A Conservative Care Program for Patients with Chronic Kidney Disease (CKD)

NefroClínicas was created in 2019, bringing a disruptive care model to a market previously exploited by speculative capital, with a fragmented care chain and alarming results.

“Chronic Kidney Disease (CKD) is a condition that results in the gradual loss of kidney function, affecting men and women of different age groups, lifestyles and genetic predispositions. Diabetes, hypertension and smoking increase the risk of developing CKD. In Brazil, in both in public and private sectors – the majority of CKD cases have a late diagnosis, resulting in costly emergency treatments and complications, particularly after the Covid-19 pandemic, with an increase in the complexity of untreated cases. NefroClínicas’ approach highlights the importance of prevention and early treatment of CKD. It emphasizes the need for preventive measures, from clinical monitoring to dialysis and transplant options, understood as the “”Chronic Kidney Disease Care Pathway””.
When entering the Care Pathway, the patient is linked to a reference nephrologist and to a Nurse navigator. Furthermore, assessments by Psychologists, Nutritionists and Physiotherapists are included in the program, at a frequency defined by the stage of CKD or the individual patient needs. A social worker is responsible for processing the patient’s registration process on the national transplant list, so that they are ready to join the Brazilian National Transplantation Program.
Reimbursement is received monthly, per patient included in the care pathway, with a percentage linked to result indicators. In renal replacement therapies, all modalities are charged the same price to avoid deviations in indications. This is the case, for example, of Conventional Hemodialysis and Peritoneal Dialysis, which are charged the same price. Inhospital patients are cared and monitored directly by the team in the hospital where we operate, or navigated remotely, through contact with the reference nephrologist and hospital staff, in those services where we are not present. This is a case with one of the largest health plan operators in the country – with more than 1.5 million beneficiaries, implemented over 4 years ago. This model aims to improve system efficiency, avoiding waste and interrupting a vicious circle of hyper-utilization.
Some indicators measured:

total number of patients undergoing conservative treatment; – progression rate of kidney disease (stages 3B, 4 and 5); – rate of patients on peritoneal dialysis; – rate of patients entering hemodialysis with definitive access; – patient satisfaction index (NPS) and treatment abandonment rate; – hospitalization rate; – transplant rate.
We highlight our Peritoneal Dialysis index, which reaches 74% in relation to other modalities. According to the 2022 census of the Brazilian Society of Nephrology, national rates do not reach 6% of the population under this kind of therapy. Furthermore, we promote public awareness in partnership with medical and civil entities, such as the Kidney Foundation, in education and information actions, as we believe this is a crucial therapeutic tool, empowering patients to take control of their health and implement positive effects on lifestyle habits.”