The Kidney Early Evaluation Program (KEEP) is a service provided by the National Kidney Foundation to screen individuals for kidney disease. A recent article published as part of the KEEP supplement in the American Journal of Kidney Diseases reviews the KEEP program. Corresponding author Dr. Claudine Jurkovitz (CJ) from Christiana Care Health System, Newark, DE, discusses an interesting observation with Dr. Kellie Calderon (eAJKD), eAJKD advisory board member.
eAJKD: KEEP is a fantastic service for the community. Will you briefly describe the goals of the program and identify your target population?
CJ: The goal of KEEP is to screen people who are at high risk of kidney disease, including people with either a personal or family history of hypertension, diabetes, or chronic kidney disease. These are community screenings organized by the local National Kidney Foundation chapter in every state. They take place in churches or community health centers, and are publicized locally. High risk patients come to be screened for kidney disease, and learn about kidney disease and how it can be treated.
eAJKD: What was your goal in evaluating the 2005-2010 data from the KEEP screenings?
CJ: The goal of this research project was to look at the control of cardiovascular risk factors in the KEEP population before and after the initial screening. Besides chronic kidney disease, we wanted to evaluate how modifiable risk factors such as hypertension, diabetes, and hypercholesterolemia were managed in people who participated in repeat screenings.
eAJKD: What did you find particularly interesting about the results?
CJ: We found that among patients who met criteria for nephrology referral, the repeat participants were more likely to have seen a nephrologist at their second screening than at their initial screening. Nevertheless, this is still a very small percentage of patients. It seems that most patients are managed by their primary care physicians and not a nephrologist. Approximately 42% of the patients who participated in repeat screenings had seen their primary care physicians in the interim. There may be a barrier for primary care physicians to refer to nephrologists, or a reluctance by patients to see a nephrologist.
Additionally, very few patients rescreened were aware of their underlying kidney disease. This is surprising since patients are informed of the findings at the first screening. We cannot assume that it is only awareness that drives consultations to the nephrologist.
eAJKD: You conclude by suggesting that improved communication between the primary care physicians and nephrologists may be a new focus for KEEP. What are your ideas to implement this?
CJ: It doesn’t seem that there are a large percentage of primary care physicians who know about the KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines. In fact, studies show less than 40% of the primary care physicians are familiar with them. That is why the National Kidney Foundation is reaching out to educate primary care physicians. This effort should help decrease the delay in referral to nephrologists.
eAJKD: What is the take-home message of your article?
CJ: We know that chronic kidney disease is associated with significant cardiovascular mortality. Surprisingly, only 8.4% of these patients who are at high risk for kidney disease have their cardiovascular risk factors controlled. Since patients who meet the criteria for referral to the nephrologist rarely see the nephrologist, we need to better understand the barriers to early referral to nephrologists.