Optimizing care for patients with CKD.

Care of patients with chronic kidney disease (CKD) is complex and requires a standardized and multidisciplinary approach. A number of strategies have been suggested to improve care for patients with CKD, including the development of clinical practice guidelines and introduction of chronic disease management (CDM) programs. CDM programs represent a proactive approach to care by supporting the physician and patient, with an emphasis on prevention of exacerbations and complications achieved through a coordinated multidisciplinary team. In addition to targeting patients at highest risk, CDM programs also emphasize intensive monitoring and proactive follow-up. The expansion of professional roles may be an important component in ensuring the success of this approach. Although observational studies suggest that specific components of CDM programs may improve care for patients with CKD, further research is needed to evaluate the program component effectiveness in CKD prevention and management. This includes well-conducted randomized trials and long-term follow-up of patients with CKD to assess changes in adverse health outcomes.