25 Years of Integrated Chronic Kidney Disease Care: A Sustainable Collaboration Model Between Nephrology and Primary Care in Barcelona

Background: Chronic kidney disease (CKD) is a growing global health problem associated with high cardiovascular risk and rising healthcare costs. International clinical guidelines and scientific societies consistently recommend integrated care models between primary care (PC) and nephrology to improve early detection, ensure appropriate referral, and optimize long-term management of CKD. However, large-scale and sustained implementation of such models remains limited. Methods: We describe the 25-year experience of an integrated CKD care program in the Barcelona Right Health District (AP AIS Dreta-Fundació Puigvert), a collaborative initiative between nephrology and PC. The program was developed through joint professional education, shared referral protocols, virtual consultations, patient-focused interventions, a multidisciplinary clinical group, and continuous evaluation. The program was evaluated using clinical indicators, activity data, and patient registries. Results: CKD prevalence in the district increased from 2.3% in 2011 to 6.9% in 2024, with a 25% rise in registered patients over the last decade. Prescriptions of ACE inhibitors or ARB nearly doubled, while chronic NSAID use fell below 2%. Blood pressure control was achieved in over 60% of hypertensive patients. Virtual consultations expanded from 145 in 2016 to 954 in 2024, resolving 79% of queries without the need for face-to-face visits. Patient-centered initiatives and professional training received satisfaction ratings above 4.7/5, and the program has been nationally recognized for its innovation in CKD care. Conclusion: The AP AIS Dreta-Fundació Puigvert program shows that sustained collaboration between nephrology and PC can be consolidated over time within a real-world territorial setting, supporting coordinated CKD detection, management, and follow-up. Its long-standing experience and multidisciplinary structure make it a relevant model for integrated CKD care, with potential for replication in other healthcare settings. Future priorities include evaluating cost-effectiveness and demonstrating improvements in clinical outcomes to strengthen long-term sustainability.