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For managed care leaders working on value-based care and risk stratification in chronic kidney disease populations, a poster presented at the National Kidney Foundation 2026 Spring Clinical Meetings in New Orleans offers a useful data point about how often high-risk patients are managed entirely outside the nephrology bench. Researchers from the University of California, San Francisco, and Zuckerberg San Francisco General Hospital, led by Sharlene Shirali with Laura Plantinga, Jennifer Evans, and Delphine Tuot, evaluated 7,364 active primary care patients with documented CKD across the San Francisco Health Network who had not seen a nephrologist in any setting, including telehealth or asynchronous eConsult, for at least 18 months.
The cohort was drawn from a population of 58,402 primary care patients aged 30 to 79. Demographics reflected the safety-net delivery context: 35.3% Hispanic or Latino, 21.5% Black, 21.1% Asian, and 15.4% White. More than half were prescribed an antihypertensive, 39% an ACE inhibitor, and roughly one in five an SGLT-2 inhibitor. Diabetes was present in 50.8% of the cohort, and 76.4% had albuminuria in the A2 or A3 categories.
The investigators applied the American Heart Association PREVENT equation to estimate 10-year atherosclerotic cardiovascular disease risk, and the Kidney Failure Risk Equation to estimate 2-year probability of kidney failure for those with CKD stages 3 through 5. The PREVENT analysis placed 57.4% of the cohort in the intermediate-to-high ASCVD risk bands, with 9.1% at high risk. KFRE results showed 4.2% at intermediate-to-high 2-year kidney failure risk, while 90.5% were at low 2-year risk.
The investigators concluded that the elevated cardiovascular risk profile of this CKD population, including patients with substantial albuminuria, supports proactive engagement by nephrology, with asynchronous eConsult as a viable delivery format. They flagged predictive modeling as the next step to identify patients most likely to benefit, an approach with clear application in value-based contracting, care-management workflows, and population-health programs that aim to slow kidney progression and reduce cardiovascular events in commercially insured and Medicaid CKD members.
