KID-LINK: Strengthening collaboration between
nephrologists and general practitioners in CKD care in Denmark
A proposed PhD project · Nyt Aalborg Universitetshospital · 2026–2029
Chronic kidney disease is managed primarily in general practice, yet the GP–nephrology interface remains fragmented. This proposal outlines a sequential mixed-methods PhD project to map, understand, co-develop, and pilot a strengthened model of cross-sectoral CKD collaboration in Denmark.
1Clinical rationale
Chronic kidney disease (CKD) affects approximately 10–15% of the adult population worldwide and is associated with substantial morbidity, cardiovascular complications, premature mortality, and rising healthcare costs [KDIGO 2024]. In Denmark, as in most healthcare systems, CKD detection and long-term management take place primarily in general practice. Specialist nephrology care becomes important when uncertainty arises about diagnosis, progression, treatment optimisation, or referral timing.
From my clinical work in nephrology at NAU, I observe daily that the interface between primary and specialist care is often fragmented. Common challenges include delayed referrals, low-value referrals that crowd outpatient capacity, inconsistent guideline implementation, limited feedback from specialist care to general practice, and unclear distribution of responsibilities for patients living with CKD and multimorbidity.
Denmark has structural advantages that make this problem worth studying empirically: a list-based general practice system with strong gatekeeping, near-universal coverage, and advanced national e-health infrastructure. These conditions are favourable but currently underutilised. No Danish empirical study has, to my knowledge, evaluated cross-sectoral CKD collaboration models in routine practice.
2International evidence
I have reviewed five international initiatives that inform — but cannot directly transfer to — the Danish context:
- Netherlands [11,12]: A cluster-randomised trial of web-based GP–nephrology consultation across 47 practices showed non-inferior care with one-third of planned referrals avoided.
- Spain [10]: The Salut en Xarxa coordinated-care programme combining shared EHR, structured referral channels, and continuous GP training improved referral appropriateness; nephrologists declined nearly 30% of low-risk referrals while providing structured feedback.
- Japan [8]: The JOINT-KD multicentre cohort of 570 stage-5 CKD patients found that primary-care–nephrology collaboration was associated with markedly lower infection-related hospitalisation (adjusted SHR 0.36, 95% CI 0.15–0.87), highlighting preventive value beyond kidney-specific outcomes.
- Canada [5]: An eConsult platform reduced nephrology response time from a median 111 days to 15 hours, with high acceptability across both groups.
- USA [6]: Veterans Health Administration telenephrology improved clinic attendance among rural CKD patients (72% vs 61%) with comparable clinical outcomes.
Across these studies, success depends heavily on local health-system context, professional culture, organisational design, and digital integration. Findings cannot be directly extrapolated to a Danish list-based, gatekeeping primary-care system.
3Proposed research
Overall aim: To explore, develop, and evaluate strategies to strengthen collaboration between nephrology and general practice in CKD management in Denmark.
I propose a sequential mixed-methods PhD project across four interrelated work packages, guided by the MRC Framework for developing and evaluating complex interventions [20].
WP1M7–18
Baseline mapping
Register-based description of current referral patterns, communication flows, and triage burden using Sundhedsdatastyrelsen registers and local NAU data. Audit of referral quality against six pre-defined dimensions.
WP2M7–18
Needs & experiences
Semi-structured interviews with 15–20 GPs, 5–10 nephrologists, and 10–15 patients. Reflexive thematic analysis (Braun & Clarke 2021) [18]. Purposive sampling for variation; COREQ-compliant reporting.
WP3M13–18
Co-development
2–3 participatory workshops (8–12 participants each) co-designing a flexible collaborative support model — possibly including outreach nephrology, tripartite consultations, eConsult, contact-physician arrangement, or shared templates. TIDieR-compliant intervention description.
WP4M19–30
Pilot & feasibility
Mixed-methods pilot in 4–8 Nordjylland practices (20–40 patients, 8–12 GPs, 4–8 nephrologists). Evaluated using Proctor et al. implementation outcomes framework — acceptability, appropriateness, feasibility, adoption, fidelity, cost.
Hypotheses
H1Tripartite consultations and other collaborative elements are feasible to implement in Danish general practice.
H2Strengthened collaboration improves communication, mutual role understanding, and shared decision-making across nephrology, general practice, and patients.
H3The intervention contributes to more appropriate and timely referrals and to higher professional and patient satisfaction.
4Preliminary work completed
To make this proposal concrete and to demonstrate methodological seriousness, I have completed substantial preparatory work before approaching the supervisor:
- I have conducted a focused review of the international literature on GP–nephrology collaboration models (Netherlands, Spain, Japan, Canada, USA) and synthesised the key findings and their relevance to the Danish context.
- I have developed a detailed draft research protocol covering study design, four work packages, sample sizes, ethical considerations, and a 36-month timeline. The protocol is a working document and will be refined under supervision.
- To demonstrate the methodological infrastructure this project will require, I have developed a prototype digital research platform (KID-LINK) incorporating: a live transcription tool with speaker tagging for qualitative interviews; a CKD staging calculator aligned with KDIGO 2024; structured field notes for observational work in the pilot; a tripartite-consultation checklist; semi-structured interview guides for all three stakeholder groups; a participant questionnaire; a Danish/English consent form generator; and a GDPR-compliant anonymisation hub. The platform is locally-processed (browser-only) and pseudonymous by design — no data leaves the researcher's device.
What this preliminary work shows: rigorous research infrastructure and a clearly articulated study design developed proactively. With supervisory support, the project is ready to proceed to formal ethical approval (VEK, DPO, Datatilsynet) and funding applications.
5What I am seeking from a supervisor
- Scientific guidance across all four work packages, with particular input on register-based methodology (WP1) and qualitative analysis (WP2)
- Support with formal PhD enrollment at Aalborg University (AAU) or an equivalent academic anchor
- Assistance with funding applications — Region Nordjylland Forskningsfonden, Nyreforeningen, Novo Nordisk Foundation (clinical research grants), and other relevant Danish sources
- Network access to participating GP practices in Nordjylland — particularly for WP4 pilot recruitment
- Co-authorship on the planned three peer-reviewed publications and on the PhD thesis
6Timeline overview
| Period | Milestones |
|---|
| M1–6 | VEK, DPO, Datatilsynet, and Sundhedsdatastyrelsen approvals · data management plan · stakeholder structures · pre-registration (OSF) |
| M7–12 | WP1 baseline analyses begin · WP2 recruitment and first interviews |
| M13–18 | WP2 completion · synthesis · WP3 co-design workshops · first manuscript |
| M19–30 | WP4 pilot implementation in 4–8 practices · interim feedback · second manuscript |
| M31–36 | Final analyses · integration across WPs · thesis · stakeholder workshop · third manuscript |
Pending funding and enrollment confirmation. The timeline assumes a 36-month full-time PhD position aligned with my anticipated hoveduddannelse trajectory in nephrology. Both will require formal arrangement with the supervisor and the relevant institutional bodies.
7References
[5]Boni L, et al. Improving access to nephrology care through eConsult integration: a Canadian pilot study. J Telemed Telecare. 2019;25(7):400–7.
[6]DeNicola L, et al. Telenephrology improves adherence and access to kidney care for rural veterans. Am J Nephrol. 2016;44(2):103–10.
[8]Murakami M, Aoki T, Sugiyama Y, et al. Association between primary care physician–nephrologist collaboration and clinical outcomes in patients with stage 5 CKD: a JOINT-KD cohort study. J Nephrol. 2025;38:1385–94.
[10]Sanz AB, et al. Results of coordination and shared clinical information programme between primary care and nephrology. Nefrologia. 2011;31(3):322–30.
[11]van Gelder VA, et al. Effect of a web-based consultation platform (telenephrology) on the rate of referrals in primary care: a cluster randomized controlled trial. J Med Internet Res. 2018;20(3):e106.
[12]van Gelder VA, et al. Web-based consultation between general practitioners and nephrologists: a prospective study in the Netherlands. Ann Fam Med. 2013;11(2):151–6.
[18]Braun V, Clarke V. Thematic Analysis: A Practical Guide. London: SAGE; 2021.
[20]Skivington K, Matthews L, Simpson SA, et al. A new framework for developing and evaluating complex interventions: update of MRC guidance. BMJ. 2021;374:n2061.
[KDIGO]Kidney Disease: Improving Global Outcomes (KDIGO). Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024.
A full reference list of 22 Vancouver-style citations is available in the project protocol and in the KID-LINK platform's References page.
⚠ Fortroligt — kun til eget brug · Tag IKKE dette ark med til mødet
Mødenoter — vejledermøde
Disse noter er til dig selv. Læs dem inden mødet, lad dem ligge i tasken under mødet. Snak naturligt — du behøver ikke følge dem ord for ord.
Hvad jeg vil sige indledningsvis~1 min
- Kort om mig: jeg er læge i intro stilling i nefrologi her på NAU, har afsluttet KBU og afventer kontrakt på 5-årig hoveduddannelse.
- "Jeg har tænkt meget over GP–nefrologi-samarbejdet i mit kliniske arbejde, og jeg vil gerne præsentere et projektudkast for dig."
- "Jeg har lavet en del forarbejde — protokoludkast, litteraturgennemgang, og en digital forskningsplatform — fordi jeg ville komme forberedt og ikke bare med en idé."
- Tone: rolig, ikke nervøs. Du har lavet seriøst arbejde — det skal mærkes.
Det kliniske problem jeg ser i hverdagen~3 min
- Konkrete eksempler — vælg 2–3 du selv har oplevet:
- Mangelfulde henvisninger uden eGFR-trend, aktuel medicinliste, eller klart spørgsmål → triage tager unødigt lang tid.
- Henvisninger der bliver afvist eller returneret med behov for yderligere oplysninger → ventetid for patienten, ekstra arbejde for begge sider.
- GP'er der ikke ved hvornår de skal henvise — for tidligt eller for sent.
- Patienter der kommer til ambulatoriet uden at GP'en har optimeret medicinen først (RAAS, SGLT2i).
- Manglende feedback fra os tilbage til GP'en når vi har set patienten — de står med samme spørgsmål næste gang.
- Konsekvensen for patienterne: fragmenteret forløb, forsinket behandling, mindre kontinuitet, særligt for ældre med multimorbiditet.
Hvad jeg har gjort hidtil~5 min · vis platformen
- Litteraturgennemgang af 5 landes erfaringer: Holland (telenefrologi-RCT), Spanien (Salut en Xarxa), Japan (JOINT-KD-kohorte), Canada (eConsult), USA (VA-telenefrologi).
- Udkast til protokol: 4 arbejdspakker, 36 måneder, MRC-framework 2021, KDIGO 2024.
- Udviklet en digital forskningsplatform — KID-LINK_Platform.html — som demonstration af den metodiske infrastruktur projektet kræver.
- [Åbn laptop her] Vis kort:
- Landingssiden med 4 arbejdspakker og international evidens
- WP3 scrollytelling — den tripartite konsultation som ét designforslag
- CKD-kalkulatoren (KDIGO 2024)
- Live-transcription med taler-tagging
- Anonymiseringshub'en med pseudonym-generator
- Vigtigt: præsenter platformen som et redskab, ikke som et færdigt projekt. "Det her er den infrastruktur jeg har brug for — det er ikke selve forskningen."
Hvad jeg søger fra dig som potentiel vejleder~2 min
- Vejledning og akademisk forankring — særligt på register-metodologi (WP1) og kvalitativ analyse (WP2).
- Hjælp til at formalisere projektet: AAU-tilknytning, etisk godkendelse (VEK), DPO, Datatilsynet, Sundhedsdatastyrelsen.
- Hjælp til finansieringsansøgninger — Region Nordjylland Forskningsfonden, Nyreforeningen, Novo Nordisk Fonden.
- Din erfaring med tværsektorielt samarbejde i Region Nordjylland — kontakter i almen praksis vi kunne tale med tidligt.
- Medforfatterskab på de tre planlagte publikationer.
Spørgsmål jeg vil stille hende
- Hvordan ser du fundinglandskabet for et projekt som dette i Region Nordjylland?
- Hvilke samarbejdspartnere i almen praksis ville du anbefale at kontakte tidligt?
- Hvad er din erfaring med at forankre et PhD-projekt i en hoveduddannelse — har du set det fungere?
- Hvad er de vigtigste første skridt — formelt og praktisk — hvis vi går videre?
- Hvilke bekymringer eller svagheder ser du ved projektet som det ligger nu?
- Er du åben for at diskutere en formel vejledningsrolle, hvis vi finder den rette ramme?
⚠ Hvad jeg IKKE siger (påmindelser til mig selv)
- Ikke oversælg — platformen er et redskab og en demonstration, ikke et afsluttet projekt.
- Lov ikke data vi ikke har. Der er ingen rigtige patienter, ingen interviews, ingen registeranalyser endnu.
- Nævn ikke AI eksplicit medmindre hun spørger direkte. Beskriv arbejdet som "protokoludvikling og litteraturgennemgang" og platformen som "egen udvikling som forberedelse".
- Vær ærlig om at jeg er tidlig i karrieren — det er en styrke, ikke en svaghed, at jeg er forberedt på dette stadie.
- Lad være med at love tidsplaner jeg ikke kan holde. "Pending funding and enrollment" er en helt acceptabel ramme.
- Hvis hun udfordrer noget — sig "godt spørgsmål, lad mig tænke over det" frem for at improvisere et svar.
Husk: målet med mødet er ikke at få en kontrakt på dagen. Målet er at hun siger "jeg vil gerne mødes igen om to uger og tale om hvordan vi kommer videre". Det er et langt forløb — første skridt er at vise at jeg er en seriøs, forberedt og samarbejdsvillig kandidat.
KID-LINK Protocol —
Platform Integration Summary
An addendum to the draft protocol (protokol_3.pdf, 17 pages), mapping each scientific element to its operational implementation in the KID-LINK research platform.
The draft KID-LINK protocol describes the scientific basis of the project — its background, four work packages, hypotheses (H1–H3), research questions (RQ1–5), sample sizes, ethical framework, and 36-month timeline. The KID-LINK research platform operationalises this protocol as a digital research infrastructure: each protocol element is supported by a specific tool that can be used during data collection, analysis, and reporting.
This document is intended as a one-page reference for supervisors, ethics reviewers, and collaborators who want to understand how the platform aligns with the underlying study design.
▸Mapping table
| Protocol element | Platform implementation |
|---|
| WP2 semi-structured interviews |
Interview guides tool — three role-specific topic guides (GP, nephrologist, patient) with opening prompts, main topics, probes, and closing questions |
| WP2 thematic analysis preparation |
Live transcription with speaker tagging (GP / nephrologist / patient / observer) and theme markers · field notes tool with four observational foci |
| WP4 TC observation |
Tripartite consultation checklist (10–30–10 structure across pre / consultation / debrief) · field notes tool |
| WP4 acceptability measurement |
Participant questionnaire — three role-specific instruments (patient, GP, nephrologist) with 1–5 ratings and open responses |
| WP4 spillover tracking |
Spillover log — secondary outcome capture for collaborative learning transferred to non-participating patients |
| Patient eligibility assessment |
CKD calculator — KDIGO 2024 staging from eGFR and uACR, with albuminuria category (A1/A2/A3) and protocol-aligned eligibility note |
| Informed consent (GDPR) |
Consent form generator — Danish/English templates, pseudonymised, with optional audio-recording and observation consent items |
| Scheduling (WP2 / WP3 / WP4) |
Session scheduler — calendar view for interviews, co-design workshops, and pilot tripartite consultations |
| Data anonymisation |
Anonymisation hub — KL-XX-### pseudonym generator · identifier scanner (CPR, phone, email, dates) · 30-minute auto-wipe |
| Print / handout materials |
Print & PDF tool — protocol summary, consent form, TC checklist, case-report form, all A4-ready |
| Reference base |
22 Vancouver-style references aligned with KDIGO 2024, MRC 2021, and Braun & Clarke 2021 |
▸Privacy and data architecture
- Browser-only processing. All tools run client-side in the researcher's browser. No data is transmitted to any external server.
- Pseudonymous by design. Participant identities are represented only as KL-XX-### IDs (e.g. KL-PT-012, KL-GP-005). The link between pseudonym and real identity is held separately in the institutional secure environment, never in this platform.
- Local storage with auto-wipe. Session data is held in browser localStorage (obfuscated, not encrypted) and automatically wiped after 30 minutes of inactivity, with a 2-minute warning.
- Manual wipe. The Anonymisation Hub provides a one-click full data wipe at any time.
- Identifier scanner. Pattern-based detection of common identifiers (CPR, Danish phone numbers, email addresses, date formats, postal codes, capitalised name pairs) to support manual anonymisation review.
▸Status and limitations
The platform is a preliminary research infrastructure developed to demonstrate methodological readiness ahead of formal PhD enrollment, ethical approval, and funding confirmation. It is not yet an approved data-collection instrument under any regulatory framework.
Before any participant data is entered into the platform in a real research context, the following must be in place:
- Approval from Videnskabsetisk Komité (VEK) for relevant interview, observational, and pilot components
- Approval from the institutional Data Protection Officer (DPO) at NAU / Region Nordjylland
- Datatilsynet notification of data processing activities
- Sundhedsdatastyrelsen permission for register-based access (WP1)
- A written data management plan aligned with FAIR principles and institutional retention policies
Bottom line: the platform is a tool, not a deliverable. Its purpose is to demonstrate that the researcher can develop and reason about the methodological infrastructure a project of this scale will require — and to provide a usable scaffold for the actual research once formal arrangements are in place.