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An all hands on deck approach to treating CKD patients


As the number of adults with chronic kidney disease will likely increase, there is a growing need-and opportunity-for physician assistants who can help promote healthy kidney function and help slow disease progression.

I can’t tell you how many times I’ve heard patients say, “No one explained the complications to me,” or “I didn’t feel bad,” as an explanation for why they neglect their health.

That’s what I heard from a male patient in his early 40s who came to me with uncontrolled diabetes, proteinuria, rising creatinine, and noncompliance with blood pressure medications. Fortunately, within three months of being diagnosed with chronic kidney disease (CKD), his condition improved-primarily because I educated him about the disease and provided him the support he needed to comply with his treatment plan.

The patient said no one ensured he understood the disease or its effects on his overall health. It was rewarding to hear that our conversation marked a shift in thinking for his well-being. That level of clarity that we as clinicians can provide as is what keeps manageable CKD cases from escalating to more serious cases.

In the United States, more than 30 million adults have CKD, according to the Centers for Disease Control and Prevention. That’s a number that may soon skyrocket. Kidney function naturally decreases over time, meaning the likelihood of developing CKD increases as we get older. As the U.S. population ages, we will need more providers to manage these patients.

Physicians can expand their reach in this area by working with certified physician assistants (PAs) to promote healthy kidney function and help slow disease progression. As a nephrology PA, here are a few ways I am helping physicians to treat CKD patients in my practice:

I’m focused on treating the whole patient. I manage all aspects of care for three dialysis units twice a week. In the dialysis units, I manage patients with anemia, conduct monthly patient care conferences, and complete annual histories and physicals for 130-150 patients. I am the first contact for any complications or other issues that arise with dialysis patients. I have also established my own panel of CKD patients to manage two additional days a week.

I’m educating patients. I take great care to explain kidney disease in plain language so my patients can easily understand. I may draw pictures or use examples featuring everyday scenarios. It is also imperative to explain how noncompliance with treatment plans will diminish their quality of life and how CKD relates to other comorbidities like hypertension, diabetes, coronary artery disease, congestive heart failure, and hyperlipidemia.

I’m helping physicians prioritize their workload. My schedule accommodates a similar number of patients as my collaborating physicians. This allows physicians to focus on other aspects of their role within the company like inpatient care, administrative responsibilities, and other requirements as medical directors of the dialysis units.

I’m improving access to treatment. In addition to my current patient care duties, I’m helping to establish a permanent CKD clinic at a second location-thus expanding access. My responsibilities include establishing nephrology care for our new consults, most of whom suffer from a variety of acute and chronic illnesses. I also collaborate with patients’ medical teams to manage comorbidities and prepare patients for the transition to dialysis, if needed.

CKD is a common condition among U.S. adults that needs to be tackled by all tiers of medical professionals. Physicians can count on certified PAs to help manage these patients during every stage of the disease.

Alkiesha Collins, DHSc, PA-C, has been a certified PA for 11 years and has worked at Sutter Gould Medical Group in Modesto, Calif., since 2015. Before becoming a PA, Collins worked as a hemodialysis technician for more than seven years. This blog was written in conjunction with the National Commission on Certification of Physician Assistants.

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