Chronic Kidney Disease

Do I Need A Primary Care Doctor To Work With My Kidney Specialist?

If you are experiencing issues related to kidney disease, you should be working with a specialist who knows your problems and deals directly with your particular needs. While that doctor is key to your health regarding your kidneys, that doesn’t mean that he or she should be your only medical practitioner. Nor should your primary doctor be the person who is solely in charge of your renal disease issues.

Too often, kidneys are overlooked in general practice. Issues can be mistaken or ignored. Too often, patients and their primary care providers can be unaware of renal problems. By failing to understand or recognize underlying kidney issues, a patient can be in stage 3 chronic kidney disease, which can quickly dwindle to stage 4 before it is caught and dealt with. In general practice, kidneys are often ignored not because of negligence but because of a lack of understanding and communication with a kidney health specialist.

 

How a Primary Care Doctor Creates a Path with Nephrologists?

Communication must be set up between the primary care doctor and the nephrologist. A nephrologist doctor specializes in the diseases and conditions that affect the kidneys. Their job is to understand and treat chronic kidney disease, kidney infections, and, ultimately, kidney failure. The hope is to catch such ailments long before reaching the situation of kidney failure and the need for dialysis. When the primary care doctor works hand in hand with the nephrologist, the patient may be able to see a far better outcome regarding his or her kidney and overall health.

There is a shortage of nephrologists in the field, and thus having a primary care doctor who is savvy and better educated about the signs of renal issues, can help catch issues before they escalate. This is not an uncommon concept. Primary care doctors have become adept at diagnosing other diseases such as cancer, diabetes, and heart disease. Collaborative care is the best hope for patients who need both the input of a specialist and the care of a primary physician who often knows the person’s medical history more intimately. Working together is the key to health success.

 

What is the best way to merge the care of a general practitioner and a kidney specialist when facing renal health issues?

The goal of any doctor is to create the best possible quality of life for his or her patients. Whether a specialist or a primary care doctor, information is the most critical factor. It is often difficult for doctors who are not working in the same practice to communicate effectively. However, we need to have these severe and intricate problem-solving conversations. The sooner a nephrologist is involved in the care of the patient-facing kidney disease, the better the chance for less stressful long-term outcomes. It will often fall upon the primary care doctor to help the patient make difficult lifestyle changes, including changes in eating habits and diet, stress management, exercise regimens, and even sleep habits. These doctors are often tasked to offer a form of psychological counseling about these difficult changes. The cross-over benefits for patients’ other diagnoses are well known.

In return, the family physician understands the importance of the guidance and planning the consulting nephrologist brings to the table as the expert on this pathology. They need to agree on the things that are of utmost importance for patients in both their care and help the patients they are working with, collaborating to succeed in making those necessary life changes. Together, they can motivate the patient to reach the best possible health outcome.

When a medical practice includes both primary physicians and nephrologists in the same environment, collaboration is far easier to achieve. Time may be of the essence with many patients. Having doctors who work well together and communicate easily is the best-case scenario when dealing with patients facing arduous treatments for kidney disease (CKD). This kind of communication between PCPs and specialists has proven track records of improved clinical outcomes when dealing with chronic illnesses. Too often, this collaboration doesn’t happen, so when it is part of the practice, the patient benefits exponentially.

PRINE Health has physical offices in the Manhasset and Hicksville, New York area that include both primary care doctors and nephrologists. They also offer telemedicine. If you’re seeking a nephrologist and primary care collaborative team, the professionals at PRINE Health would love to speak with you and assist you in your health success.

What Does A Nephrologist Do? And Why You May Need One.

A nephrologist is a physician who specializes in the field of nephrology.

 

Nephrology

Nephrology is a specialty of internal medicine that focuses on the management and treatment of kidney disease or kidney disorders.

The kidneys have several vital functions, including:

  • removing waste and excess fluid from the blood
  • maintaining your body’s electrolyte balance
  • releasing hormones with functions such as managing blood pressure

 

Nephrologist

Primary care physicians often work to help prevent the early stages of kidney disease. As the situation progresses, a primary care physician may refer you to a kidney specialist, or the nephrologist.

A Nephrologist has completed a 3-year residency in Internal Medicine and a specialty fellowship in nephrology that is typically at least 2 years. Some nephrologists have sub-specializations in areas of nephrology such as hypertension (high blood pressure), transplant, glomerular disorders (protein or blood in urine), or critical care medicine.

 

What Conditions Does A Nephrologist Treat?

  • protein or blood in the urine
  • chronic kidney disease
  • kidney stones
  • kidney infections
  • kidney swelling due to glomerulonephritis or interstitial nephritis
  • kidney cancer
  • polycystic kidney disease
  • renal artery stenosis
  • nephrotic syndrome
  • end-stage kidney disease
  • kidney failure, both acute and chronic

A nephrologist may also be involved in the management of the following common conditions:

  • high blood pressure
  • diabetes
  • heart disease
  • peripheral vascular disease

 

Types Of Tests A Nephrologist My Order

Blood tests

  • Serum creatinine. Creatinine is a waste product and is present at higher levels in the blood of people with kidney dysfunction. This is the single best routine blood test to screen for kidney problems.
  • Blood urea nitrogen (BUN). This is also a waste product related to a protein that is found in the blood and a sign of kidney dysfunction.
  • Glomerular filtration rate (GFR) – This test measures how well your kidneys are filtering your blood. GFR begins to decrease below normal levels in kidney disease.
  • Estimated Glomerular filtration rate (eGFR) – This is a test that uses other laboratory data to approximate the glomerular filtration rate. The eGFR relates to the severity of kidney dysfunction which is broken into Stages from Stage 1 to Stage 5.
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5
eGFR in the normal range (greater than 90) with other signs of kidney damage, like protein in the urine or physical damage to the kidneys eGFR in the normal range (60-89) with other signs of kidney damage, like protein in the urine or physical damage to the kidneys eGFR 30-59, moderate kidney damage eGFR 15-29, severe kidney damage eGFR less than 15, the kidneys are close to failure or have already failed

Urine tests

  • Urinalysis. A simple urine test can help to reveal the presence of abnormal amounts of blood, glucose, or protein, or whether there may be an infection.
  • Albumin/creatinine ratio (ACR). This measures the amount of the protein, albumin in your urine. Albumin in the urine may be a sign of kidney dysfunction.
  • 24-hour urine collection for Creatinine Clearance. This method uses a special container to collect all of the urine that you produce during a 24-hour period to calculate the amount of creatinine that is cleared. This may provide a more accurate assessment of kidney function compared with the eGFR.

 

Procedures

In addition to reviewing and interpreting laboratory tests, a nephrologist may also perform or work with other specialists on the following procedures:

  • imaging tests of the kidneys, such as ultrasound (Renal Sonogram)
  • dialysis, including placement of the dialysis catheter or creation of a Fistula or Graft for dialysis use
  • kidney biopsies
  • kidney transplants

 

What Is The Difference Between Nephrologists And Urologists?

The fields of nephrology and urology share some overlap because they can both involve the kidneys. Nephrologists are the medical specialists of the kidney whereas Urologists are surgical specialists of the kidneys.  A Urologist also focuses on diseases and conditions that can affect the male and female urinary tracts such as the ureters, bladder, and urethra. A urologist also works with the male reproductive organs, such as the penis, testes, and prostate.

 

When To See A Nephrologist

Kidney disease is very common. About 1 in 7 Americans have kidney disease and it is estimated that 33% of the population is at risk. The risk factors for chronic kidney disease are:

  • diabetes
  • High blood pressure (hypertension)
  • heart disease
  • obesity
  • a family history of kidney problems

Early stages of kidney disorders may not have any symptoms or may have nonspecific symptoms such as fatigue, sleep problems, and changes in urination. Regular testing can monitor your kidney function, particularly if you’re at risk for kidney disease. An abnormality in one of the tests above would often lead to a referral to a nephrologist. You may also seek the attention of a nephrologist if you have:

  • protein in your urine
  • recurring kidney stones
  • high blood pressure that’s more challenging to control
  • swelling in your legs
  • a rare or inherited cause of kidney disease

 

Conclusion

A nephrologist is a type of doctor who specializes in diseases and conditions that affect the kidneys. Nephrologists work to treat conditions such as chronic kidney disease and help delay the progression of kidney disease to end-stage kidney disease (requiring dialysis or transplant).

PRINE Health is a medical group with several nephrologists along with primary care and other complementary providers. If you need a Nephrologist, we are here to help. Contact us today!

Primary Care Physician During the Early Stages of CKD

Chronic kidney disease, or CKD, is known as the gradual loss of kidney use. The kidneys filter waste and liquids from your blood, which is then discharged into your urine. When CKD becomes more advanced, a dangerous amount of fluids can build up in the body. About 200,000 people a year are diagnosed in the U.S. with this disease. It can be detected through two simple tests, administered by your primary care physician (PCP), which benefits you. What many don’t realize is that your PCP can be a great help in detecting CKD and what the next steps may be for you!

 

Benefits Of Visiting A Primary Care Physician:

Early detection of CKD by your primary care physician calls for immediate action. He will lower your cardiovascular risk and will make an effort to slow the progression of CKD. There are 5 stages of chronic kidney disease. Any condition beyond Stage 3 should be monitored by a nephrologist as well. Some of the benefits of a primary care physician are listed below:

  • Open communication – Patients should be encouraged to discuss any changes in medication, comfort, urine
  • Effective treatment – Although there is no treatment for CKD, your primary care physician can specify the direct cause of your individualized CKD condition and provide treatment.
  • Stabilization of metabolism – Unfortunately, CKD affects more than just the kidneys and renal function. Your primary care physician can address and regulate any abnormalities in your metabolism.
  • Holistic approach – Your primary care physician will already be familiar with any other factors that could be affecting CKD. With a holistic approach, the medical group in Manhasset will form the best plan for you.

 

How Can A Primary Care Physician Help CKD?

During the early stages of CKD, it is crucial to work with your primary care physician to manage the disease. It has been found that co-management of this particular disease can help provide the highest-quality and safest treatment. With initial interference and a complete, integrative physician team approach, your primary care physician can help stay on top of the following:

  •  The stabilization of renal functions (this includes blood pressure and diabetes control as well)
  • Reducing risk factors like hypertension and hyperlipidemia
  • Preventing Vitamin D levels from dropping
  • Lowering Lipids
  • Smoking Cessation

Your PCP can also guide you through the testing procedure once you have been diagnosed. These tests can help determine how well your kidneys are actually functioning as well as which treatment will be best for you. These tests may include:

  • Calculating your Glomerular Filtration Rate (GFR) – This test is specifically used to show how much kidney function you have.
  • Perform an Ultrasound or CT Scan – Both tests are used to show the size of your kidneys, whether they are too small or too large, as well as a full picture of your kidneys and urinary tract.
  • Perform a Kidney Biopsy – This can show any type of kidney disease and any damage that has occurred.

 

Why You Should Visit Our Offices On Long Island:

Although there is no cure for chronic kidney disease, visiting a primary care physician early enough will help treat and lessen your symptoms, as well as slow the progression of this disease. At PRINE Health, we understand that chronic kidney disease is largely overlooked. This is why we have created a medical group consisting of both nephrologists and primary care physicians, to help treat the millions of Americans affected. Contact us today to receive the treatment plan perfect for you!

The Importance Of Kidney Care For Diabetics

If you have diabetes, taking care of your kidneys should be a top priority. Your kidney’s main function is to filter out and remove any waste and extra water from your blood. Diabetes is the most common cause of both kidney disease and kidney failure, due to the fact diabetes can lead to your kidneys no longer functioning. Speak with a professional at a medical group in Nassau County if you are concerned with how your diabetes could affect your kidneys. At PRINE Health we can provide you with the proper care and information to help you take care of as well as protect your kidneys.

 

How Diabetes Damages Your Kidneys:

Diabetes is characterized by high blood sugar, which means the kidneys have to work even harder to filter out the waste in your blood.  Your kidneys are overworked and damaged protein starts to leak into your urine. Soon after your blood pressure rises, waste builds up in the blood, and kidney function will continue to decrease until you reach kidney failure.  If there is no treatment before the kidneys reach kidney failure, a kidney transplant or regular dialysis will be needed to filter out your blood.

 

Symptoms of Kidney Disease:

Various signs point to kidney disease.  Here are some things to look for if you think you could have kidney damage:

  • High blood pressure
  • Blood test shows a poor estimated glomerular filtration rate (eGFR)
  • Urine tests show high protein levels
  • Urinating more often than normal
  • Swollen ankles
  • Weight gain
  • Decrease in appetite
  • Feeling weak

 

Ways to Treat Kidney Disease:

If you have diabetes and kidney damage, there are a few ways a medical group in Nassau County may suggest to help you treat your kidney damage or slow down its progression.  Here are some of those ways:

  • Lifestyle changes – Regular exercise and healthy eating habits can help manage your cholesterol, blood glucose, and blood pressure and help your kidneys not have to work too hard.  Lifestyle changes including eating less protein, salt, or fat, limiting alcohol consumption, and quitting smoking are also recommended.
  • Medication – Limiting the consumption of painkillers can help slow down kidney damage.  If you have diabetes your doctor might prescribe ACE Inhibitors or angiotensin receptor blockers to also help slow kidney damage and manage blood pressure.
  • Regular monitoring – Check your blood glucose often to keep your diabetes in check and also check your blood pressure often to make sure it isn’t too high.

 

How a medical group in Nassau County Can Help You:

If you are diabetic and need guidance on taking care of your kidneys, consider visiting a medical group in Nassau County.  At PRINE Health, there are plenty of experienced doctors who can answer questions, keep you informed, and help you take care of your kidneys to ensure that you are in the best health possible. Contact us for more information on how we can help you.

PRINE Health Nephrology Group Expands Further Beyond The Kidney

Garden City, NY: Today, PRINE Health Nephrology expands its practice, with plans to launch two new divisions, PRINE Vascular and PRINE Podiatry. In September, PRINE is set to open a full-service Vascular Lab at Parker Jewish Institute in New Hyde Park, NY.  PRINE Health cares for a large kidney patient population, but the vascular initiative will not be limited to dialysis access. Due to the high incidence of peripheral vascular disease in this population, there will be an emphasis on PVD, wound care, and cutting-edge, interventional procedures. The new Chief of PRINE Vascular is Dr. Daniel Simon, a highly skilled Interventional Radiologist who was a past Co-Chief of Interventional Radiology at Northwell’s North Shore University Hospital in Manhasset. PRINE has also signed Dr. Robyn Joseph, a prominent local podiatrist, to become the Chief of PRINE Podiatry for this complementary division which is planned to go live in October.

PRINE Health is led by the former CEO of Beacon Health Partners, Dr. Simon Prince, a nephrologist with experience in population health and provider networks.  Dr. Prince said, “We are just getting going. Everyone at PRINE is excited about our new vascular and podiatry initiatives, as well as our potential to innovate and elevate the care we deliver to this often overlooked vulnerable patient population.”

 

ABOUT PRINE HEALTH

 

PRINE Health, with its tagline, Primary Nephrology is a unique, multispecialty medical group focused on chronic kidney disease. PRINE launched last year with the merger of 6 independent nephrology groups to become the largest independent nephrology group in New York. In addition to the nephrologists, interventional radiologists, and podiatrists, PRINE has brought in seasoned primary care physicians and is involved in multiple ongoing conversations with other complementary specialties. There are currently 9 office locations and 18 dialysis center affiliations in Long Island and Queens.

PRINE also has a management company (MSO) that is owned and governed by physicians. The MSO provides traditional practice management and population health services to the medical group. Over the last several months, PRINE has developed care management capabilities and several strategic relationships. PRINE has partnered with managed care payors and was recently selected by CMS to participate in a new value-based kidney care program, Kidney Care First in 2021.  Additionally, PRINE has partnered with the data scientists at pulse data to use predictive analytics and artificial intelligence on their growing patient population as efforts are being made to get ready to take risks in this complex, costly CKD/ESRD population.

To find out more about PRINE, visit www.prinehealth.com.

PRINE Podiatry Coming Soon

People with chronic kidney disease have a high incidence of peripheral vascular disease. PRINE is looking to expand our offerings and provide more comprehensive care. To compliment our upcoming Vascular Division we are happy to announce that we are launching PRINE Podiatry this Fall.

Do You Know That 1 In 3 CKD Patients May Have Peripheral Vascular Disease?

Peripheral vascular disease (PVD) also known as peripheral arterial disease (PAD) is a slow and progressive disorder characterized by a narrowing, blockage, or spasms in blood vessels in the body. While PVD may affect any blood vessel outside of the heart, the distal extremities (legs and feet) are most commonly affected.

Population data from the National Health and Nutrition Examination Survey (NHANES 1999-2000) reported that 24% of persons with CKD stage 3 or greater (creatinine clearance of <60 mL/min) had peripheral arterial disease as objectively defined by an ankle-brachial index (ABI) <0.9. The use of the ABI as the key diagnostic criteria significantly increased prevalence rates to nearly 35%, especially in more advanced chronic kidney disease.

 

HOW IS PERIPHERAL VASCULAR DISEASE DIAGNOSED?

  • Ankle-brachial index (ABI). An ABI is a comparison of the blood pressure in the ankle with the blood pressure in the arm. To calculate the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm.
  • Doppler ultrasound. This uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Your doctor may use the Doppler technique to measure and assess the flow of blood. Faintness or absence of sound may mean blood flow is blocked.
  • Angiogram. This is an X-ray of the arteries and veins to detect blockage or narrowing. This procedure involves inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the X-ray.

 

WHAT ARE THE COMPLICATIONS OF PERIPHERAL ARTERIAL DISEASE?

  • Amputation (loss of a limb)
  • Poor wound healing
  • Restricted mobility due to pain or discomfort
  • Severe pain in the affected extremity
  • Stroke (3 times more likely in people with PVD)

 

HOW TO PREVENT PERIPHERAL VASCULAR DISEASE

  • Quit smoking, including avoidance of second-hand smoke and use of any tobacco products
  • Weight loss
  • Limiting or quitting alcohol intake
  • Medicine to reduce your risk for blood clots, as determined by your healthcare provider
  • Exercise 30 minutes or more daily
  • Control of diabetes, cholesterol, and high blood pressure

Once PVD is symptomatic there are more invasive treatments that may be indicated such as angioplasty or vascular surgery.

Due to the high prevalence of PVD in the CKD patient population, PRINE Health is launching PRINE Vascular. We have brought in a skilled interventional radiologist and seasoned Podiatrist. We are starting a sonogram program and will be screening patients in our offices with ABI measurements proactively. A new Vascular lab will be opening in September at Parker Jewish Institute.

Which Vitamins Are Best For People Dealing With Kidney Disease?

Vitamins are important for everyone. The human body functions best when in balance. The best way to achieve optimum health is through a balanced diet, but with our busy lives and often unhealthy eating habits, diet alone may not work for many people. This is especially true for people with chronic kidney disease (CKD), which is why good vitamins are important.

Our bodies need vitamins and minerals to help them with our most basic and critical bodily functions. It would be great if we could simply get everything we need from the foods we eat, but when that is not possible, vitamins will work to help your body repair tissue and get as much energy as possible from the foods you eat, so you maintain a healthier life. Vitamins and minerals are essential for the overall health of your body.

People suffering from kidney disease, especially those on dialysis, may not be getting enough of the daily vitamins needed to increase their health and assist with keeping CKD under as much control as possible. This can lead to issues such as skin lesions, fatigue, muscle weakness, and nerve pain.

When dealing with CKD, there may be a variety of reasons why a patient may not be able to get all the recommended vitamins needed. Some water-soluble vitamins will have more stringent requirements to work well with issues CKD may cause. Some kidney medicines may not play well with specific vitamins. If you have CKD, your waste products will likely build up and affect how vitamins react to your body. Your physician will likely make changes in your diet so you may not get some of the vitamins from certain foods no longer part of your day-to-day foods and eating habits will change based on how well you feel day-to-day. Some days your appetite may not be robust.

 

Vitamins that are typically recommended for CKD patients:

B1, B2, B6, B12, folic acid, niacin, pantothenic acid, and biotin, as well as some vitamin C, are essential vitamins for people with CKD. Vitamin C may be suggested in low doses as large doses can cause a buildup of oxalate. Oxalate can cause build-up in bones and soft tissue and can be painful over time.

You will often see B complex vitamins grouped together, but each of the B vitamins plays a different role. Pantothenic acid and niacin are part of the B complex group and are taken so that the food you eat can more easily be turned into the energy your body will need. B1, B2, B6, B12, and folic acid work in conjunction with iron, preventing you from becoming anemic. Your doctor will decide if you need to take iron and, if so, what dosage.

Vitamin C can help bruises heal faster, and your doctor will probably recommend adding this to your vitamin regimen. Vitamin D is also significant, especially in maintaining healthy bones. If you’re dealing with CKD, your doctor will recommend what type of vitamin D and dosage is needed.

You will likely need to avoid some vitamins if you have kidney disease. A, E, and K can cause nausea and dizziness at the very least if too much of these build up in your system over time.

 

What about herbal remedies and supplements?

It is best to avoid herbal remedies and supplements sold over the counter if you suffer from chronic kidney disease and are on dialysis. These remedies may cause issues when interacting you’re your doctor-prescribed medicines and may cause serious side effects. Always ask your doctor before taking any vitamin or supplement.

 

What is the best way to get the vitamins I need if I am dealing with CKD?

No one wants to take several pills every day. Filling pillboxes and remembering to take every vitamin needed to stay as healthy as possible can be cumbersome. Dealing with CKD is a challenge. If it is at all possible, you will be better off taking one vitamin formula that includes everything your body needs.

PRINE Health has created a formula called PRINE VITE, which includes vitamins B1, B2, B6, B 12, folic acid, niacin, pantothenic acid, and biotin, as well as a small dose of vitamin C. PRINE VITE also includes Vitamin D 1000 IU and a higher dosage of B1 which has been shown to decrease and potentially reserve early diabetic kidney disease. This formula also contains two herbs, Dandelion Extract, known for its anti-inflammatory, diuretic, and cholesterol-lowering effects, and Uva Ursi, which has a history of aiding the urinary tract and UTIs. This formula is also gluten-free and non-GMO.

For more information on PRIVE VITE, or if you seek the advice of a Nephrologist, visit us at https://prinehealth.com/

Skip The Salt

Facts About Salt And Hypertension In The United States

High blood pressure (also known as hypertension) is associated with three leading causes of death, cardiovascular disease, stroke, and kidney disease. Hypertension is extremely prevalent around the world. About half of adults (45%) with uncontrolled hypertension have a blood pressure of 140/90 mm Hg or higher. This includes 37 million U.S. adults. In 2017, the American College of Cardiology and the American Heart Association published new guidelines for hypertension management and defined high hypertension as blood pressure at or above 130/80 mm Hg. Stage 2 hypertension is defined as blood pressure at or above 140/90 mm Hg.  One notorious contributor to hypertension is excessive dietary salt intake.

Blood Pressure Category Systolic Blood Pressure Diastolic Blood Pressure
  Normal <120 mm Hg and <80 mm Hg
  Elevated 120-129 mm Hg and <80 mm Hg
Hypertension
  Stage 1 130-139 mm Hg or 80-89 mm Hg
  Stage 2 ≥140 mm Hg or ≥90 mm Hg

Salt and Hypertension

Salt is perhaps the most popular flavoring added to food. Unfortunately, there is a downside. Too much salt can lead to fluid retention and worsen hypertension. How much is too much? Well, we need salt. We need about 500 mg per day. Americans consume much, much more than that. We take in on average closer to 3,500 mg, more than 7 times what is necessary. The Dietary Guidelines for Americans by the FDA advise we stick to a diet of fewer than 2,300 mg per day (about one teaspoon).

Salt is ubiquitous and added to all sorts of foods you consume on a daily basis. Moreover, the is often a salt shaker around to add even more. If you already have hypertension you are at risk for extra salt worsening your hypertension. So, when you can help it, skip the salt!  Learn more about High blood pressure.

PRINE Health Selected By CMS For Kidney Care First Initiative

 

Kidney Care First Initiative – CMS

PRINE Health is happy to announce our preliminary acceptance by CMS to participate in the upcoming Kidney Care First program, a new offering from CMS – CMMI under the Kidney Care Choices initiative. This is a program that stems from the Executive Order, Advancing American Kidney Health, and championed by HHS. We will make a final decision in Fall 2020 as to whether we will participate in the first performance year which is set to kick off, on April 1, 2021. The start was initially set for January 1, 2021, but was delayed due to COVID-19.

PRINE is excited to partner with CMS and other managed care payors on value-based kidney care initiatives. We feel this important, high-cost, complex patient population has been overlooked for too long. There is a great deal we can do together to raise the level of care and improve alignment between payors, patients, providers, and other caregivers.

In the meantime, PRINE is investing in technology and care management resources to further prepare for value-based contracting with various strategic partners.

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