Date of Award

Spring 4-30-2023

Document Type


Degree Name

Doctor of Nursing Practice (DNP)




Dr. Kirk Hummer, DNP, MBA, RN, APRN, CNP

First Committee Member

Dr. Kirk Hummer, DNP, MBA, RN, APRN, CNP

Second Committee Member

Dr. Chai Sribanditmongkol PhD, RN, IBCLC, CNS

Third Committee Member

Joy Shoemaker DNP, APRN, FNP-BC, CNE


Nephrology, End Stage Renal Disease, Chronic Kidney Disease, Referrals

Subject Categories

Medicine and Health Sciences


End-stage renal disease may greatly affect a patient’s overall health and outcomes. This project aimed to look at early versus late nephrology referrals. A retrospective chart review of patient’s demographic and health outcome data was reviewed through a patient’s electronic health record. The patient data from the chart review, along with the evidence obtained from the review of the literature has been utilized to describe findings and develop evidence-based practice-guided recommendations for nephrology referrals in clinical practice. This project has been completed at a dialysis center in rural Ohio. The patient population included around 60 patients who had dialysis at the clinic within the past year. Excluding patients with a genetic or an acute kidney disease. This project has taken place from August 2022 to March 2023. The model of the project was a retrospective quantitative chart review. The patient’s charts were reviewed looking for demographic information, stage of chronic kidney disease at initial contact with a nephrologist and lab values. Information was then collected on time to start dialysis, fistula placement, lab values including, potassium, phosphorous, hemoglobin, blood urea nitrogen, mortality, and hypertensive control. The information was organized in a data collection sheet. The information was then organized into an excel spreadsheet which was password protected to keep information private. Barriers to this project included missing medical history from electronic health records (EHR), patient compliance with treatment plans and available patient population. The data collected showed a clear correlation between earlier nephrology referrals and improved patient outcomes. Improved outcomes included blood pressure control, decrease in potassium levels, decrease in time prior to having to start HD. Given the evidence presented patients should be referred to a nephrologist when a patient is approaching a stage 3a. Providers should be referring patients earlier prior to a significant decrease in kidney function. This project will improve clinical practice, health, and the life expectancy of patients with ESRD.

Acknowledgement 1


Acknowledgement 2


Licensing Permission

Copyright, all rights reserved. Fair Use

CKD_Brown_Poster.pdf (522 kB)



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