Degree Name
Nursing Practice, DNP
Publication Date
9-28-2026
First Advisor
Lisa Drake
Second Advisor
Beatrice Bailey
Abstract
Chronic hypertension is an established risk factor for chronic kidney disease (CKD). Baseline chart review at a Texas family practice clinic showed inconsistent renal risk documentation, and providers did not use a standardized renal risk-stratification tool to guide nephrology referral. The aim of this quality improvement project was to implement a standardized Kidney Failure Risk Equation (KFRE) workflow to improve renal risk documentation, nephrology referral decision-making, and provider self-efficacy for adults with chronic hypertension over eight weeks. Lewin's Change Theory guided practice change, the Donabedian model guided quality evaluation, and the Plan-Do-Study-Act (PDSA) cycle structured implementation. Three providers (one physician, two nurse practitioners) received education on the KFRE workflow. This quantitative pre-implementation and post-implementation project compared 100 chart audits per time point using chi-square tests and measured provider self-efficacy with the Confidence Scale (C-Scale) using paired t and Wilcoxon signed-rank tests. KFRE documentation increased from 0% to 20% of charts, χ²(1, N = 200) = 22.22, p < .001. Nephrology referrals increased from 13% to 27%, χ²(1, N = 200) = 6.12, p = .013. Follow-up plan documentation increased from 54% to 61%, χ²(1, N = 200) = 1.00, p = .317. Mean C-Scale scores increased from 12.33 (SD = 1.53) to 18.67 (SD = 2.52), t(2) = 9.50, p = .011; the Wilcoxon test was not significant (p = .250). The project introduced a standardized renal risk-stratification process at the project site, although KFRE adoption remained incomplete.
Rights Management
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
Recommended Citation
Siddiqi, Shawn A., "Integration of the Kidney Failure Risk Equation to Guide Nephrology Referral in Adults with Chronic Hypertension" (2026). Doctor of Nursing Practice Projects. 410.
https://arch.astate.edu/dnp-projects/410
