FFH Network × National Kidney Foundation × [Your Institution]
🫘 Prepared Patient Series · Course #14

Become a Certified Prepared Patient
for Chronic Kidney Disease

A guided learning path that turns you (and your care partner) into the most informed, confident, and effective members of your own care team. CKD is silent until late — but highly modifiable when caught early. The SGLT2 era genuinely changed the prognosis. ACE/ARB + SGLT2i ± finerenone form the modern triple-protection stack. NSAID avoidance is lifelong. Pre-emptive transplant before dialysis is the gold-standard outcome. The AA/APOL1 disparity story, honest framing. Family kidney testing. A longer, fuller life — and the skills to help others do the same.

3HEALTH-LITERACY LAYERS
10EVIDENCE-BASED COMPETENCIES
3IDENTITIES YOU EARN
1HEALTH PASSPORT (FRIDGE-READY)
1
Learn It
2
Live It
3
Share It
Force Field strength: 0% (0/10 competencies)
Demo FFH client preview — synthetic data for walk-through. Use these buttons to populate or reset the demo experience.
Customizable Welcome from [Your Institution Name]. Need help with this course? Call our CKD Care navigator [Navigator name, RN / SW — (555) 123-4567], M–F 8a–5p, or the National Kidney Foundation helpline 1-855-NKF-CARES (1-855-653-2273). You can also message us through the [MyChart patient portal].
🛡 Force Field Fact Sheet New here? Start with the one-page Force Field Fact Sheet — 16 squares of essential CKD knowledge, plain-language, printable, free. Then come back for your full Certified Prepared Patient course. Open Fact Sheet →
🏅Your Path to Certification

Earn your way up three evidence-based tiers. Each builds on the last. Finish all three and receive your Certified Prepared Patient · CKD badge and printable certificate, recognized across the FFH Network.

Tier 1

Aware · Identity: Self-Advocate

You know your body and your disease. Layer 1 — Condition Literacy.

  • Complete Modules 1–4 (Condition Literacy)
  • Pass the "What CKD Is" quiz (≥80%)
  • Identify your CKD stage (G1–G5 + A1–A3), eGFR trend, UACR, BP target, and current med stack
  • Build your home BP + weight log + lab-trend tracker with the FFH "Notice and Name" framework
2 of 4 done50%
Tier 2

Active · Identity: Care Team Member

You partner with your team and navigate the system. Layer 2 — Care & System Literacy.

  • Complete Modules 5–7 (Make Every Visit Count · When to Call vs ED · Comorbidity Awareness)
  • Demonstrate teach-back on your treatment plan, sick-day medication-hold rules, and your "when to call vs 911" decision rule
  • Complete one "great visit" prep + debrief
  • Build your When-to-Call plan + Care Team card
  • Successfully resolve one prior auth (SGLT2i / finerenone), copay-help application, or nephrology care-navigator engagement
0 of 5 done0%
Tier 3 · Certified

Certified Prepared Patient · Identity: Ambassador

You teach, mentor, fight stigma, and shape research & policy. Layer 3 — Advocacy & Ambassadorship.

  • Complete Modules 8–10 (Family & Care Team · Talk to Kids/Partner/Employer + Mentor · Mastery & Graduation)
  • Mentor 1 newly-diagnosed person or family via NKF Peers OR present at a dialysis-unit / transplant-clinic / faith-community education session
  • Sign the Prepared Patient Pledge
  • Complete advance care planning (POA, proxy, advance directive, POLST/MOLST, will) — important across the long CKD arc
  • Submit one advocacy action (story, feedback letter, transplant-evaluation experience, policy comment on dialysis access)
0 of 5 done0%
📋Master Pre / Post Assessment 7 Likert dimensions · open to take or review

Where You Stand — Confidence Before & After

Seven dimensions of being a Prepared Patient. Answer once at the start of your journey and again at the end. Your goal is to see real growth across understanding, self-management, communication, and optimal utilization — knowing when to call your team, when to use Day Hospital, and when to go to the ER. Your answers stay on this device unless you choose to share with your clinician.

📈 Your Pre→Post Growth

Saved on this device · No backend yet · PHIT integration after Banner demo
📞Know Who to Call — Before the ER

CKD care runs as a long arc — early detection, slowing progression, preparing for transplant or dialysis, then post-transplant or on-dialysis maintenance. Most days are routine. Some days bring lab/medication calls. Rare moments are true emergencies. Knowing the right number to call — your nephrology team, the NKF helpline, or 911 — saves time, dignity, and unnecessary ED visits. Save these numbers in your phone today. The numbers below are placeholders — your institution will fill in the right ones for you.

🚨 Severe BP, sudden swelling, decreased urine output, or post-NSAID/contrast symptoms — call same day; severe symptoms = ED

BP >180/120 with chest pain, severe headache, vision change, or shortness of breath = 911. Sudden severe swelling + rapid weight gain >2 lb/day + decreased urine output after a new medication, NSAID exposure, contrast scan, or illness with vomiting/diarrhea = same-day call to nephrology. Symptoms of severe high potassium (muscle cramping, weakness, palpitations, irregular heartbeat) = call now or ED if severe. Confusion, severe shortness of breath, chest pain = 911.

🧭 New swelling, BP changes, lab-result questions, sick-day rules — call before the ED

For new swelling, BP that runs higher than your usual baseline, lab-result questions, or to confirm sick-day rules (whether to hold ACE/ARB, SGLT2i, diuretic, metformin during vomiting/diarrhea/can't keep fluids down), call your [Nephrology Triage Line: (555) 123-4567]. Before any contrast CT or angiogram, call nephrology to discuss pre-hydration. Most issues are addressable in clinic.

💬 Routine questions, refills, scheduling, caregiver support

Use [MyChart portal] first — most messages answered within 1 business day. For SGLT2i / ACE-ARB / finerenone refills or copay help, call [Specialty Pharmacy: (555) 222-9050]. For peer mentoring, transplant-pathway questions, and local resources, call the NKF helpline 1-855-NKF-CARES (1-855-653-2273) or visit peers.kidney.org — free, real humans, weekdays.

🚑 Call 911 right away for any of these

Chest pain · sudden severe shortness of breath · confusion · fainting · seizure · signs of severe hyperkalemia (palpitations + muscle weakness/paralysis) · severe BP elevation with end-organ symptoms (severe headache, chest pain, vision change, neurologic deficit) · severe injury · suspected sepsis (fever + rigors + low BP, especially if on dialysis with a catheter or after transplant on immunosuppression) — 911.

📚Condition Literacy & the 10 Prepared Patient Competencies

A Prepared Patient builds three kinds of health literacy — and grows into three identities. Each competency works through the FFH three pillars: Learn It · Live It · Share It.

🛡️

Advocate for Self

You speak up for your own care, plan, pain, and goals.

🤝

Care Team Member

You partner with your team — not above, not below.

📣

Ambassador

You teach, mentor, and shape research, policy & access.

1

🧬 Condition Literacy Learn It · Tier 1 Aware

"I know my body and my disease." The foundation. Without this, nothing else holds.

Identity earned: Self-AdvocateCompetencies 1–4
1 🫘

What CKD Is

Gradual loss of kidney function over months or years. Stages G1–G5 by GFR + A1–A3 by albuminuria (KDIGO heat map). Often silent until G4–G5 — that's why screening matters in HTN, T2D, AA/Hispanic/Native families, and prior AKI.

Learn ItLive It
My confidence (1–5)
Pre: — · Post: —
2 🩸

Know My Numbers & Risk Factors

eGFR (race-free 2021 CKD-EPI), UACR (A1/A2/A3), BP (target <130/80 in CKD), A1c if diabetic, K+, phosphorus, bicarb, hemoglobin, PTH. Family history. AA/APOL1 risk variants in ~13% of AA adults. NSAID and contrast exposure history.

Learn ItLive It
My confidence (1–5)
Pre: — · Post: —
3 🥗

Lifestyle Force Field — DASH, NSAID Avoidance, Hydration Sense, Smoking, Sleep

DASH-style eating with sodium <2300 mg/day. NSAID avoidance for life. Sensible hydration (2 L/day) — do NOT "flush" kidneys with extra water. Smoking cessation, alcohol moderation. Adequate (not high) protein. Restrict K+/phosphorus only when labs require. Renal-dietitian referral is gold.

Learn ItLive It
My confidence (1–5)
Pre: — · Post: —
4 💊

Medications — The SGLT2 Revolution + ACE/ARB + Finerenone + Statin

ACE/ARB (1990s foundation, never both together). SGLT2 inhibitors (the 2020s revolution — ~30–40% progression reduction with or without diabetes; CREDENCE, DAPA-CKD, EMPA-KIDNEY). Finerenone adds ~17% in diabetic CKD. Statins for CV protection. Late-stage agents (phosphate binders, ESAs, vitamin D, K+ binders). Adherence is everything.

Learn ItLive It
My confidence (1–5)
Pre: — · Post: —
2

🤝 Care & System Literacy Live It · Tier 2 Active

"I'm part of the team. I navigate the system." Where most preventable ED visits, AKI episodes, and frustration happen — and where this course pays off the most. Optimal utilization lives here.

Identity earned: Care-Team MemberCompetencies 5–7
5 📊

Make Every Visit Count — SHARE Approach + Teach-Back

AHRQ SHARE Approach (Seek, Help, Assess, Reach, Evaluate). Teach-back at every visit. 3-question max written priority list. Numbers card + med list + second pair of ears. Oncology visits are complex; preparation multiplies value.

Learn ItLive It
My confidence (1–5)
Pre: — · Post: —
6 🚨

When to Call vs Go to ED — AKI Triggers, Severe BP, Hyperkalemia

BP >180/120 with end-organ symptoms → 911. Severe shortness of breath, chest pain, confusion → 911. Hyperkalemia symptoms (cramping + weakness + palpitations) → call now / ED if severe. Sudden swelling + rapid weight gain + decreased output (especially after NSAID or contrast) → same-day nephrology call. Sick-day rules: hold ACE/ARB + SGLT2i + diuretic + metformin if vomiting/diarrhea.

Learn ItLive It
My confidence (1–5)
Pre: — · Post: —
7 🌐

Comorbidity Awareness — CV Equivalent, Anemia, CKD-MBD, Hyperkalemia, Mood, Sleep, Frailty

CKD-specific Module 7. The renal outcome arc of the unified vascular cluster — HTN + T2D drive the inputs (cluster module CROSS-REFERENCED, not embedded). CKD itself is a CV risk equivalent. Anemia from low EPO. CKD-MBD bone disease. Hyperkalemia common (limits ACE/ARB). Depression >30%. Sexual dysfunction. Sleep apnea. Frailty/sarcopenia rises with stage.

Learn ItLive It
My confidence (1–5)
Pre: — · Post: —
3

📣 Advocacy & Ambassadorship Share It · Tier 3 Certified

"I speak up. I lift others. I shape the future." This is what turns a Prepared Patient into a force multiplier for the whole community.

Identity earned: AmbassadorCompetencies 8–10
8 🤝

Family, Caregiver, and the Care Team — Long-Arc Trajectory + Transplant Pathway

The family caregiver helps with BP cuff, daily weight, medication tracking, NSAID-avoidance vigilance, and renal-friendly meal planning. Multi-specialty team: nephrology + PCP + RN care manager + renal dietitian (essential!) + pharmacist + social work + behavioral health + NKF peer mentor + vascular access surgeon (plan early) + transplant team (start by GFR ~20). Pre-emptive transplant before dialysis is the gold-standard outcome.

Learn It
My confidence (1–5)
Pre: — · Post: —
9 🎤

Sharing — Talk to Kids, Partner, Employer; Donor Conversation; Mentor

Kids/adult children (especially in AA/Hispanic/Native families): family eGFR + UACR test by their 30s. Partner: kidney donation conversation deserves time and honesty — living donation is the gold-standard outcome. Employer: ADA covers CKD; dialysis is a 3×/wk 4-hr commitment, transplant recovery 6–12 weeks. Most patients return to work. NKF Peers for mentoring. FFH "Notice and Name" — observation, never diagnosis.

My confidence (1–5)
Pre: — · Post: —
10 🏆

Mastery & Graduation — Slow Progression, Transplant Readiness or Comfortable Dialysis, ACP, Peer Mentor

Slow progression with the SGLT2/ACE-ARB/finerenone/statin stack. Pre-emptive transplant readiness or peace with planned dialysis pathway. Advance care planning while capacity is clear. Caregiver wellness plan. NKF peer mentoring active. Story contributed to the AA / Hispanic / Native equity arc. Earn Certified Prepared Patient · CKD.

Learn It
My confidence (1–5)
Pre: — · Post: —
👥My Care Team

Your team is bigger than just the doctor — and the care partner is part of it. Click any card to edit, or click the + tile to add a new team member. Saved on this device. The Force Field Emergency Card below auto-syncs from this list. Starter roster pre-populated for CKD — your institution can edit any row. The Force Field Emergency Card auto-syncs from this list.

Edit Team Member

📖Glossary — words you'll hear 10 plain-English terms · click any to expand

Plain-English definitions for terms doctors and labs use. Tap to expand.

Chronic Kidney Disease (CKD)
Reduced kidney function (eGFR <60 mL/min/1.73m²) or markers of kidney damage (most often albumin in the urine, abnormal imaging, or biopsy findings) for ≥3 months, regardless of cause. Staged by both filtration (G1–G5) and albuminuria (A1–A3) — the KDIGO heat map.
eGFR (estimated Glomerular Filtration Rate)
An estimate of how much blood your kidneys filter per minute, in mL/min/1.73m². Calculated from creatinine, age, and sex (the 2021 race-free CKD-EPI equation). Stages: G1 ≥90 (with damage), G2 60–89 (with damage), G3a 45–59, G3b 30–44, G4 15–29, G5 <15 (kidney failure).
UACR (Urine Albumin/Creatinine Ratio)
The amount of albumin (a protein) leaking into the urine, divided by urine creatinine, in mg/g. A1: <30 (normal-to-mild). A2: 30–300 (moderately increased). A3: >300 (severely increased). UACR is a powerful predictor of CKD progression and cardiovascular events.
KDIGO heat map
Kidney Disease: Improving Global Outcomes risk grid that combines G stage and A stage. Risk rises from green (low) to red (very high) as filtration falls and albuminuria rises. Predicts CKD progression and CV events better than either number alone.
ACE inhibitor / ARB
Angiotensin-Converting Enzyme inhibitors (lisinopril, ramipril, enalapril) and Angiotensin Receptor Blockers (losartan, valsartan, irbesartan). The 1990s foundation for CKD progression-slowing. Lower BP, reduce proteinuria, slow decline. Use one — never both together. Watch potassium.
SGLT2 inhibitor
Sodium-Glucose Co-Transporter-2 inhibitors (empagliflozin / Jardiance, dapagliflozin / Farxiga, canagliflozin / Invokana, ertugliflozin). Originally diabetes drugs. Now indicated for CKD with or without diabetes. Trials (CREDENCE, DAPA-CKD, EMPA-KIDNEY) showed ~30–40% reduction in CKD progression. Slight rise in creatinine first 2–4 weeks is expected and protective.
Finerenone (Kerendia)
A non-steroidal mineralocorticoid receptor antagonist. Adds ~17% additional progression-reduction in diabetic CKD on top of ACE/ARB + SGLT2i. Trial evidence: FIDELIO-DKD and FIGARO-DKD. Watch potassium.
APOL1
A gene with high-risk variants (G1 and G2) present in roughly 13% of African American adults. Evolved as protection against the Trypanosoma brucei parasite (African sleeping sickness). Two copies of high-risk variants raise risk of focal segmental glomerulosclerosis, HTN-attributed kidney disease, and faster CKD progression. Biology, not destiny — meds work for everyone.
Acute Kidney Injury (AKI)
A sudden drop in kidney function over hours to days. Top triggers in CKD: NSAIDs, IV contrast, dehydration, certain antibiotics, and ACE/ARB during volume loss. Each AKI episode permanently drops your baseline eGFR. The "acute on chronic" pattern is the most preventable progression accelerator in CKD.
Sick-day rules
When you are vomiting, having diarrhea, or can't keep fluids down: hold ACE/ARB, SGLT2i, diuretics, metformin, and (always) NSAIDs. Resume when eating and drinking normally for ≥24 hours. Call the team early. The point is to protect the kidney from a brief dehydrated stress on top of meds that lower kidney perfusion.
Hyperkalemia
High potassium in the blood (>5.0–5.5 mEq/L). Common in CKD. Made worse by ACE/ARB, SGLT2i, finerenone, K+ supplements, and potassium-sparing diuretics. Severe hyperkalemia (palpitations + muscle weakness) is a medical emergency. Potassium binders (patiromer, sodium zirconium) sometimes allow continued use of kidney-protecting meds despite borderline K+.
CKD-MBD (Mineral & Bone Disorder)
As CKD progresses, the kidneys lose their ability to activate vitamin D, control phosphorus, and regulate calcium. The result: high phosphorus, low active vitamin D, secondary hyperparathyroidism (high PTH), and bone disease (osteodystrophy) plus vascular calcification. Managed with phosphate binders, vitamin D analogs, and PTH-targeting drugs in advanced CKD.
Pre-emptive kidney transplant
A kidney transplant performed before the patient ever starts dialysis. The gold-standard outcome in CKD: best survival, best quality of life, lowest cost. Requires starting transplant evaluation by GFR ~20 (or earlier if rapidly progressing) — well before crisis. Living-donor transplants outperform deceased-donor transplants.
Dialysis modalities (HD vs PD vs home)
Hemodialysis (HD): blood circulated through a machine, usually 3 days/week × ~4 hours, in-center or at home. Needs vascular access (AV fistula preferred — plan early). Peritoneal dialysis (PD): uses your own peritoneum to filter, done at home, often overnight with a cycler. Both work; the choice depends on lifestyle, anatomy, support, and access. Home options preserve more independence.
🧪Lab Test Tutor — what your numbers mean click to expand

Lab Test Tutor — what your numbers mean

Don't just see a number — know what it means and what to ask. Your "normal" may be different from a friend's. Ask your team to write your personal baseline in the column on the right.

TestWhat it measuresTypical adult rangeWhat to ask if it's offMy baseline
eGFR (race-free 2021 CKD-EPI)Estimated kidney filtration in mL/min/1.73m². The single most-tracked CKD number. Trend matters more than one value.≥90 normal · 60–89 mild ↓ · 45–59 G3a · 30–44 G3b · 15–29 G4 · <15 G5What is my trend? Are we losing >5 mL/min/year? On SGLT2i?[fill in]
UACR (urine albumin/creatinine ratio)Protein leak from the kidneys. As predictive of outcomes as eGFR, sometimes more so. Should be checked annually in HTN, T2D, and known CKD.A1 <30 · A2 30–300 · A3 >300 mg/gWhat's my A stage? Is ACE/ARB at the right dose? On SGLT2i?[fill in]
BP (home + clinic)Home BP averages over 7 days predict outcomes better than office readings. Use a validated upper-arm cuff.Target generally <130/80 in CKD; lower if heavy proteinuriaAm I at goal on home averages? Are my meds optimized?[fill in]
A1c (if diabetic)3-month average glucose. Target individualized in CKD — usually ~7%; 7.5–8% may be appropriate in advanced CKD or older adults to avoid hypoglycemia.<7% common target · individualizedWhat is my individualized A1c target given my CKD stage and age?[fill in]
Potassium (K+)Often runs higher in CKD. Critical for ACE/ARB / SGLT2i / finerenone dosing. Severe high K+ is dangerous (cardiac).3.5–5.0 mEq/L; CKD often runs 4.5–5.5Is K+ blocking my kidney-protecting meds? Could a K+ binder help?[fill in]
PhosphorusRises in advanced CKD as kidneys can't excrete it. High phos drives bone disease and vascular calcification.2.5–4.5 mg/dL (target may be lower in CKD)Do I need a phosphate binder? With which meals?[fill in]
Bicarbonate (HCO₃⁻)Acidosis is common and progressive in CKD; replacement (sodium bicarbonate) modestly slows progression.22–28 mEq/LShould I take sodium bicarbonate to slow progression?[fill in]
Hemoglobin (Hgb)Anemia of CKD from low EPO. Often appears around G3b–G4. Iron-stores check first; ESAs added if needed.Men ≥13.5 · Women ≥12.0 (general); CKD often lowerAm I anemic from CKD? Iron studies done? ESA needed?[fill in]
PTH (parathyroid hormone) + Vit D + CalciumPTH rises early in CKD as part of CKD-MBD. Vit D is activated by the kidneys; deficiency common. Calcium often low or normal until late.PTH 15–65 pg/mL (CKD targets are stage-specific); Vit D 25-OH ≥30 ng/mL; Ca 8.5–10.2Are my CKD-MBD numbers in target? Vit D analog needed?[fill in]
Lipids (total, LDL, HDL, trig)CKD itself is a CV risk equivalent. Statin almost always indicated unless contraindicated.LDL to ASCVD goal · individualizedAm I on a statin? Is the dose right for my CKD stage?[fill in]
Med list with renal-dose reviewMany drugs need renal dose adjustment. Review with the pharmacist at every change. Always tell every clinician (dentist, urgent care, ED) about CKD before any prescription or scan.Renal dosing tables (Lexicomp, Sanford, etc.)Are all my doses correct for my eGFR? Any nephrotoxic drugs?[fill in]
Add-On Modules & Earnable Badges

Stackable modules that match your situation. Complete one to earn an extra badge on your certificate. Your institution can add their own.

Add-on
🩺 Home BP Cuff Routine

Validated upper-arm cuff (validatebp.org), AM and PM readings, 7-day averages. Home averages predict outcomes better than office readings. The single highest-leverage daily habit in CKD.

Add-on
⚖️ Daily Weight + Edema Check

Same scale, same time of day. Track ankles, legs, around the eyes in the morning. Sudden gain >2 lb/day = call. Especially important on diuretics or in advanced CKD.

Add-on
🤒 Sick-Day Medication-Hold Rules

When vomiting/diarrhea/can't keep fluids: hold ACE/ARB + SGLT2i + diuretic + metformin + (always) NSAIDs. Resume after 24h of normal eating. Call the team early. Print and post on the fridge.

Add-on
🚫 NSAID-Avoidance Audit

OTC + family-doctor + dentist + urgent care + ED — every encounter. Read OTC labels: ibuprofen, naproxen, hidden in many cold combos (Advil, Aleve, Excedrin, Goody's, BC, Motrin). Use acetaminophen for most aches.

Add-on
💉 AV Fistula Care

If approaching dialysis. Vein mapping, fistula creation, maturation (months — plan early!), thrill check, bruit listening, vein protection (no IVs / BPs in the access arm), recognizing infection or stenosis.

Add-on
🏠 Peritoneal Dialysis Catheter Care

If choosing PD. Catheter insertion + exit-site care, sterile technique for daily exchanges or nightly cycler, recognizing peritonitis (cloudy effluent, abdominal pain, fever — call same day), travel routine.

Add-on
🏠 Home Hemodialysis Routine

If choosing home HD. Machine training, water-system maintenance, partner training, telemetry monitoring, vascular access care, treatment scheduling for life flexibility.

Add-on
🌱 Transplant Evaluation Pathway

The full list — labs, cardiac workup, dental clearance, financial review, social-work assessment, nutrition counseling, behavioral-health, surgical evaluation, listing, donor identification (living + deceased).

Add-on
💊 Transplant Medication Regimen

Lifelong immunosuppression after transplant: tacrolimus (or cyclosporine) + MMF + prednisone (often). Adherence is everything. Drug interactions, infection prevention, cancer surveillance, BP/lipids/glucose monitoring.

Add-on
📋 Contrast-Scan Pre-Medication Routine

If a CT-with-contrast or angiogram is needed: call nephrology first. Pre-hydration with isotonic saline, often N-acetylcysteine, hold metformin/SGLT2i, sometimes alternative imaging (MRI without gadolinium, ultrasound, non-contrast CT) avoids it entirely.

Trial
🧪 In a CKD Clinical Trial?

Protocol literacy, side-effect tracking, when to call the study coordinator vs your usual nephrology team. Trials currently enrolling in CKD include novel anti-fibrotics, RNA therapies, and trial extensions of existing meds.

Add-on
📋 Advance Care Planning Workshop

POA, healthcare proxy, advance directive, POLST/MOLST, will, financial plan — done while capacity is clear. Important across the long CKD arc, especially before any decision about dialysis withdrawal or transplant evaluation.

Family
👨‍👩‍👧 Family Kidney Testing (esp. AA/Hispanic/Native)

Encourage adult children, siblings, and parents to ask their family doctor for an eGFR + UACR test by their 30s. Simple, cheap, and high-leverage in families with HTN, T2D, or known CKD history.

Custom
+ Add Your Institution's Module

Drop in your own — local nephrology center onboarding, dialysis-unit intro, transplant-center mentor program, anything.

🛡️Force Field Emergency Card Fridge · Wallet · EMT-ready

🛡️ Force Field Emergency Card FRIDGE · WALLET · EMT-READY

A one-page emergency record for any EMT, ER, new doctor, or transition visit. Print one for the fridge, one for your wallet. Updates anytime. This is the document you hand to a stranger when you can't speak for yourself.

🤝 My Care Team — call list for any clinician picking up my care
📘My Health Passport Patient-Owned Journal

📘 My Health Passport PATIENT-OWNED JOURNAL

This is your record — not your hospital's. Log every visit, capture every question for next time, and watch your own trends. Many of you get care at more than one hospital, on more than one record system. This Passport travels with you. Future versions will let you import data directly from your patient portals (the "Blue Button" vision).

        Blue Button vision: A future release will let you connect your patient portals (Epic MyChart, Cerner, Athena, VA, others) and pull your labs, meds, and visit history straight in. Until then, this Passport is your single, portable record across institutions — you own it.
        🩺Working With a Prepared Patient

        Your patient is going through a structured, evidence-based course. Here's how to get the most out of every visit, reduce ED use, prevent NSAID-driven AKI episodes, support the caregiver, and partner well. Built on the AHRQ SHARE Approach, the IOM teach-back method, NKF / KDIGO 2024 guidelines, ADA Standards of Care (diabetic kidney disease), USPSTF kidney screening recommendations, and the landmark CREDENCE / DAPA-CKD / EMPA-KIDNEY / FIDELIO-DKD / FIGARO-DKD trials of the SGLT2 era.

        The SHARE Approach — your 5-step playbook

        Use these steps in any order. Cycle back. Use teach-back at every transition. Source: AHRQ Pub. No. 25-0005 (Oct 2024).

        💬Teach-Back & Risk Communication

        The two highest-yield, lowest-cost SDM techniques. Use both at every visit.

        🔁 Teach-Back (1–2 min)
        • "Just so I know I explained it well — what would you tell your spouse about why we're adding empagliflozin (or finerenone)? About the sick-day rules?"
        • Open-ended ("what" / "how"), not yes/no.
        • If they get it wrong: "I must not have explained it well — let me try a different way." Then teach-back again.
        • Use it for: NSAID avoidance + sick-day rules + medication routine, when to call vs 911, transplant evaluation pathway, advance care planning while capacity is clear.
        • Document teach-back in your note — it's a quality measure and a billable element of care.
        🔢 Communicating Numbers
        • Use absolute risk, not relative. "13 out of 100" beats "13%" beats "1 in 8" beats "low risk."
        • Keep denominators & timeframes constant when comparing options.
        • Show, don't tell: icon arrays, Wong-Baker FACES, written summary.
        • For lab numbers: give the action threshold, not just the value. "Your eGFR dropped from 42 to 36 — under 30 we accelerate transplant evaluation. We're still well above that threshold."
        ⚠️CKD-Specific Clinical Guardrails

        Detection & Staging

        • Screen at-risk adults: eGFR + UACR in HTN, T2D, family history of kidney disease, age >60, prior AKI, autoimmune disease, AA/Hispanic/Native heritage, recurrent stones.
        • Race-free 2021 CKD-EPI equation is now standard. Use cystatin-C as confirmatory in select cases (low muscle mass, atypical creatinine).
        • KDIGO heat map staging combines G stage and A stage. Both predict outcomes. Repeat to confirm CKD diagnosis at >3 months.
        • Refer to nephrology by stage G3b–G4, persistent A3, or unexplained rapid progression (>5 mL/min/year drop).
        • Investigate cause: HTN nephrosclerosis, diabetic nephropathy (~70% combined), glomerular disease (consider biopsy if A3 + active sediment), PKD, obstruction, NSAID/contrast injury history.

        Disease-Modifying Therapy

        • ACE inhibitor or ARB first-line for HTN + CKD (especially if proteinuric); titrate to maximum tolerated dose; never both together; monitor K+.
        • SGLT2 inhibitor indicated for CKD with or without diabetes (eGFR ≥20–25, varies by agent). Counsel about expected initial creatinine bump (~10%, hemodynamic, protective).
        • Finerenone indicated for diabetic CKD on top of ACE/ARB + SGLT2i (eGFR ≥25, K+ ≤4.8 to start).
        • Statin: CKD itself is a CV risk equivalent — almost always indicated unless contraindicated.
        • Sick-day rules: hold ACE/ARB + SGLT2i + diuretic + metformin + (always) NSAIDs during volume loss; resume after 24h normal eating. Patient-counseling item.

        Complications & Late Stage

        • Anemia of CKD: check iron stores first; ESAs (epoetin, darbepoetin) when Hgb <10 with goal 10–11.5; emerging HIF-PH inhibitors (daprodustat) oral alternative.
        • CKD-MBD: monitor PTH, phosphorus, calcium, 25-OH vitamin D; phosphate binders, vitamin D analogs, calcimimetics per stage.
        • Acidosis: sodium bicarbonate for serum HCO₃⁻ <22 modestly slows progression.
        • Hyperkalemia: dietary review, loop diuretics, K+ binders (patiromer, sodium zirconium) often allow continued ACE/ARB/SGLT2i/finerenone use.
        • Vascular access: refer for AV-fistula creation by GFR ~20–25 (months to mature; plan early).
        • Transplant evaluation: refer by GFR ~20 (or earlier if rapidly progressing); pre-emptive transplant is the gold-standard outcome.
        • Dialysis modality: discuss in-center HD vs home HD vs PD with patient and family well before need; modality choice affects life flexibility.
        • Vaccinations: pneumococcal (PCV20 or PCV15+PPSV23), Hep B (essential before dialysis/transplant), influenza, COVID, RSV (60+), Shingrix.
        • Avoid nephrotoxins: NSAID counseling at every visit; alert on every contrast scan; renal-dose every prescription.
        🌍Cultural Competence & Trust

        CKD is one of the starkest examples of health disparity in U.S. medicine. Black/AA adults are 3–4× more likely to progress to kidney failure than white Americans, and constitute about a third of dialysis patients despite being ~13% of the population. The story has both biological (APOL1) and social (SDOH, late referral, transplant access) drivers. Hispanic and Native American risk also elevated. The 2021 race-free CKD-EPI equation removed a "race correction" that had artificially raised AA patients' eGFR — delaying referrals, delaying transplant listing. Repair starts in your office.

        • Use the race-free 2021 CKD-EPI equation. If your lab still reports a "race-corrected" eGFR for AA patients, push your institution to switch — it's a system correction with direct equity impact.
        • Refer early. Don't wait for late stage. Referral disparities (later in AA / Hispanic patients) translate directly into worse transplant access. Refer by G3b or A3, sooner if rapid progression.
        • Discuss APOL1 honestly when relevant — biology, not race-as-cause. Two high-risk variants raise FSGS and HTN-attributed CKD progression risk; the conversation should be careful, accurate, and non-deterministic. Meds work for everyone.
        • Use qualified medical interpreters — never family, never minor children except in true emergencies. Transplant-evaluation, dialysis-modality, and donor conversations must be done in the patient's primary language.
        • Invite the caregiver in. With patient consent — decisions about transplant evaluation, dialysis modality, family kidney testing, and donor-pair conversations are family decisions in many cultures.
        • Name the bias. "I know access to transplant referral and SGLT2i has been uneven for AA / Hispanic / Native patients. We track that here, and you can tell me if anything feels off."
        🏥Customize for Your Institution

        Clone this course and replace the highlighted blocks with your own information. Each editable field below is a placeholder — change it once and it propagates through the patient view.

        📞 What Should Replace the When-to-Call Block
        • 24/7 nephrology on-call number
        • Nephrology center outpatient hours & address
        • Specialty pharmacy line (SGLT2i / finerenone / iron / ESAs)
        • Vascular access surgery line (AV fistula planning)
        • Transplant center referral & coordinator contact
        • Dialysis-unit phone lines (in-center HD + home programs)
        • NKF local resources / chapter contact
        • Patient portal login URL with caregiver proxy
        👤 Who Is Your Nephrology Care Navigator?
        • Name, role, photo, calendly/booking link.
        • What teach-back / device check-ins they own (home BP cuff routine, daily weight, sick-day rules, NSAID-avoidance audit, vascular access prep).
        • How patients and care partners reach them between visits.
        • How they handle prior-auth navigation (SGLT2i, finerenone), copay help, and transplant-evaluation triage.
        📚 Add Your Own Modules
        • Your clinical trial protocols (anti-fibrotics, RNA therapeutics, novel agents in CKD).
        • Renal dietitian onboarding letter — myths to dispel, individualized meal planning.
        • Insurance & financial-aid pathways (especially SGLT2i / finerenone copay assistance, NKF Kidney Cars, foundation grants).
        • Local peer support partners (NKF Peers chapter, transplant recipient + living-donor mentor pairs, AA / Hispanic / Native community partners).
        🎨 Re-skin in 2 Lines of CSS
        • --inst-primary: your brand color
        • Replace the FFH × NKF × [Your Institution] cobrand in the hero
        • Drop in your logo PNG (white version) — same 48px height as FFH logo

        📚 Evidence Base — what this course is built on

        Course content is educational and not a substitute for medical advice from your own clinicians. Institutions cloning this course are responsible for accuracy of all customized blocks.

        Prepared Patient · CKDChapter 1 · Learn It

        1Module title

        Module description.

        Take the Pre-Check, work through Learn It → Live It → Share It, then take the Post-Check (≥4/5 to mark complete).