Impact of CAMP in an Ambulatory Renal Clinic

Chronic kidney disease (CKD) is a serious condition associated with premature mortality,
decrease quality of life, and increase health-care costs. An estimated 19 million Americans
(1 in 9 US adults) have non-dialysis dependent CKD (Stages 1-4).1 The health care
expenditures for caring for patients with CKD are substantial. According to Centers for
Medicare and Medicaid Services (CMS), the estimated annual health cost per patient for
managing patients with CKD is markedly higher ($28,000) compared to the costs for caring for
diabetic patients ($10,000 per patient) and heart failure patients ($5000 per patient). 2
According to the National Kidney Foundation, as renal function declines, the number of renal
complications, notably high blood pressure, anemia, malnutrition, and mineral and bone
disorders, increases along with the severity. A large proportion of patients with CKD also
develop multiple co-morbidities, particularly hypertension, diabetes, and hyperlipidemia.
Fortunately, accumulating evidence indicates that treatment of earlier stages of chronic
kidney disease can prevent the development of kidney failure (Stage 5)3. In addition, early
prevention of cardiovascular risk factors in patients with CKD may reduce cardiovascular
events before and after the onset of kidney failure.3 Because many patients, particularly in
the later stages of CKD, have multiple renal complications and chronic co-morbidities, these
patients are potentially at high risk of medication non-adherence and non-persistence
(defined as premature discontinuation of medication therapy). Studies have demonstrated that
patients with chronic diseases typically take only 50% of prescribed doses of medication,
leading to increased disease severity, clinic visits, and hospital admissions, resulting in
substantial healthcare expenditures.4,5 In the United States alone, the cost of illness, due
to non-adherence was estimated to be $170 billion per year.6 In addition, the associated
total cost of treating the complications resulting from poor adherence in dialysis and
transplant patients exceeds $950 million.7 Potential barriers to medication adherence for
patients with chronic diseases include, but are not limited to, complex medication regimens,
multiple drug doses, treatment of asymptomatic conditions, and cognitive factors. Although
not well-studied in pre-dialysis patients, limited data suggests that important causes of
medication non-adherence in chronic dialysis patients include inadequate prescription
coverage or high medication costs, lack of transportation, and adverse effects. 8

Inclusion Criteria:

Patients will be eligible for enrollment if they are > 18 year old men or women receiving
care from the VAMCSF Renal Clinic with a documented diagnosis of CKD stage 2-5, and are
receiving pharmacological treatment for one or more medical conditions of CKD, including
hypertension, diabetes, CKD-mineral and bone disorders, and/or anemia of chronic disease.

Exclusion Criteria:

Patients will be excluded from the study if they obtain medications prescribed for the
above medical conditions from a facility outside the VAMCSF, are enrolled in Medi-Set
clinic, are kidney transplant patients, are diagnosed with CKD stage 1, require assistance
in the administration of their medications (i.e. caregiver), lack adequate transportation
to clinic, and/or lack telephone access.