Ongoing Projects: The Concept of Prevention in Kidney Disease

Novel Biomarkers of Kidney Injury to Detect Kidney Function Decline across Race/Ethnicity Groups: A Shift to Primary Prevention

Principal Investigator: Carmen Peralta

Funding Source: Harold Amos Medical Faculty Development Program, Robert Wood Johnson Foundation

Project Summary: The overall goal of this proposal is to identify novel biomarkers in the urine that can identify persons at risk for developing kidney disease. This will build a foundation that will translate into targeted prevention strategies for CKD by allowing identification of persons in the community at elevated risk. Subsequent work would target novel interventions for preventing CKD onset in this highest-risk subset of the general population.


A Triple Marker Approach to Optimize CKD Detection among Black and White Adults

Principal Investigator: Carmen Peralta

Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases (5R03DK095877)

Project Summary: This project has three aims: 1. To determine the prevalence of occult CKD by cystatin C and/or albuminuria among non-diabetic adults across the age spectrum in multi-ethnic cohorts. 2. To investigate the relative importance of risk factors for occult CKD by cystatin C and/or albuminuria among non-diabetic adults across the age spectrum. 3. To develop and validate a prediction tool for occult CKD among non-diabetic adults and to create a clinician–friendly, on-line tool to guide testing for occult CKD.


Lowering Blood Pressure Among Hypertensives with Screen-Detected Kidney Disease

Principal Investigator: Carmen Peralta

Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases (5R34DK102152)

Project Summary: We designed a pragmatic, cluster-randomized clinical trial to improve BP control for non-diabetic, hypertensive adults with screen-detected CKD in primary care. The first intervention will evaluate the efficacy of a nurse-led screen-and-educate strategy that utilizes a “triple-marker” CKD screening approach, coupled with both patient and provider education, compared with usual care. The second intervention will evaluate whether a screen, educate, and intensify treatment program co-led by both a nurse and a clinical pharmacist can improve BP management among persons with highest risk CKD, compared with the screen-and-educate strategy and with usual care. Based on the Chronic Care Model for primary care, this project is specifically designed to leverage an existing multi-disciplinary team to improve BP levels and increase appropriate use of inhibitors of the renin-angiotensin system (ACE/ARB). We will also evaluate the feasibility and process implementation of these programs using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. If successful, these interventions could help to reduce the burden of CKD and its associated complications.


CKD awareness and self-management: interventions for safety-net patients

Principal Investigator: Delphine S. Tuot

Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases (K23DK094850)

Project Summary: Delivery of effective management for CKD is limited because few CKD patients are aware of their disease, which is largely clinically silent. This is of particular importance among patients with low socioeconomic status, who often receive care from safety-net delivery systems. We are exploring the implications of patient awareness of CKD on health outcomes, examining the impact of an existing CKD self-management program on behavior change, and identifying safety-net patients’ unmet needs to engage in risk-reduction behaviors. In turn, these data will be used to refine existing self-management programs to improve health outcomes among safety-net patients with CKD.


Enhancing CKD health: Kidney Awareness Registry and Education (KARE) trial

Principal Investigator: Delphine S. Tuot

Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases (R01DK104130)

Project Summary: Interventions exist that help delay CKD decline and decrease CKD-associated morbidity and mortality. However, many individuals with CKD are not benefiting from these scientific advances. This lack of translation may be due in part to very low levels of CKD awareness among providers and patients leading to inadequate primary care delivery of CKD care and poor patient engagement to participate in healthy lifestyles and adhere to medication regimens. To address this need, our multi-disciplinary team has developed two interventions that aim to increase awareness among providers and patients and translate that knowledge into more optimal CKD care. The provider intervention is a CKD registry tailored to the entire healthcare team that provides point-of-care decision support and outside-of care summaries to optimize delivery of guideline-concordant CKD care via outreach and population health. The patient intervention is a comprehensive self-management support program that includes low-literacy educational materials and linguistically/culturally health coaching. The Kidney Awareness Registry and Education (KARE) trial will test the impact of these two interventions, alone and in combination, on health outcomes in a large diverse, low-income population.


Spreading eConsult across California's safety-net

Principal Investigator: Delphine S. Tuot

Funding Source: Blue Shield of California Foundation

Project Summary: Suboptimal delivery of specialty care, including nephrology care, is one of the most pressing health care issues for safety net patients. eReferral, the electronic referral and consultation (eCR) system developed by UCSF faculty at San Francisco General Hospital, fundamentally redefines the primary care provider (PCP)-specialist interface by moving away from a narrow reliance on visit-based care. In so doing, it has improved access to specialty care, increased PCP and specialist satisfaction, and enhanced communication among providers in San Francisco’s safety net. The primary care-specialty care interface and referral patterns are influenced by many factors; a “one-size fits all” approach to enhancing specialty care access across health systems is not feasible. Engaging local PCPs, specialists, health plans, patients, and other stakeholders is necessary to successfully adapt eReferral for different health care delivery systems. With this project, our team will guide the implementation and evaluation of new eCR programs across California designed to increase access to specialty care for vulnerable populations.