TOPLINE:

A study found that a nurse practitioner (NP)-led clinic for chronic kidney disease (CKD) increased use of guideline-directed therapies and improved albuminuria and blood pressure, while maintaining stable kidney function and achieving high patient satisfaction. 

METHODOLOGY:

• Researchers conducted a prospective cohort study at a metropolitan tertiary service in an area with a high prevalence of CKD and diabetes, evaluating 95 patients (median age, 63 years; 45.3% women) who had their first appointment with an NP for early CKD from October 2023 to October 2024.
• Cardiometabolic comorbidity was common, with 82.8% of patients having a history of hypertension, 55.6% having diabetes, and 25.2% having cardiovascular disease. The risk for progression of CKD was moderately increased in 16.8%, high in 50.5%, and very high in 31.5% of patients.
• Patients were seen within 6 weeks of referral over a median of three visits, with a median of 112 days in the service.
• Outcomes were assessed across three domains: changes in the clinical measures of estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (UACR), and blood pressure; the prescription of guideline-concordant medications; and patient satisfaction with care.

TAKEAWAY:

• The median UACR was significantly lower at discharge vs referral (12.4 mg/mmol vs 32.3 mg/mmol; P < .001). No significant change was observed in the median eGFR at referral (58 mL/min/1.73 m²) and discharge (60.5 mL/min/1.73 m²; P = .815).
• Both systolic and diastolic blood pressure were significantly reduced at discharge (mean differences, 10.1 mm Hg and 5.2 mm Hg, respectively; P < .001 for both).
• The proportion of patients on SGLT2 inhibitors increased from 28.4% at referral to 53.6% at discharge (P < .001), whereas the use of mineralocorticoid receptor antagonists increased from 5.2% to 23.1% (P < .001), and the use of GLP-1 receptor agonists among patients with diabetes increased from 9.6% to 23.1% (P < .001). The percentage of patients on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers increased from 76.8% at referral to 88.4% at discharge (P = .017).
• Overall, 51.6% of patients responded to the satisfaction survey, with 100% of them agreeing or strongly agreeing that the care provided was satisfactory, that their understanding of kidney disease improved after seeing the NP for CKD care, and that they were motivated to improve their condition.

IN PRACTICE:

“The CKD nurse practitioner clinic is an effective model of care to increase the number of patients on guideline-directed medical therapies for early CKD and was associated with significant improvements in blood pressure control and albuminuria reduction,” the authors wrote.

“Future research is required to understand the longer-term outcomes and potential cost savings,” they added.

SOURCE:

The study was led by Hannah Wallace, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia. It was published online on March 16, 2026, in Clinical Kidney Journal.

LIMITATIONS:

Patients were not randomly assigned, and the study lacked a control group, limiting the ability to compare outcomes with standard care involving nephrology physicians. The clinical follow-up period concluded at discharge from the service.

DISCLOSURES:

No funding was received for the study. One author reported receiving research funding from Boehringer Ingelheim and Eli Lilly alliance.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.