Caring for the Chronic Kidney Disease Patient

Source: CMSA Today


The United States Renal Data System (USRDS, 2018) notes that for every 100 U.S. citizens, 15 will have chronic kidney disease. Of concern is the continuing lack of awareness of this prevalent disease and the significant impact it is having on individuals and our society. Case management professionals have an important role in advocating for this vulnerable population and developing strategies to build effective collaborative pathways across the continuum of care.

We know that the social determinants of health have a major influence on acquiring chronic kidney disease, awareness, treatment options and access to dialysis. A number of social determinants of health affect how individuals make decisions about where to access healthcare. For example, poverty or economic stability may necessitate that a patient access care through a hospital emergency department to manage chronic kidney disease symptoms or seek emergent dialysis.

Management of chronic kidney disease in emergency room settings is not ideal and provides limited continuity and management of care. The patient also may require additional laboratory testing prior to treatment than otherwise would be required in an established outpatient setting. Dialysis provided through the emergency department further exacerbates hospital throughput issues and can result in delayed treatment and access of other emergency room patients.

At this point, case managers need to become quickly involved in determining the barriers in managing the patient’s chronic kidney condition and, if required, outpatient dialysis. This is where previously built community relationships and referral protocols are imperative so that effective transitions of care can occur. Many facilities have developed collaborative agreements and/or relationships with nephrology groups, surgical groups (for AV fistula placement), and outpatient dialysis centers that coordinate care for community members.

Educational attainment continues to be a key social determinant that drives chronic kidney disease outcomes (Green & Cavanaugh, 2015). As professional case managers, how can we simplify our communication and education to individuals and their caregivers? Is our messaging clear across the continuum of care?

There is significant evidence that nutrition is a significant factor in chronic kidney disease outcomes and, frankly, our overall health. Oftentimes, I am struck that the most basic human need is the one that is most forgotten. The United States Department of Agriculture (2017) estimates that 12 out of 100 people are not food secure. It is refreshing to see the involvement of case management professionals in community outreach efforts to connect individuals with resources that can help meet basic needs.

Caring for the chronic kidney disease patient takes collective effort. As professional case managers, we can make a difference in reducing barriers for this vulnerable population. Take time to review this issue’s articles on other ways that you can make a difference.  ■


  • Green & Cavanaugh. (2015). Understanding the influence of educational attainment on kidney health and opportunities for improved care. Advances in Chronic Kidney Disease. 22:1. pp. 24-30.
  • United States Department of Agriculture. (2017). Food security in the U.S. Retrieved from:
  • United States Renal Data System. (2018). 2018 Annual data report highlights. Retrieved from:

Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE, FAAN

President, CMSA


Dr. Alejandro is the director of case management at UC Irvine Health, Orange County’s only Level 1 Trauma and Burn Center.