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Chronic Kidney Disease — A Quiet Revolution in Nephrology

Six Case Studies

by Richard A. Rettig, Roberto B. Vargas, Keith C. Norris, Allen R. Nissenson

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Examines changes in nephrology as it evolves from a focus on end-stage renal disease (ESRD) to the treatment of earlier stages of chronic kidney disease (CKD). Once patients reach ESRD, treatments are limited to kidney transplantation and dialysis. However, the progression of earlier stages of CKD can be slowed, halted, or reversed when treated. Data from 15 clinics focusing on CKD are examined, with the focus on six case studies. Clinics are still establishing best-practice models, and reimbursement remains a challenge. Recommendations also include widespread education for primary care physicians on how to interpret levels of kidney function and on referral of patients with decreased kidney function to nephrologists before ESRD is reached.

Table of Contents

  • Chapter One

    Introduction: Chronic Kidney Disease, a Major Public Health Imperative

  • Chapter Two

    Overview of Findings

  • Chapter Three

    The Chronic Kidney Disease Clinic at Northwestern University, Chicago, Illinois

  • Chapter Four

    Associates in Nephrology, Chicago, Illinois

  • Chapter Five

    Mayo Clinic Nephrology, Jacksonville, Florida

  • Chapter Six

    Indiana Medical Associates, Fort Wayne, Indiana

  • Chapter Seven

    St. Clair Specialty Physicians, P.C., Detroit, Michigan

  • Chapter Eight

    Winthrop University Hospital, Division of Nephrology and Hypertension, Mineola, Long Island, New York

  • Chapter Nine

    Conclusions and Recommendations

  • Appendix

    Interview Template

This work was sponsored by the National Institutes of Health's National Center for Research Resources, which funded the Comprehensive Center for Health Disparities at Charles Drew University. The research was conducted in RAND Health, a division of the RAND Corporation.

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