Over the past year, the Division of Nephrology and Hypertension began a series of quality improvement (QI) initiatives to normalize the vitamin D status of our patients with chronic kidney disease (CKD). And, to promote standardization within the division as to how we care for patients, we decided, for the first time, to consider CKD and kidney transplant patients as a single group.

The literature has shown that many CKD patients and many kidney transplant patients have low serum levels of 25-hydroxyvitamin D. There is also good evidence to support the recommendation that these patients would have healthier bones and otherwise benefit from having normalized levels greater than 30 ng/mL.

As a first step, our two nephrology dieticians began a rapid cycle improvement collaborative (RCIC) initiative to heighten the frequency of vitamin D monitoring. By making vitamin D monitoring a component of pre-visit planning for both the kidney transplant and CKD teams, we were able to flag patients who needed vitamin D levels checked before they came to clinic. The goal was to have vitamin D levels checked, at minimum, every 15 months.

As a result, the team achieved a greater than 20 percent increase (from 67 to over 90 percent) in the number of patients receiving adequate vitamin D monitoring, for our CKD and kidney transplant patient populations combined. For the kidney transplant population alone, the increase was 40 percent.

Although this initial component of our project was focused on process, the CKD sub-unit has also demonstrated a 20 percent improvement in outcome: almost 65 percent of CKD patients have now achieved a goal 25-hydroxyvitamin D level of greater than 30 ng/mL. Efforts are now underway to increase this percentage even further, to improve the health of our CKD and kidney transplant populations.