Cardiorenal care coordination: holistic patient care opportunities in the primary care setting for patients with chronic kidney disease and atherosclerotic cardiovascular disease

ABSTRACT

Objectives

Chronic kidney disease (CKD) and atherosclerotic cardiovascular disease (ASCVD) are closely linked conditions, and the presence of each condition promotes incidence and progression of the other. In this study, we sought to better understand the medical journey of patients with CKD and ASCVD and to uncover patients’ and healthcare providers’ (HCPs) perceptions and attitudes toward CKD and ASCVD diagnosis, treatment, and care coordination.

Methods

Cross-sectional, US-population-based online surveys were conducted between May 18, 2021, and June 17, 2021, among 239 HCPs (70 of whom were primary care physicians, or PCPs) and 195 patients with CKD and ASCVD.

Results

PCPs reported personally diagnosing CKD in 78% and ASVD in 64% of their patients, respectively. PCPs reported they are more likely to serve as the overall coordinator of their patient’s care (89%), while slightly more than half of PCPs self-identified as a patient’s coordinator of care specifically for CKD (54%) or ASCVD (59%). In contrast, patients viewed their PCP as their coordinator of care for CKD (25%) or ASCVD (9%). PCPs who personally treated patients with CKD and ASCVD most often recalled primarily prescribing or recommending pharmacologic treatments for CKD and ASCVD; however, patients reported that lifestyle modification was the most common treatment modality they had ever used to manage CKD and ASCVD.

Conclusion

CKD and ASCVD are interrelated cardiometabolic conditions with underlying risk factors that can be managed in a primary care setting. However, few patients in our study considered their PCP to be the coordinator of their care for CKD or ASCVD. PCPs can and should take a more active role in educating patients and coordinating care for those with CKD and ASCVD.

Plain Language Summary

Chronic kidney disease (CKD) is a medical condition where the kidneys are damaged, and their function is reduced. CKD is often linked to other health problems. Atherosclerotic cardiovascular disease (ASCVD) is a condition where cholesterol builds up in the arteries, leading to reduced blood flow and heart issues. This study wanted to understand what patients and healthcare providers (HCPs) know about these two conditions and how they are managed. We sent questionnaires to 195 patients with CKD and ASCVD as well as 239 HCPs who treat patients with CKD and ASCVD. The results showed primary care physicians (PCPs) are the main healthcare providers for most patients, but specialists are often involved in managing CKD and ASCVD. PCPs play a crucial role in helping patients understand how other health care conditions can impact their risk for CKD and ASCVD. PCPs can also guide patients on making lifestyle changes to lower their risk of these diseases and can refer patients to specialists, while still providing guidance on management of these conditions.

GRAPHICAL ABSTRACT

KEYWORDS:

• renal insufficiency
• cardiovascular disease
• physicians
• chronic kidney disease
• cross-sectional studies
• atherosclerosis

Acknowledgments

The authors thank Stephanie Burkhead of KJT Group, Inc., Rochester, NY for providing medical writing support, which was funded by Novo Nordisk Inc., Plainsboro, NJ in accordance with Good Publication Practice (GPP 2022) guidelines.

Declaration of financial/other relationships

E Miller serves on the Speakers Bureau and as an Advisory Board member for Eli Lilly, Boehringer-Ingelheim, Novo Nordisk, Abbott, Bayer and Research Abbott. M Cavender reports research support to his institution for studies in which he is the principal investigator from Amgen, Boehringer-Ingelheim, CSL Behring; consulting fees from Amgen, Bayer, Boehringer-Ingelheim, Medtronic, Merck, Novo Nordisk, Zoll. S Mehanna and R Ochsner are employees of, and shareholders in, Novo Nordisk, Inc. At the time of the study, T Namvar was a health economics and outcomes research fellow with Novo Nordisk, Inc. and Rutgers University. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Eden Miller, upon reasonable request.

SUPPLEMENTARY MATERIAL

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00325481.2023.2256209

Additional information

Funding

Novo Nordisk Inc. funded the study and had a role in the study design, data collection, analysis, and interpretation of data, as well as writing support of the manuscript.