I think that there's a discomfort with kidney disease that sort of extends to all health care professionals. 

What we need to do is help clinicians – whether dietitians, pharmacists, or nurses, or physicians – to feel more comfortable.

One of the most important things that we can do is to address kidney disease in the primary care setting. The opportunity to make a difference occurs way before most patients with chronic kidney disease get referred to a nephrologist.

For a health care provider to tell someone they have kidney disease is a difficult thing to do. And in time-constrained visits, it can be hard to fit in. And if the creatinine is a little bit elevated or the GFR is a little bit down and you're at minute 8 of a 10- or 12-minute visit, you may choose strategically to focus on something else and defer talking to the patient about their asymptomatic kidney disease until next time, and it often keeps getting deferred.

It's important for physicians to remember that a lot of the things that we recommend that they do, or that be done for patients with chronic disease, don't have to be done by the physician.

Kidney disease is probably one of the best examples where the whole team-based approach really works, but for that to work, you have to have a team.

You know, patient education is very time consuming, and if you do have a team, the physician member may not be the best patient educator. It might be the nurse. Pharmacists and dietitians get a lot more training in how to talk to patients than many physicians do in medical school, and may be more effective communicators, but also may be less intimidating to the patient. 

So how do we make things better in a pragmatic way? I think most of the things that are evidence-based, most of the interventions that are evidence-based, are widely understood by most clinicians. What's left out is actually educating the patient and giving them the knowledge that they can manage their kidney disease along with their other health problems, including diabetes. 

What we've tried to do is to create some materials that make it easy to convey to the patients that they have kidney disease, what their laboratory tests mean, and what they can do about it. And we've included ways of doing that, which might extend a visit by 90 seconds, but not by 30 minutes. 

On the one hand, be straightforward with them, and on the other hand, be reassuring. And if possible, try to deliver information in small digestible doses. It means seeing patients more often or arranging for them to see one of other people you're associated with – a nurse or a dietitian. I think that it's important to remember that you don't have to do it all yourself. 

[Find resources by searching Kidney Disease at niddk.nih.gov]