Comanagement of Diabetic Kidney Disease by the Primary Care Provider and Nephrologist

Diabetic kidney disease (DKD) is a common disorder, and few patients achieve current therapeutic targets. Careful collaboration between all health care providers and the creation of disorder-specific health care systems seem to offer the best opportunity for improving the management and clinical outcomes of these patients. This article explores the barriers to effective collaboration between physicians in the management of patients with DKD, attitudes and perceptions of physicians toward collaborative management, and the physiologic challenges in patients with DKD that would warrant specialist involvement in their care. A model for collaborative DKD care delivery is also proposed.