Kidney Week

Abstract: SA-PO0472

From Silos to Integration: Infrastructure and Initial Experience of a Cardiovascular-Kidney-Metabolic (CKM) Clinic

Session Information

• CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Bansal, Shweta, University Health, San Antonio, Texas, United States

Shweta Bansal, MD, MBBS, FASN

• Cardona Estrada, David Alejandro, University Health, San Antonio, Texas, United States

David Alejandro Cardona Estrada, MD

• Venkatesh, Aruna, University Health, San Antonio, Texas, United States

Aruna Venkatesh, MD

• Sanchez Cintron, Brenly M., University Health, San Antonio, Texas, United States

Brenly M. Sanchez Cintron, PharmD

• Taranova, Anna G., University Health, San Antonio, Texas, United States

Anna G. Taranova, MD, MS

• Gomez, Vanessa, University Health, San Antonio, Texas, United States

Vanessa Gomez, MA

• Brown, Danielle I., University Health, San Antonio, Texas, United States

Danielle I. Brown, RN

• Valdez, Laura Ashley, University Health, San Antonio, Texas, United States

Laura Ashley Valdez, RN

• DeFronzo, Ralph A., University Health, San Antonio, Texas, United States

Ralph A. DeFronzo, MD

Background

Patients with overlapping cardiovascular, kidney, and metabolic diseases are at high-risk and often receive fragmented, siloed and suboptimal guideline directed care due to uncertainty about safety and appropriateness of cross-specialty therapy adjustments. Multidisciplinary clinics integrating expertise across these domains offer a strategy to align care, address barriers and improve outcomes, but real world data are limited. We describe the implementation of clinic operations and early process measures of a CKM clinic at a tertiary care center.

Methods

We established a multidisciplinary CKM clinic comprising nephrologist, cardiologist, and endocrinologist supported by a clinical pharmacist, dietician, social worker and nurse coordinator. Implementation initiated with securing leadership support, developing EMR templates to standardize multidisciplinary documentation and aligning insurance approval processes. The workflow incorporates previsit review, synchronized specialty evaluation, engagement of appropriate ancillary resources and postvisit care coordination. A database captures patient characteristics, medication optimization, and outcomes.

Results

Over Feb-Apr 2026, 15 patients (1 had 3 visits, 3 had 2 visits = total 20 visits) were evaluated in 5 sessions. Initally 1 and later 2 patients were scheduled in per hour slot. The mean age was 62±13 yrs, 6 were female, all had diabetes, 12 had CKD, 11 heart failure, 7 CAD, 6 PAD, BMI was 30±9 kg/m², SBP 142±20 mmHg, eGFR 34±22 mL/min/1.73 m², LDL 63±24 mg/dl, HbA1C 7.6±1.5%, median uACR 800 (range 8-13,000) mg/gm, and BNP 142 (range 16-5000) pg/ml. Therapeutic optimization included initiation of SGLT2i in 3 patients (10 were already on), GLP-1RA in 4 (4 were already on), and initiation/adjustment of diuretics in 9 (11 were already on). One patient was diagnosed with wild type ATTR cardiac amyloidosis and started on tafamidis within 4 weeks of initial appointment. Social work and PharmD addressed transportation, medication access, and health literacy barriers in patients with identified needs. In patients with FU visits, SBP dropped from 142±82 to 117±25 mmHg, fatigue and dyspnea improved in 3 of 4 patients.

Conclusion

Implementation of a multidisciplinary CKM clinic is feasible and enables whole patient-centered, coordinated, evidence-based care of a high-risk population. Ongoing evaluation will assess scalability and outcomes.