title: Improving treatment for patients with chronic kidney disease.
abstract: OBJECTIVE
  Kidneys in a Box (KIB) was developed to identify the effect of a performance improvement CME (PI-CME) project on the management of patients with diabetes who are at risk for chronic kidney disease (CKD). The program provided nonnephrology practitioners with research-based interventions known to slow CKD progression.
  
  
  METHODS
  PAs were given the KIB tool kit, which described the scope of CKD identified high-risk diagnoses such as diabetes, and listed six modifiable risk factors that have been shown to slow progression of diabetic kidney disease when implemented. The PAs self-selected the factor(s) and evaluated 10 charts of patients diagnosed with diabetes before implementing the modifications. After implementing changes for a minimum of 12 weeks, the PAs again self-selected 10 different charts and evaluated the extent of the intervention application. A preintervention/postintervention assessment and demographic sheet were then submitted to the American Academy of Nephrology PAs for CME credit.
  
  
  RESULTS
  302 PAs completed the program in the first 24 months, with full data available for 213 PAs. Statistically significant improvement was shown in five of the six areas: CKD staging, urine albumin-creatinine ratio (UACR), statin use, over-the-counter (OTC) yellow alert medications, and A1C. Improvement in smoking cessation interventions did not reach statistical significance.
  
  
  CONCLUSIONS
  Known interventions to slow progression of diabetic kidney disease can be effective if implemented in early stages of the disease. KIB demonstrates that education focused on the nonnephrology PA can be effective in slowing CKD progression.
authors.affiliation: Kendra Thomsen practices hospital medicine at Baylor Scott and White Medical Center in Temple, Tex. Kim Zuber is executive secretary of the American Academy of Nephrology PAs in Oceanside, Calif. Jane Davis is a nurse practitioner in the Nephrology Division of the Department of Medicine at the University of Alabama at Birmingham. Greg Thomas is director of external relations at the National Commission on Certification of Physician Assistants in Johns Creek, Ga. The authors have disclosed no potential conflicts of interest, financial or otherwise.
authors.forename: Kendra
authors.initials: K
authors.lastname: Thomsen
authors.forename: Kim
authors.initials: K
authors.lastname: Zuber
authors.forename: Jane
authors.initials: J
authors.lastname: Davis
authors.forename: Greg
authors.initials: G
authors.lastname: Thomas
mesh_terms: D002908:Chronic Disease; D003928:Diabetic Nephropathies; D018450:Disease Progression; D006801:Humans; D007668:Kidney; D009398:Nephrology; D010823:Physician Assistants; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012307:Risk Factors