool.duke.edu/stories/rising-tide-kidney-disease-rural-communities