Blood pressure monitoring and chronic care management for nephrology practices
Blood pressure, volume status and medication adherence shape CKD progression, and all three change between visits. We give your patients daily home readings, weekly check-ins and a care team that routes what matters back to you.
Chronic kidney disease in the U.S.
What we watch for in CKD patients
The program captures home readings and what patients tell us on calls. Lab monitoring stays with your practice; we help patients keep the follow-up and lab visits you order.
Blood pressure
Home readings from a validated cuff, reviewed against the targets you set for each patient.
Volume and weight
Daily weights for patients with CKD and heart failure or edema, with rapid gain escalated according to your thresholds.
Diabetes
Home glucose readings and medication adherence for patients with diabetic kidney disease.
Medication safety
Over-the-counter NSAID use and other nephrotoxic exposures asked about on calls; dose changes reconciled.
Visit follow-through
Reminders to keep the follow-up and lab visits your practice orders.
Why home blood pressure matters in CKD
Consistent blood pressure control is central to slowing CKD progression, and home readings give your team data between visits instead of a single office value.
Published results reflect specific program designs and patient populations. Outcomes for any program depend on patient selection, engagement and how escalations are acted on.
Large, underdiagnosed population
More than 1 in 7 U.S. adults, about 35.5 million people, are estimated to have CKD, and as many as 9 in 10 don't know it.1
Home telemonitoring improves control
In a randomized trial where 19% of participants had chronic kidney disease, home blood pressure telemonitoring with case management lowered systolic pressure 9.7 mmHg more than usual care at 12 months.2
Control remains the exception
Only about 1 in 4 U.S. adults with high blood pressure has it under control.3
Cardiorenal patients
For patients with CKD and heart failure, home telemonitoring has been associated with 29% fewer heart failure hospitalizations.4
Diagnoses commonly referred from nephrology
Most CKD referrals combine kidney disease with hypertension, diabetes or heart failure.
| Condition | ICD-10-CM |
|---|---|
| Chronic kidney disease, stage 3a | N18.31 |
| Chronic kidney disease, stage 3b | N18.32 |
| Chronic kidney disease, stage 4 | N18.4 |
| Chronic kidney disease, unspecified | N18.9 |
| Hypertensive chronic kidney disease | I12.9 |
| Hypertensive heart and CKD with heart failure | I13.0 |
| Type 2 diabetes with diabetic CKD | E11.22 |
| Heart failure, unspecified | I50.9 |
| Essential hypertension | I10 |
Questions from nephrology practices
Do you track lab values like eGFR or potassium?
No. The program captures home readings for blood pressure, weight, glucose and oxygen saturation. Lab monitoring stays with your practice, and we help patients keep the lab visits you order.
Can blood pressure targets reflect CKD guidance?
Yes. Targets and escalation thresholds follow your protocols and can be set for each patient.
Can you support patients who also see cardiology?
Yes. One care plan covers all of a patient's conditions, and we coordinate with the other specialists involved.
Other specialty programs
Let's talk about your patients.
A short conversation is usually enough to see whether VitalityMed is the right fit for your practice.
- We review your specialty, your patients and what you want to improve.
- You see a sample monthly summary before you commit.
- Getting started takes one onboarding call and your clinical protocols.
Patients and families can call the same number.
Request a conversation
We'll reply by phone or email. Please don't include patient health information.
References
- Centers for Disease Control and Prevention. Chronic kidney disease in the United States, 2023. www.cdc.gov
- Margolis KL, Asche SE, Bergdall AR, et al. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA. 2013;310(1):46-56. pubmed.ncbi.nlm.nih.gov
- Centers for Disease Control and Prevention. High blood pressure facts. www.cdc.gov
- Inglis SC, Clark RA, Dierckx R, Prieto-Merino D, Cleland JGF. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev. 2015;(10):CD007228. pubmed.ncbi.nlm.nih.gov
Page last reviewed 2026-09. This page is for health care professionals and is not medical advice.