Nephrology - Chronic Kidney Disease

Chronic Kidney Disease Clinic

The Chronic Kidney Disease Clinic provides comprehensive medical care using a team approach for each patient, with a nephrologist, certified nurse practitioners, nursing staff, chronic kidney disease (CKD) educators, and a renal dietitian. More than 500 patients have been enrolled in the clinic. The Chronic Kidney Disease Clinic has several primary goals:

  • To delay the progression of CKD with the aim of easing the burden of end-stage renal disease (ESRD)
  • To reduce CKD morbidity and mortality through intensive cardiovascular risk management
  • To optimize transition to renal replacement therapies, such as dialysis and kidney transplantation

Patients treated by the Chronic Kidney Disease Clinic are referred from Cleveland Clinic and non-Cleveland Clinic physicians for CKD evaluation and management. Patients’ electronic medical records are included in the CKD registry database, which provides fertile ground for identifying appropriate candidates for enrollment in clinical research projects. Patients included in the CKD registry have had at least 1 face-to-face outpatient encounter with a Cleveland Clinic health system healthcare provider and have had (1) 2 estimated glomerular filtration rates (eGFRs) of < 60 mL/min/1.73 m² more than 90 days apart as of June 1, 2005, and/or (2) ICD-9 code diagnoses for kidney disease. The demographics and comorbidities of the more than 100,000 patients included in the registry are summarized in the following table.

Characteristics of Chronic Kidney Disease Registry Patients Stratified by Disease Stage on Date of CKD Confirmation

2005 — 2017

Characteristic Stage 3ᵃ (N = 110,867) Stage 4ᵃ (N = 8600) Stage 5ᵃ (N = 2812) ICD-9 Code Diagnosis Only (N = 20,684) Total (N = 142,963)
Age, mean ± SD 71.7 ± 11.6 72.2 ± 13.9 61.7 ± 15.2 64.7 ± 15.8 70.5 ± 12.8
Years in registry, mean ± SD 4.2 ± 3.6 3.4 ± 3.3 2.7 ± 2.9 1.8 ± 2.4 3.7 ± 3.5
Gender, N (%)
Female 60,751 (54.80) 4666 (54.26) 1262 (44.88) 8428 (40.75) 75,107 (52.54)
Male 50,116 (45.20) 3934 (45.74) 1550 (55.12) 12,256 (59.25) 67,856 (47.46)
Ethnic group, N (%)
Missing 0 (0) 0 (0) 0 (0) 1237 (5.98) 1237 (0.87)
White 97,054 (87.54) 7045 (81.93) 1833 (65.18) 13,172 (63.68) 119,105 (83.31)
Black 12,380 (11.17) 1439 (16.73) 889 (31.61) 5705 (27.58) 20,413 (14.28)
Asian 541 (0.49) 38 (0.44) 20 (0.71) 173 (0.84) 772 (0.54)
Other 892 (0.80) 77 (0.90) 70 (2.49) 397 (1.92) 1436 (1.00)
Comorbidities at inclusion, N (%)
Diabetes mellitus 26,793 (24.17) 2654 (30.86) 995 (35.38) 9433 (45.61) 39,875 (27.89)
Hypertension 96,762 (87.28) 7144 (83.07) 2424 (86.20) 16,960 (82.00) 123,290 (86.24)
Coronary artery disease 23,801 (21.47) 2123 (24.69) 523 (18.60) 4895 (23.67) 31,342 (21.92)
Congestive heart failure 10,202 (9.20) 1403 (16.31) 351 (12.48) 3028 (14.64) 14,984 (10.48)
Hyperlipidemia 87,408 (78.84) 6343 (73.76) 1875 (66.68) 14,759 (71.35) 110,385 (77.21)
Cerebrovascular disease 10,791 (9.73) 932 (10.84) 208 (7.40) 1908 (9.22) 13,839 (9.68)

ᵃCKD stage at confirmatory eGFR using the Chronic Kidney Disease Epidemiology Collaboration equation.