“A patient’s CKM stage can help clinicians decide how actively to look for kidney disease and how quickly to act,” Amir Abdi Pour, MD, chief of internal medicine-nephrology at Loma Linda University Health and a co-author of the study, told Pharmacy Times. “It should prompt risk-based care, rather than serve as a treatment decision on its own.”
Once patients reach stage 2, Abdi Pour said, clinicians should check both estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). “These tests should be used together because kidney risk may be evident through albuminuria even when eGFR is preserved,” he said.
Primary Care Clinicians Weigh the Framework
In the second study, researchers at the University of Virginia School of Medicine interviewed 9 primary care clinicians who spent at least half their time in ambulatory adult care. Participants watched a brief video on CKM before semistructured interviews, and the team sorted the resulting themes into strengths, weaknesses, opportunities, and threats.2
Every participant identified at least 1 strength of CKM, including its intuitive structure, simplicity, and preventive focus. Participants said that, if implemented strategically, the framework could support early CKD recognition and management and help standardize care; however, they also cited a perceived lack of evidence and uncertain value beyond existing care models, and they pointed to structural barriers, administrative burdens, and impracticality as threats to adoption.2
The investigators concluded that the framework will need a strong evidence base and must address workflow, social, and administrative barriers to be widely adopted.2
Implications for Pharmacists
ASN’s guidance identifies renin-angiotensin system inhibitors and sodium-glucose cotransporter 2 inhibitors as foundational therapies in CKD, with glucagon-like peptide-1–based therapies and nonsteroidal mineralocorticoid receptor antagonists added according to an individual patient’s cardiovascular and metabolic risk profile. It warns against therapeutic inertia and recommends integrating the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equation with kidney outcome predictors in routine counseling.4
“Pharmacists can help translate the AHA’s CKM framework into routine care by making kidney risk harder to overlook,” Abdi Pour said. During medication reviews or visits for diabetes, hypertension, obesity, or cardiovascular disease, he said, pharmacists can flag patients who may need kidney assessment and prompt the care team to obtain eGFR and UACR.
Once results are available, pharmacists can help identify patients who may benefit from kidney-protective treatment, review medication choice and dosing for kidney function, identify potentially harmful or interacting medicines, and support adherence and follow-up, Abdi Pour explained. Both Kidney Week findings come from conference abstracts, and the qualitative study’s sample was small.
