Table 4.

Major Themes and Sub-themes from Patient-Physician Discussions About Chronic Kidney Disease with Representative Quotations

	Representative quotations
Diagnosis of CKD	“…like I said, your kidneys are not exactly working perfectly” (physician 8) “This goes along with your chronic kidney disease.” (physician 5)
Assessment and review of laboratory data	“So the first test we’re looking at is the kidney function test, the creatinine. Your number is exactly stable with what we’ve been seeing, your number has been between 1.3 and 1.4… which is actually an improvement from a year ago.” (physician 4) “Now you’re due for some blood work. Gotta check on your kidneys and we’ll see where everything else is.” (physician 1) “We definitely do need to see what’s happening with your kidney’s function, so if you could come tomorrow. I won’t make any changes to any medicines until we have that number back.” (physician 8)
Management to delay CKD progression
Control of risk factors	“Well, if you control your blood pressure better, maybe your kidney test will improve.” (physician 6) “Um but really the most critical thing is to get the diabetes under control. Because those [blood pressure] medications can really only do so much. The critical thing really is to get those sugars down. “(physician 4)
ACE inhibitors and ARBs	“It’s the Irbesartan…It’s for blood pressure and it also protects the kidneys, especially when they’re not filtering protein properly. (physician 6) “..so there are a group of blood pressure medicines that have been shown to slow down that type of damage in the kidneys. …since we’ve seen two urine tests that show a little bit of that protein and the fact that the blood pressure is not quite as good as we need it to be yet, what I would like to recommend to you is that we add a low dose of one of these medicines to what you’re already taking.” (physician 4)
Medication safety	“Unfortunately, when they drew your blood in June, your kidney test was worse, so you can’t take Metformin now.” (physician 6) “I know we talked about not taking the aleve or advil, Right? because of your kidneys”. (physician 2)
Complications of CKD	“And the reason for the bloodwork tomorrow, like I said, your kidneys are not exactly working perfectly which may also be part of the reason that you’re swelling so we want to make sure nothing has changed with that.” (physician 8) “And another one who had kidney failure, she’s on dialysis. And she had a lot of complications with fluids. Fluid, fluid, fluid. Back and forth to the hospital.” (physician 7)
Coordination of care with a nephrologist	“So, we have to refer you to a nephrologist to sit down and talk to you about your kidneys.” (physician 5) “Yeah. So here I’m kind of reviewing the kidney, you saw the nephrologist almost 4 months ago.” (physician 3)