A pilot point-of-care kidney disease clinic in primary care to pharmacologically optimise people with chronic kidney disease (PROTECT KIDNEY).

Abstract

Chronic kidney disease (CKD) is increasing in prevalence and is associated with substantial morbidity and mortality. Early initiation of cardiorenal protective medications is recommended to improve outcomes. Barriers to implementation include renal function monitoring and resources to initiate and titrate treatment. We aimed to evaluate the feasibility and acceptability of a protocolled point-of-care testing (POCT) pathway to optimise people living with proteinuric CKD in primary care. A pilot quality improvement study conducted across three general practices in Greater London, United Kingdom. Inclusion criteria were adults (18-80 years) with hypertension and/or type 2 diabetes mellitus, proteinuria, and reduced kidney function (eGFR 30-75 ml/min/1.73m2), who were identified using electronic health records. POCT for creatinine and potassium enabled real-time decision-making using a traffic light clinical decision support system. The primary outcome was recruitment rate and patient acceptability. Secondary efficacy outcomes included medication optimisation and renal function changes. Twenty-five (52%) of 48 patients agreed to participate. Overall, 23/25 (92%) completed the pathway and 20/25 (80%) achieved pharmacological optimisation. There were no significant adverse events. POCT was successful in 44/57 (77%) of cases and well tolerated by most participants (10/13; 77%). Patient satisfaction was high (12/13; 92%), with most preferring advanced nurse practitioners or pharmacists in future clinics. A POCT-led CKD optimisation pathway is feasible and well-accepted in primary care. While high medication optimisation rates were achieved, barriers to recruitment and engagement remain. Future studies should evaluate scalability, long-term clinical impact, and cost-effectiveness to inform wider implementation.