PAs are Altering the Course of Chronic Kidney Disease

According to the National Kidney Foundation, over 50 percent of people age 30-49 could develop Chronic Kidney Disease (CDK) in their lifetime. Diabetes is the leading cause of kidney failure and patients with diabetes are prime candidates for intervention.

A new continuing medical education (CME) program developed by PAs for PAs is altering the course of diabetes and the outcomes for patients - preserving kidney function to the extent possible for the patient.

Called “Kidneys in a Box” (KIB), the CME activity was developed specifically for non-nephrology providers to increase early detection by primary-care providers and slow down the progression of the disease.  It was designed in concert with the American Academy of Nephrology PAs and is a straight-forward way to improve both care for your patients and outcomes for your practice.

KIB helps do two things:

• Provide early detection for patients who are unaware CKD is in their future.

• Set these patients on a course to slow the disease progression.

How does it work?

KIB identifies six modifiable factors that medical providers can review with diabetic patients to assess their current status regarding the factors.  PAs then counsel patients on why these factors are important and assist them in reaching compliance.

The six factors are basic yes/no questions that allow the PA to catch kidney disease early:
• Is the patient taking a statin drug? If so, does this need to be re-evaluated?

• Has the hemoglobin A1C been measured in the last 6 months?  This test is a quick indicator of the average control of blood sugar over time.  Better control of diabetes helps limit damage to the kidneys from diabetes.

• Has the urine albumin-creatinine ratio been checked in the last year? We will see an increase in this ratio before kidney efficiency drops, and this allows us to refer sooner to nephrology.

• Has the stage of CKD been determined?  Diagnosing CKD at an earlier stage will allow for earlier referral to specialist and possible intervention.

• Does the patient have a yellow caution over-the-counter medication list that alerts them to OTC medications that could be harmful to the kidney? PAs in our study were surprised by the number of OTC products that diabetic patients with CKD should avoid. • Has the patient been counseled on smoking cessation? Smoking increases blood pressure, which leads to worsened kidney function.

Is this only for primary care?

If CKD seems outside your realm of expertise, consider that many of the 302 PAs who completed our study practice outside of internal medicine and family practice. Almost half practice in surgical specialties, urgent care, emergency medicine, critical care, and internal medicine specialties.

What were the results?

According to an article published in the Journal of the American Academy of Physician Assistants, PAs selected 10 charts of patients with diabetes before implementing the modifications and recorded simple metrics. Then for 12 weeks, they addressed the six modifiable factors with diabetic patients.  Participants then reviewed 10 charts again and found that statistical improvement came in five of the six areas. (Only improvement in smoking cessation was not statistically significant.)  This demonstrates that any provider can readily assess the first five factors during an office visit and make a positive impact.  This is an opportunity for all providers to give our patients the gift of early detection and intervention.

Why is it important?
The results of these six check points allow us to help patients at risk and potentially change the course of the patients’ disease. Although it was created by Certified PAs, the six check points are something that physicians and nurse practitioners can readily assess as well.

Patients suffer both personal and financial burdens as a result of diabetes and CKD.  Adopting protocols to assess these risk factors and educating our patients on them can alter their personal history.  We can be the change in our diabetic patients’ lives.

Kendra Thomsen, PA-C, is the chief PA in cardiothoracic surgery at Baylor Scott & White, at the Austin/Round Rock campus in Texas.  She has been a Certified PA for nine years and has also worked in endocrinology, family medicine, and orthopaedic surgery. She is a member of the board of directors of the NCCPA.