Ontario Renal Network | Reseau Renal de L'Ontario

Referral Guidance: KidneyWise Clinical Toolkit

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The KidneyWise Clinical Toolkit provides guidance to primary care providers on which patients are at high risk of developing chronic kidney disease (CKD) and recommendations on how to properly diagnose and best manage the patient to reduce the risk for further disease progression.

The KidneyWise Clinical Toolkit includes:

  • An evidence-based Clinical Algorithm that helps with identification, detection, and management of patients with CKD and guidance on which patients may benefit from referral to a nephrologist.
  • An Evidence Summary that offers further clinical detail regarding the algorithm content, including references to clinical guidelines that were used in the development of the toolkit.
  • A Standardized Outpatient Nephrology Referral Form that provides referral guidance by outlining clinical scenarios that would require consultation with the appropriate investigations that should accompany the referral.

About the KidneyWise Toolkit:

In 2012, a needs assessment was conducted with 340 primary care providers in Ontario to better understand their educational needs relating to CKD. The survey identified an overwhelming majority of the respondents were interested in improving their CKD knowledge. When asked about methods to improve their CKD knowledge, access to reference tools/decision aids based on clinical practice guidelines and evidence ranked first in most helpful. In response, the ORN created the KidneyWise Clinical Toolkit.

Production of the Clinical Algorithm commenced in mid-2013, and was adapted from a publication on a study that looked at nephrology referral patterns at The Ottawa Hospital (Akbari et al., 2012). A literature review of the following guidelines was completed and referenced in the development of the KidneyWise Clinical Toolkit:

  • Kidney Disease Improving Global Outcomes CKD Guidelines 2012,
  • Canadian Hypertension Education Program Guidelines 2014,
  • Canadian Cardiovascular Society Dyslipidemia Guidelines 2012, and
  • Canadian Diabetes Association Clinical Practice Guidelines 2013.

Based on the aforementioned guidelines and soliciting feedback from nephrologists and PCPs, additional content was added to the Clinical Algorithm using an iterative process. Production of the Standardized Outpatient Nephrology Referral Form began in 2014 and underwent a similar process as the Clinical Algorithm. The Toolkit has been vetted and endorsed by nephrology and primary care leaders within Ontario and across Canada.

The development process was led by the following ORN Medical Leadership:

Dr. Allan Grill, MD, CCFP, MPH
Provincial Primary Care Lead, ORN

Dr. Allan Grill is an Assistant Professor in the Department of Family & Community Medicine at the University of Toronto and is the Lead Physician at the Markham Family Health Team. He enjoys an active community-based clinical practice and has a staff appointment at Markham Stouffville Hospital. Dr. Grill also teaches medical students and family medicine residents at Sunnybrook Health Sciences Centre where he is a part-time physician in the Division of Long-Term care. In November 2012, Dr. Grill became the Provincial Primary Care Lead for the Ontario Renal Network. His team focuses on innovative ways to improve Early Detection and Prevention of Progression of Chronic Kidney Disease in the primary care setting.

Dr. Scott Brimble, MD, MSc, FRCPC
Provincial Lead of Early Detection & Prevention of Progression, ORN

Dr. Scott Brimble received an MSc. from Brock University and his MD at the University of Toronto. Residency training was completed at McMaster University. He is currently an Associate Professor of Medicine at McMaster University and a staff nephrologist at St. Joseph’s Healthcare. He is also currently the Divisional Director of Nephrology in the Department of Medicine at McMaster University. His clinical interests focus on the management of patients with chronic kidney disease, hypertension and peritoneal dialysis. He is the Provincial Lead for Early Detection and Prevention of Progression at the Ontario Renal Network (ORN). He currently holds peer-reviewed grants and is involved in a number of clinical research projects.

Send us your feedback or questions

If you have questions or feedback about the KidneyWise Toolkit, please e-mail us at kidneywise@renalnetwork.on.ca.