Resource Hub: Chronic Kidney Disease (CKD) screening
This hub provides practical, evidence-based resources to support GPs participating in EMPHN’s Clinical Insights CKD screening pilot program.
The program is based on the Kidney Health Australia (KHA) Guidelines: CKD Management in Primary Care, 5th Edition.
Additional resources to support decision-making and patient care are available below.
On this page:
Data sources and definitions
| Data sources |
|---|
| Data in this report are based on what is recorded in the designated fields in the clinical software at your practice and uploaded to POLAR. POLAR is unable to extract data from progress notes. |
| POLAR can only capture Blood Pressure (BP) that is recorded in the measurement field of your clinical software. |
| Term | Definition |
|---|---|
| RACGP active patients | Patients who have attended the practice 3 or more times in the past 2 years. |
| Patient allocation to GP | A patients is allocated to the GP who has the highest number of the patient’s records in the last 2 years (i.e. at least >50% of the time). If a patient doesn’t see any GP for >50% of the time, they will be allocated to the GP they last saw. |
| Condition inclusions & exclusions | Hypertension Diabetes Note: Patients with diagnosed CKD or had a nephrectomy have been excluded in the report |
Resources
How this information can be used to improve patient care
Accessing patient data: Your Clinical Insights report shows you an aggregate of patients who may benefit from a review. To view this list of patients, log in to POLAR Explorer: https://polarexplorer.org.au/login.
Your clinical software provider can provide support with recalling patients via your clinical software.
Chronic Condition Management Plan: Some patients may be eligible for a GP Chronic Condition Management Plan. Guidance and templates for Chronic Conditions Management Plan is available via Services Australia: GP chronic condition management plan – Health professionals – Services Australia
Health professional resources
Kidney Health Australia (KHA) Health Professional Hub
The KHA Health Professionals Hub is an online platform where clinicians can register to access resources, news, latest research and educational webinars.
Clinicians can refer patients to KHA via the Kidney Helpline. Referring patients to Kidney Health Australia gives them access to KHA staff to provide relevant information and answers to their questions.
HealthPathways Melbourne
HealthPathways Melbourne is a clinical management and referral resource designed for use during consultations. It gives clinicians a single website to access clinical referral pathways and resources.
Consumer resources
Visit the Kidney Health Australia (KHA) website for consumer resources to support your patient with understanding and managing CKD.
Continuing Professional Development (CPD)
Time spent reviewing the chronic kidney disease screening report and exploring improvement opportunities will contribute towards 12 (6 MO, 5RP and 1EA) CPD hours.
Frequently Asked Questions (FAQs)
- How often will I receive the Clinical Insights report?
During the pilot phase, you will receive an initial Clinical Insights report, with the next topic expected in early 2026. Reports are shared periodically, aligned with key phases of the program and data availability. You will be notified when a new report is ready. - What is the process for receiving the report?
Once you have signed up to receive the reports, we will securely share the report with you via email. Click here for sign up. - How does this report benefit me and my patients?
The report provides actionable insights based on your practice data, helping you identify patients at risk of CKD and improve early detection, management, and referral pathways. - How did we access the data?
Your practice owner has provided consent for data sharing as part of the Clinical Insights program. Data is securely extracted through POLAR and used solely for quality improvement purposes. - Is my data secure and private?
Yes. All data is handled in accordance with strict privacy and following our protocols. Only de-identified or practice-approved data is used for reporting, and it is never shared externally without consent. - Can I opt out of the program?
Yes. If you or your practice wishes to opt out of the Clinical Insights program, please contact clinicalinsights@emphn.org.au and our team will guide you through the process.