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Kidney Week

Abstract: TH-PO001

Quality Improvement in CKD Management in a Resident Primary Care Clinic

Session Information

  • Educational Research
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Educational Research

  • 900 Educational Research


  • Wyatt, Nicole, Brookwood Baptist Health, Birmingham, Alabama, United States
  • Madonia, Phillip, Brookwood Baptist Health, Birmingham, Alabama, United States

Primary care physicians (PCPs) are in a unique position to identify and manage CKD early in the disease process, preventing disease progression. Given the recent increased emphasis on providing resources and education for PCPs, we identified a need to implement an educational protocol to train internal medicine residents on the diagnosis and management of CKD in the primary care clinic. We present preliminary data evaluating the impact of this educational training.


A retrospective electronic medical record (EMR) search included all patients in the resident clinic diagnosed with CKD stage 3 from June 2019 to October 2021. Each chart was evaluated for urinary albumin creatinine (ACR), blood pressure and glycemic control, therapy with ACEi/ARB and SGLT2i, and referral status to nephrology. Then, an educational presentation and informational handout was given to the residents. A repeat EMR search was made 6 months post-education to re-evaluate the above parameters.


Pre-intervention data showed 71 clinic patients diagnosed with CKD3. Blood pressure was controlled in 31% and glucose controlled in 66% with HbA1c ordered (n=59). ACR was ordered at least once in 50.7% and annually in 15.5%. Of those without contraindications (n=65), 84.6% had ACEi/ARB therapy. SGLT2i therapy had been initiated in 2.8%. Referrals to nephrology were made in 42.3%. Review performed 6 months post-intervention revealed 45 patients with CKD3, including those that returned or were newly diagnosed. Blood pressure was controlled in 48.9% and glucose controlled in 67.6% with HbA1c ordered (n=34). Annual ACR had been ordered in 60%, ACEi/ARB therapy was ordered in 78.9% without contraindications (n=38), and SGLT2is were prescribed to 20.9%. Referrals were made in 46.7%. One-year post-intervention data is still being collected.


Preliminary results at 6-months post educational training show a promising trend in improvement in the management of CKD stage 3 patients in the resident clinic population. Importantly, there has been an increase in annual ACR orders and SGLT2 inhibitor initiation. We expect this trend to continue with our 12-month interval data collection. Given the importance of PCPs in the identification and management of CKD patients, as well as an overall shift to value-based care, it is integral to improve graduate medical education on this topic.