For nephrology to survive, we need to develop a preventative mindset. As I am in private practice, that is the furthest from actuality and we will need a generation to pass before we see these results. Academia might have a different mindset, but as of now that goal is extremely unrealistic.

Plateauing for now; much of that is also a repercussion of COVID. Give it 5yrs and the tables will turn. My stance, ultimately, is that is nephrology will take on a proactive approach, also unrealistic. The PCP's are too over burdened and we do not have enough resources to manage all CKD II patients

CKM needs to include the main driver into the equation and that is chronic dysregulated inflammation, which is also the dominate cause of disease. Furthermore, and equally important, is the issue of sarcopenia that develops in the elderly population. So much literature and yet no meaningful action.

I also have issues with the CKM model. It is, at best, a limited approach to preventative care. Once the "boxes are checked" most providers will claim victory. Unfortunately, they will neglect the larger picture that will continue to progress despite achieving GDT.

I do not disagree entirely. Change, in this country, appears to happen extremely slow and with the increase in the elderly population and therefore CKD population we will need nephrologists and especially APP more than ever.