KID-LINK · PhD research · 2026–2029 · Nyt Aalborg Universitetshospital

Strengthening
collaboration
in CKD care

A three-year PhD research project across four interrelated work packages — mapping current collaboration, exploring professional perspectives, co-developing a collaborative support model, and piloting its feasibility in routine Danish general practice and nephrology care. Previously known as Kiss the Frog, the project was renamed KID-LINK to reflect its cross-sectoral bridging ambition.

Explore the four WPs
KID-LINK at a glance
A sequential
mixed-methods study
4
Work packages
Interrelated WPs
CKD 3–5
Adult population
Focus on 3b–4
36
Months
2026–2029
MRC 2021
Framework
Complex interventions
WP1 Baseline mapping
WP2 Needs & experiences
WP3 Co-development
WP4 Pilot & feasibility
Why Denmark, why now

The Danish
healthcare context

International studies of GP–nephrology collaboration have been conducted in the Netherlands, Spain, Japan, Canada, and the United States. Their findings are promising but cannot be directly extrapolated to Denmark. Danish general practice is list-based: almost every citizen is registered with a specific GP who acts as first-line provider and coordinator of care.

This strong gatekeeping role, combined with advanced national digital infrastructure and a tightly organised specialist sector, creates favourable conditions for cross-sectoral CKD care — but does not in itself ensure coordinated clinical pathways. Empirical knowledge about current nephrology–primary care collaboration in Denmark remains limited.

List-based GP registration Strong gatekeeping Universal coverage Advanced e-health infrastructure Regional organisation of specialist care Sundhedsdatastyrelsen registers
International evidence

What works abroad,
studied at home

Five countries have demonstrated that structured GP–nephrology collaboration can improve referral quality, communication efficiency, and provider satisfaction. No Danish study has yet evaluated the feasibility of cross-sectoral CKD collaboration models in routine practice — KID-LINK addresses that gap.

Netherlands
Telenephrology RCT
Web-based GP–nephrology consultations proved non-inferior to conventional care in a cluster-randomised trial; roughly one-third of planned referrals were avoided.
van Gelder et al. 2018
Relevant for WP3: digital consultation channels as a possible collaborative support element
Read the full study →
Spain
Salut en Xarxa
Coordinated-care programme linking primary care and nephrology via shared EHR, structured channels, and continuous GP training. Improved referral appropriateness and prioritisation.
~30% referrals declined
Relevant for WP3: shared templates and continuous GP education as model components
Read the full study →
Japan
JOINT-KD cohort
Multicentre cohort of 570 stage-5 CKD patients. Collaboration did not delay dialysis initiation but was associated with markedly lower infection-related hospitalisation.
SHR 0.36 [0.15–0.87]
Relevant for WP4 outcomes: preventive-care value of ongoing collaboration
Read the full study →
Canada
eConsult integration
Integrated eConsult platform reduced nephrology response time from a median of 111 days to 15 hours. High feasibility and acceptability among GPs and nephrologists.
15 h vs 111 days
Relevant for WP3: online case-based consultations as a model option
Read the full study →
USA
VA telenephrology
Veterans Health Administration programme for rural CKD patients improved clinic attendance from 61% to 72% while delivering clinical outcomes comparable to face-to-face care.
72% vs 61% attendance
Relevant for WP3: outreach nephrology and equity-of-access arguments
Read the full study →

Effects on patient-level outcomes remain mixed across the literature, and success depends heavily on local health-system context, professional culture, organisational design, and digital integration. KID-LINK tests these conditions in the Danish setting.

Study design

Four work packages,
one trajectory

A sequential mixed-methods design, guided by the Medical Research Council Framework for developing and evaluating complex interventions (Skivington et al., BMJ 2021). Findings from WP1 and WP2 inform the intervention co-developed in WP3, which is pilot-tested in WP4.

WP1Baseline mapping
Current collaboration & referral quality
Register-based analysis, audit of referrals, descriptive mapping of cross-sectoral practice. Specialist perspective on referral volume, completeness, and triage burden.
Register dataReferral auditM7–18
WP2Exploration
Needs & experiences across stakeholders
Semi-structured interviews with 15–20 GPs, 5–10 nephrologists, 10–15 patients. Optional focus groups and GP survey. Purposive sampling for variation.
QualitativeThematic analysisM7–18
WP3Co-development
Collaborative support model
2–3 participatory workshops (8–12 participants each). Flexible model adapted to local needs — may include outreach visits, online case consultations, tripartite consultations, a contact-physician arrangement, shared templates, or education.
Co-designTIDieRM13–18
WP4Pilot & feasibility
Pilot implementation in routine practice
Pilot in a defined setting (may include Vendsyssel). 4–8 practices, 1–2 nephrology departments, 20–40 patients, 8–12 GPs, 4–8 nephrologists. Mixed-methods evaluation.
FeasibilityAcceptabilityM19–30
DANISH HEALTHCARE CONTEXT List-based GP system · Gatekeeping · Digital infrastructure WP1 Baseline mapping Register + referral audit WP2 Exploration Needs & experiences WP3 Co-development Support model WP4 Pilot & feasibility 4–8 practices Thesis & scale-up Practice recommendations iterative refinement
Click any WP node to open full details
WP3 design options

The tripartite
consultation option

One of several collaborative support elements that may emerge from WP3 co-design. The tripartite consultation brings a nephrologist into the GP practice for a joint meeting with the GP and the patient — sometimes described as the Specialist on the Move model. A 10–30–10-minute structure has been used in earlier Danish cross-sectoral pilots and may inform the KID-LINK co-design workshops.

10 min · Pre
30 min · TC
10 min · Debrief
10:00
Pre-meeting
Preparing
GP
General practitioner
Host · primary carer
Active
Ne
Nephrologist
Consultant visitor
Reviewing
Pt
Patient
Active participant
Waiting
Reviewing the latest eGFR trend, albumin-creatinine ratio, potassium, bicarbonate, and full medication list. The GP crystallises a specific clinical question for the nephrologist.
Illustrative labs
32
eGFR
5.4
K⁺ mmol/L
85
uACR mg/mmol
Pre-meeting: labs under review (KDIGO 2024 interpretation)
10 min · Pre-meeting

One question,
crystallised

The GP and nephrologist meet briefly before the patient enters. The GP has reviewed the laboratory data and arrives with one specific clinical question — for example, whether to continue an SGLT2 inhibitor as eGFR falls into the low 30s. The pre-meeting is where clinical uncertainty is translated into a shared professional agenda.

30 min · Consultation

Three voices,
one decision

The patient is active — not merely present. The nephrologist contributes specialist interpretation of laboratory trajectories, the GP contributes longitudinal context, and the patient contributes what matters most to them. The qualitative research lens attends to how authority shifts when the specialist enters the GP's space, and how the patient's voice is accommodated.

An observational focus of WP4 research: who chairs the consultation, and does the GP's authority reassert itself in the debrief?
10 min · Debrief

Where clinical
learning is consolidated

Explicit task allocation (who adjusts the RAAS inhibitor? who follows up the labs?), an educational recap applicable to similar CKD patients in the GP's caseload, and a brief reflective exchange on the dynamics of the encounter. GPs in earlier Danish pilots have reported applying debrief learning to other CKD patients who never participated in a tripartite consultation.

Other WP3 model options may include: nephrology outreach or sparring visits to general practice · online case-based consultations between nephrologist and GP · a designated nephrology contact-physician arrangement · shared templates or documentation tools · structured educational or case-based support. The final model will emerge from WP3 co-design workshops with participating clinicians and patient representatives.
Role portals

Everyone has
their own entrance

Five role-specific portals provide the resources, responsibilities, and guidance relevant to each stakeholder group. Click any card to open the detailed portal.

Supervisor / PI
Protocol governance and publication strategy
Research aims · Publication plan · Ethics & approvals
Open portal →
Nephrologist
Specialist input for collaborative CKD care
Role & consultative posture · Clinical focus · Co-design participation
Open portal →
General practitioner
Host and coordinator of continuity care
Role & context expertise · Patient selection · Preparing for a TC
Open portal →
Patient
Your care, your voice, your choice
What is a TC? · Your preparation · Your rights & consent
Open portal →
Research team
Methods, reflexivity, analysis
Thematic analysis · Observational framework · Reflexivity
Open portal →
Platform tools

Everything you need,
in one place

The platform's research toolkit — all processing is local, all data is pseudonymous, no information leaves your browser.

Live transcription
Real-time speech-to-text with speaker tagging, timestamps, theme markers, and pseudonymised export
CKD calculator
eGFR + uACR → KDIGO 2024 stage + albuminuria category + study eligibility
TC checklist
Interactive 10-30-10 checklist with progress tracking
Field notes
Structured observation notes with timestamped entries and export
Session scheduler
Calendar for interviews, workshops, and pilot sessions
Participant questionnaire
Structured instruments for patient, GP, and nephrologist perspectives — all responses fully pseudonymised
Spillover log
Record when collaborative learning transfers to patients who did not directly participate
Medication reference
Educational reference on CKD pharmacotherapy — KDIGO 2024
Consent generator
Generate pseudonymised consent forms in Danish or English
Print & PDF
Print-ready protocol, consent, checklist, questionnaire
Simulation engine
Generates 15 synthetic patients, 5 GPs, 5 nephrologists and simulates referrals, responses, and tripartite consultations — for testing platform workflows. Uses your own Claude API key
Synthetic data generator
Generate fictional patient, GP, and nephrologist profiles for testing — uses your own Claude API key
Qualitative coding tool
Structured instruments for patient, GP, and nephrologist perspectives — all responses fully pseudonymised
Meeting documents
Structured documents for supervisor meetings — protocol status, decisions log, next steps
Referral toolkit
Structured referral builder with required-field checks, a curbside consult log, and a TC eligibility checklist — built from patterns observed in the simulation runs
Project timeline

Three years,
four work packages

The PhD project runs over a three-year period (2026–2029). The timeline below summarises the planned milestones for each phase. Exact dates depend on ethical and data-protection approvals, funding, and recruitment pace.

Dissemination
Three peer-reviewed publications (one per main phase), conference presentations, feedback sessions with participating practices, and a final stakeholder workshop.
Setup
Months 1–6
Approvals & infrastructure
Obtain VEK, DPO, and Datatilsynet approvals. Finalise the data management plan following FAIR principles. Establish supervisory and stakeholder structures. Prepare quantitative and qualitative data collection. Register the study protocol (e.g. OSF).
WP1 + WP2 begins
Months 7–12
Baseline analyses & first interviews
Conduct baseline quantitative analyses (WP1) using Sundhedsdatastyrelsen registers and local referral data. Begin qualitative recruitment and interviews (WP2). Initiate specialist and GP mapping of current collaboration.
WP2 completion + WP3
Months 13–18
Synthesis & co-design
Complete WP2 data collection and analysis. Synthesise findings to inform intervention design. Conduct co-design workshops (WP3) with clinicians and patient representatives. Develop a TIDieR-compliant intervention description.
WP4 pilot
Months 19–30
Pilot implementation
Implement pilot activities (WP4). Monitor feasibility and collect process data (activity logs, case-report forms, post-event surveys). Conduct interim feedback and iterative refinement of the model.
Integration
Months 31–36
Final analyses & thesis
Complete final analyses. Integrate findings across work packages. Finalise manuscripts and thesis. Conduct dissemination activities including the final stakeholder workshop.
Get in touch

Interested in
participating?

We're actively recruiting for the four work packages. Whether you're a GP practice considering participation, a patient with questions, or a colleague interested in collaboration — we'd be glad to hear from you.

Primary contact
kid-link@example.com
PhD researcher · Department of Nephrology, NAU · placeholder — confirm before launch
Institution
Nyt Aalborg Universitetshospital
Department of Nephrology · Nordjylland Region
Pilot recruitment
WP4: 4–8 GP practices in Nordjylland
Recruitment opens 2027 · pilot period 2027–2028
Express your interest

Fill in your details below and your email client will open with a pre-filled message. All form fields are optional. No data is sent or stored by the platform.

Anonymous mode
KID-LINK research platform

Welcome to your research workspace

All tools process data locally and anonymously. Nothing leaves your browser. Use the sidebar to navigate by work package, role, or tool — or search at the top.

4
Work packages
36
Months project duration
0
Scheduled sessions
0%
Checklist completion

Work packages

WP1M7–18
Baseline mapping & referral audit
Register-based description of current nephrology–general practice collaboration. Audit of referral quality, completeness, and triage burden.
WP2M7–18
Needs & experiences
Qualitative interviews with GPs, nephrologists, and patients. Identify barriers, facilitators, and preferences for a collaborative support model.
WP3M13–18
Co-development
Participatory workshops to co-design the collaborative support model. Output: a TIDieR-compliant intervention description ready for piloting.
WP4M19–30
Pilot & feasibility
Pilot the co-developed model in 4–8 practices. Mixed-methods evaluation of feasibility, acceptability, and perceived impact.

Quick actions

🎙️ Start a transcription
Open the live transcription tool and begin recording a consultation, interview, or workshop. Real-time speaker tagging, timestamps, and theme markers.
🧮 CKD calculator
Enter eGFR and uACR to classify the patient by KDIGO 2024 stage and albuminuria category. Discuss with the GP/nephrologist team.
📅 Schedule a session
Plan an interview, co-design workshop, or pilot tripartite consultation. All entries are local to your browser.
GDPR & local-only processing: Every tool in this platform runs entirely in your browser. No audio, text, or metadata is transmitted to any external server. Pseudonymous IDs (KL-XX-000) are the only identifiers stored.
Platform is a research scaffold: This platform supports the conduct of the KID-LINK study but is not itself a data-collection or regulatory instrument. Final clinical data and consent forms must follow institutional procedures at Nyt Aalborg Universitetshospital.
WP1 Months 7–18

Baseline mapping of current collaboration

A quantitative, register-based description of referral patterns, communication practices, and role distribution between nephrology and general practice in CKD care — with particular focus on the specialist perspective on referral quality and triage burden.

Objectives

  • Describe current referral patterns from general practice to nephrology in Nordjylland Region
  • Characterise nephrologists' experience of current collaboration, referral quality, and workload
  • Quantify the triage burden on nephrology departments
  • Identify variation across practices, demographics, and CKD stages

Referral audit — six dimensions

DimensionOperational definitionSource
QualityStructured assessment against pre-defined criteria (relevant clinical question, adequate clinical reasoning, appropriate urgency level)Audit rubric · 2 raters, Cohen's κ
RelevanceIs the referral clinically indicated given current KDIGO 2024 guidance and regional referral criteria?Audit rubric
CompletenessPresence of minimum data: eGFR trajectory, albuminuria, current medications, comorbidities, reason for referralChecklist-based audit
VolumeNumber of referrals per 1,000 registered patients per practice per yearOutpatient contact register
Rejection / redirectionFrequency of rejection, redirection to other specialty, or request for additional informationLocal triage log
Triage timeMinutes of nephrologist time per referral (triage, information request, acceptance/rejection)Prospective time-use log (optional)

Data sources

National & regional
Sundhedsdatastyrelsen registers · Danish National Patient Register (LPR3) · Regional clinical laboratory data (Labka) · Outpatient activity data · Optional: Statistics Denmark linkage
Local (NAU)
Referral letters and clinical correspondence · Outpatient contact data · Triage logs · Nephrology ward activity data · Optional survey of nephrologists on perceived collaboration

Outcomes

Primary
• Time from confirmed CKD to first nephrology contact
• Referral completeness (% with minimum data set)
• Referral appropriateness (% accepted without need for further information)
Secondary
• Hospitalisation rates (cardiovascular, infection-related)
• Variation across practices and patient subgroups
• Nephrology time-use per referral
Analytic approach: Descriptive statistics with 95% CIs; regression models adjusting for age, sex, comorbidity; funnel plots for practice-level variation. All analyses pre-specified in a statistical analysis plan.
WP2 Months 7–18

Exploring needs & experiences across stakeholders

Qualitative research with GPs, nephrologists, and patients to explore experiences of current collaboration, perceived barriers and facilitators, and preferences for a strengthened support model.

Sample & purposive sampling

Participant groupTarget nSampling variation
General practitioners15–20Geography · practice size · years in practice · special interest in CKD
Nephrologists5–10Seniority · subspecialty (general neph, transplant, dialysis)
Patients with CKD 3–510–15CKD stage · comorbidity · age · experience of referral
Optional GP survey60–100Regional electronic survey if qualitative findings warrant quantification

Methods

  • Semi-structured interviews (45–60 min) using topic guides developed from WP1 findings and literature
  • Optional focus groups if triangulation needed (e.g. mixed GP/nephrologist group to explore collaborative preferences)
  • Reflexive thematic analysis (Braun & Clarke, 2021), data-driven and theoretically informed
  • Dual coding of a subsample by supervisor; coding framework iteratively refined
  • COREQ checklist for reporting of qualitative findings
  • Reflexive memos throughout to attend to researcher positionality

Topic areas explored

With GPs
Need for nephrology sparring · preferences for forms of sparring and teaching · access satisfaction · referral opportunities · telephone support · self-assessed knowledge gaps · contact-physician arrangement · willingness to pilot
With nephrologists
Referral quality experience · triage burden · perceived communication gaps · educational needs · willingness to participate in outreach or shared-care models · organisational constraints
With patients
Experience of cross-sectoral care · preferences for specialist involvement · care-close-to-home values · communication gaps · role in decision-making
Output: A stakeholder-informed needs assessment identifying key barriers, facilitators, preferences, and practical requirements for a strengthened collaboration model — directly feeding into the co-design phase (WP3).
WP3 Months 13–18

Co-developing a collaborative support model

Rather than locking the intervention to one format from the outset, WP3 develops a flexible model adapted to local needs. Co-design is participatory, iterative, and anchored in findings from WP1 and WP2.

Possible model elements

The final intervention will be decided through co-design. It may include one or more of the following:

🏥 Nephrology outreach / sparring visits
A nephrologist visits the GP practice for case discussions or teaching sessions
💻 Online case-based consultations
GP–nephrologist consultations via secure video/eConsult platform
👥 Tripartite consultations (TCs)
Joint 10–30–10-minute meeting with patient, GP, and nephrologist (Specialist on the Move model)
📞 Contact-physician arrangement
A designated nephrology contact for each participating general practice
📋 Shared templates & documentation
Structured referral templates, shared care plans, standardised follow-up
🎓 Educational & case-based support
Structured teaching, online learning modules, case discussions

Co-design process

WorkshopFocusParticipants
Workshop 1Present WP1/WP2 findings · prioritise needs · identify candidate model elements8–12: GPs, nephrologists, patient representatives, research team
Workshop 2Develop detailed workflows · draft eligibility criteria · identify implementation barriers8–12: same core group ± additional stakeholders
Workshop 3 (optional)Refine model after pilot feedback · finalise implementation proceduresCore group + pilot practice representatives

Reporting frameworks

  • TIDieR (Template for Intervention Description and Replication) — detailed intervention description
  • GRIPP2 — reporting of patient and public involvement
  • Theory of change — explicit logic model linking inputs, activities, outputs, and expected outcomes
Output: A co-designed collaborative support model with clear implementation procedures, eligibility criteria, communication protocols, and supporting documentation — ready for pilot testing in WP4.
WP4 Months 19–30

Piloting the model — feasibility & acceptability

A mixed-methods pilot evaluation in a defined setting (Nordjylland, possibly Vendsyssel). The primary aim is not effectiveness but feasibility: can this model be delivered in routine practice, and is it acceptable to those who use it?

Setting & sample

Participant groupTarget nRecruitment
GP practices4–8Expression-of-interest · purposive selection for variation
Nephrology departments1–2NAU + possible secondary site
Patients (CKD 3–5, focus 3b–4)20–40Via participating GPs with clinically relevant need for shared care
Participating GPs8–12Within the 4–8 pilot practices
Participating nephrologists4–8Within the 1–2 departments

Feasibility framework

Evaluation is anchored in Proctor et al.'s (2011) implementation outcomes framework, adapted for a feasibility study:

Acceptability
Do GPs, nephrologists, and patients find the model agreeable, satisfying, useful?
Appropriateness
Is the model perceived as relevant and compatible with routine practice?
Feasibility
Can the model actually be carried out within existing clinical workflows?
Adoption
What proportion of eligible practices and clinicians take up the model?
Fidelity
To what extent is the model delivered as designed (per TIDieR)?
Cost
Exploratory estimation of time use and resource implications

Data collection methods

  • Activity logs & case-report forms — one per TC / consultation / sparring event
  • Brief post-event surveys — immediate acceptability ratings from all three parties
  • Follow-up interviews — with participating GPs, nephrologists, and a subset of patients at pilot end
  • Pre/post referral audit — comparing referral volume and quality before and after the pilot in participating practices
  • PROM/PREM measures (patient-reported outcome and experience measures) — to capture patient perspective (research extension, not protocol mandate)
  • Observational field notes — selected TCs observed ethnographically by researcher

Success criteria

Better and more relevant referrals · fewer unnecessary referrals · increased GP satisfaction · high specialist acceptability · improved clarity of collaboration · feasibility within ordinary clinical workflows
Output: Feasibility and implementation data, including practice-based recommendations for future scale-up, refinement, or larger intervention studies.
Research questions & hypotheses

The questions driving KID-LINK

Five research questions and three hypotheses underpin the PhD project. Each question is addressed by one or more work packages.

Research questions

RQ1 · Current distribution of responsibilities
How are responsibilities, communication processes, and referral pathways currently distributed between nephrology and general practice in CKD care in Denmark?

Addressed by: WP1 (quantitative baseline) + WP2 (qualitative exploration)

Approach: Register-based descriptive mapping combined with qualitative description of perceived role distribution from nephrologist and GP interviews.

RQ2 · Barriers & facilitators
What barriers and facilitators do nephrologists and GPs perceive in relation to effective cross-sectoral collaboration in CKD management?

Addressed by: WP2

Approach: Reflexive thematic analysis of semi-structured interviews. CFIR 2.0 (Consolidated Framework for Implementation Research) used as an analytic lens to structure findings across inner/outer setting, individual, and process domains.

RQ3 · Co-design of a support model
How can a structured model for tripartite consultations (or other collaborative elements) be co-developed and implemented in Danish general practice?

Addressed by: WP3

Approach: Participatory co-design workshops. Explicit use of TIDieR for intervention description, theory of change for logic modelling, and GRIPP2 for PPI reporting.

RQ4 · Experiences of the pilot model
How do nephrologists, GPs, and patients experience tripartite consultations, and which organisational conditions support or hinder their use?

Addressed by: WP4

Approach: Post-pilot semi-structured interviews, post-event surveys, and observational field notes from selected TCs. CFIR framing of organisational conditions.

RQ5 · Feasibility, acceptability, and impact
What is the feasibility, acceptability, and perceived impact of tripartite consultations on communication quality, referral appropriateness, and continuity of CKD care?

Addressed by: WP4 (mixed methods)

Approach: Proctor et al. (2011) implementation outcomes framework — acceptability, appropriateness, feasibility, adoption, fidelity, cost. Pre/post comparison of referral quality in participating practices.

Hypotheses

H1 · Feasibility
Tripartite consultations between nephrologists, GPs, and patients are feasible to implement in Danish general practice settings.
H2 · Communication & shared decision-making
Tripartite consultations improve communication, mutual understanding of roles and responsibilities, and shared decision-making across nephrology, general practice, and patients.
H3 · Referrals & satisfaction
Strengthened collaboration through tripartite consultations contributes to more appropriate and timely referrals, improved continuity of care, and higher professional and patient satisfaction.
Outcomes by work package

What we measure, and why

A structured overview of primary and secondary outcomes for each work package. Primary outcomes drive the main analyses and publications; secondary outcomes provide triangulation and depth.

WP1Baseline mapping

Primary outcomes

  • Time from confirmed CKD to first nephrology contact
  • Referral completeness (% with minimum data set)
  • Referral appropriateness (% accepted without further information request)

Secondary outcomes

  • Selected hospitalisations (cardiovascular, infection-related) if feasible
  • Practice-level variation in referral volume
  • Nephrology time-use per referral
WP2Exploration

Qualitative outcomes (themes)

  • Experiences of current collaboration across sectors
  • Role understanding and perceived boundaries
  • Barriers and facilitators (mapped to CFIR 2.0 domains)
  • Educational needs and preferences for sparring formats
  • Preferences for support models (TCs, outreach, eConsult, etc.)
  • Patient preferences regarding care pathways
WP3Co-development

Outputs

  • A co-developed collaborative support model
  • Intervention components (TIDieR-compliant)
  • Implementation procedures
  • Supporting tools and documentation templates
  • Theory-of-change diagram linking inputs → activities → outputs → outcomes
WP4Pilot & feasibility

Primary outcomes

  • Feasibility (Can the model be delivered as designed?)
  • Acceptability (Do participants find it agreeable?)
  • Participation rates (% eligible patients/practices who enrol)
  • Deliverability within routine practice workflows

Secondary outcomes

  • Perceived improvement in communication
  • Perceived clarity of roles
  • GP and nephrologist satisfaction
  • Perceived patient benefit (PROM/PREM)
  • Exploratory changes in referral quality and relevance (pre/post)
Variables & data sources

The data landscape

A structured overview of variables measured, their operational definitions, and the data sources from which they are drawn. Each variable is linked to one or more work packages.

Core patient variables

VariableOperational definitionSource
Age, sexAt baseline (first observed CKD record)CPR register
eGFRCKD-EPI 2021 equation (race-free), in mL/min/1.73 m²Labka
Albuminuria / uACRAlbumin-creatinine ratio in mg/mmol; KDIGO category A1/A2/A3Labka
CKD stageKDIGO 2024 G1–G5 based on eGFR, with albuminuria categoryDerived
ComorbidityDiabetes, hypertension, cardiovascular disease, COPD, malignancy — ICD-10 codes (via LPR3)LPR3
Medication useRelevant CKD-related prescriptions (optional sub-analysis)Prescription register

Referral & communication variables

VariableOperational definitionSource
Referral initiationBinary: was a referral sent from general practice to nephrology?Outpatient register · referral log
Time to first contactDays from confirmed CKD (per registry algorithm) to first nephrology contactDerived
Referral completenessStructured audit against minimum-data checklistAudit
Referral appropriatenessAudit per KDIGO 2024 referral criteriaAudit
Number & type of contactsOutpatient, virtual, inpatient, telephoneOutpatient register
Requests for additional informationBinary per referralTriage log
Documented shared plansPresence of cross-sector shared care planClinical correspondence

Pilot implementation variables

VariableOperational definitionSource
Completed collaborative contactsCount of delivered TCs, outreach visits, eConsults per practiceActivity log
Participation rate% eligible patients who enrol; % GPs who deliver ≥1 TCCRF
Time useMinutes per collaborative event (by role)CRF · activity log
Workflow feasibilitySelf-rated 1–5 scale + free-text barriersPost-event survey
AcceptabilitySelf-rated 1–5 scale across three partiesPost-event survey
Perceived usefulnessSelf-rated 1–5 scale + free textPost-event survey
Perceived impact on communicationPost-pilot interview themesInterview
Data management plan (DMP): Follows FAIR principles. Identifiable register extracts are stored in a secured institutional environment (forskermaskine / researcher VM). Pseudonymised datasets for analysis. Retention period defined per institutional policy and GDPR.
36-month timeline

The project year by year

Detailed month-by-month plan across the three PhD years (2026–2029). Milestones are indicative; actual dates depend on approvals and recruitment.

Months 1–6 · Setup

  • Obtain approvals: Videnskabsetisk Komité (VEK), institutional DPO, Datatilsynet register-data permission
  • Finalise the data management plan following FAIR principles
  • Register the study protocol on a public registry (e.g. OSF, ClinicalTrials.gov if applicable)
  • Establish supervisory and stakeholder structures (steering committee, advisory patient panel)
  • Prepare quantitative data extraction procedures (WP1) and qualitative topic guides (WP2)
  • Patient and public involvement (PPI) setup — identify patient representatives per GRIPP2
Milestones: All approvals obtained · study setup finalised · protocol pre-registered · PPI panel established

Months 7–12 · WP1 + WP2 launch

  • Conduct baseline quantitative analyses (WP1) using Sundhedsdatastyrelsen registers and NAU local data
  • Develop and pilot-test interview guides (WP2)
  • Begin qualitative recruitment and interviews (GPs first, then nephrologists, then patients)
  • Initiate descriptive mapping of current collaboration patterns
Milestones: Preliminary WP1 descriptive results · first interviews conducted · early coding framework established

Months 13–18 · WP2 completion + WP3 launch

  • Complete WP2 data collection, transcription, and thematic analysis
  • Synthesise WP1 + WP2 findings as input to WP3
  • Conduct co-design workshops (WP3) — workshop 1 and 2
  • Draft the collaborative support model per TIDieR
  • Submit first manuscript (WP1)
Milestones: WP2 needs assessment complete · prototype collaboration model developed · first paper submitted

Months 19–30 · WP4 pilot

  • Recruit 4–8 pilot practices and nephrology department(s)
  • Deliver the pilot model for approximately 12 months in routine practice
  • Collect activity logs, post-event surveys, and field notes ongoing
  • Conduct interim feedback and iterative refinement (potential Workshop 3)
  • Submit second manuscript (WP2)
Milestones: Pilot underway · interim feasibility findings · second paper submitted

Months 31–36 · Integration & thesis

  • Complete final WP4 analyses (pre/post audit, interviews, surveys)
  • Integrate findings across all four WPs
  • Finalise manuscripts: WP3 co-design paper, WP4 feasibility paper
  • Write the PhD thesis (synopsis + published papers)
  • Conduct dissemination: stakeholder workshop, conference presentations, practice feedback
Milestones: Thesis submitted · all manuscripts submitted or published · stakeholder dissemination completed
Ethics & approvals

Ethics, data protection, and participant rights

KID-LINK is designed to comply with the Danish Code of Conduct for Research Integrity, GDPR, and the Danish Data Protection Act. This page summarises the ethical and regulatory framework.

Approvals required

Videnskabsetisk Komité (VEK)
Regional research ethics committee. Required for interview-based and pilot intervention components. Submitted before recruitment begins.
Institutional Data Protection Officer
NAU / Region Nordjylland DPO. Approval of data processing activities and data management plan.
Datatilsynet notification
Danish Data Protection Agency. Notification of register-data processing with legal basis under GDPR Art. 9(2)(j) (research purposes).
Sundhedsdatastyrelsen
Danish Health Data Authority. Application for access to national registers for WP1.

Informed consent

  • Written and verbal information provided to all participants in interviews, workshops, surveys, and pilot activities
  • Separate consent items for: interview participation · audio recording · pseudonymised quotation in publications · follow-up contact
  • Voluntary participation with right to withdraw at any time without consequences for clinical care or professional relationships
  • Translated materials available where needed; interpreter support for non-Danish-speaking patients where feasible
  • Accessible format for patients with literacy or cognitive considerations

Data protection measures

  • Register-based data processed within secure institutional environment (forskermaskine / researcher VM) — never downloaded to personal devices
  • Interview data pseudonymised immediately upon transcription; audio files stored separately from transcripts
  • Key linking pseudonym to identity stored in a separate, access-controlled location
  • Pilot data pseudonymised at source via the platform's KL-XX-000 ID system
  • All research outputs quote pseudonyms only; any identifying detail redacted from quotations
  • Retention period and destruction schedule specified in the DMP
This platform: The KID-LINK research platform is a local tool for researchers' own work. It is not itself an approved data-collection system. All clinical and regulatory data collection must follow institutional procedures — the platform supports, but does not replace, formal documentation.
Dissemination plan

Making findings matter — publication & practice

Dissemination targets both academic and clinical audiences, with explicit feedback to participating practices and regional stakeholders.

Peer-reviewed publications

Paper 1 · Baseline
WP1 descriptive mapping of CKD referrals and collaboration patterns in Nordjylland. Target: Nephrology or primary-care journal.
Paper 2 · Stakeholder needs
WP2 qualitative study of GP, nephrologist, and patient perspectives. Target: Health services research journal. COREQ-compliant.
Paper 3 · Pilot feasibility
WP3+WP4 co-design and pilot feasibility evaluation. Target: Implementation science or primary-care journal. TIDieR + GRIPP2 compliant.

Other dissemination

  • Conference presentations — Danish Society of Nephrology, DSAM (Danish College of General Practitioners), international (ERA-EDTA, NAPCRG)
  • Stakeholder workshop — final event involving participating practices, region representatives, patient advocates
  • Practice feedback — tailored reports to each participating practice and nephrology department
  • Lay summaries — accessible findings for patient participants and the public
  • Policy brief — summary for regional health authorities and the Danish health ministry
  • Open science — code, anonymised data where possible, and reporting templates on OSF
Full protocol

The KID-LINK protocol

A structured view of the full PhD protocol. For the original PDF, contact the research team.

References

The evidence base

Vancouver-style references underpinning the protocol. All 22 references are listed below.

Research tool · Local processing only

Live transcription

Real-time speech-to-text with speaker tagging, timestamps, and theme markers. Uses the browser's Web Speech API — no audio leaves your device.

Local processing: The Web Speech API processes audio on-device. Accuracy varies by browser, microphone, and background noise. Always review transcripts before use.
Clinical tool · KDIGO 2024

CKD calculator & staging

Enter eGFR and uACR to classify the patient by KDIGO 2024 stage and albuminuria category. Eligibility assessment is a clinical judgement, not an automated output.

uACR is an albuminuria parameter (KDIGO category A1/A2/A3), not a comorbidity.

Comorbidities (per protocol)

Clinical judgement required: Whether a patient has a clinically relevant need for shared nephrology–general-practice management is a judgement call made with the GP and nephrologist — it cannot be automated. This tool supports that conversation.
Research tool · WP4 pilot

Tripartite consultation checklist

Interactive 10–30–10 checklist covering all three phases of a TC. Progress is saved locally in your browser.

Overall progress
0%
Educational reference · KDIGO 2024

CKD medication reference

Educational overview of classes of medication relevant to CKD management, aligned with the KDIGO 2024 CKD clinical practice guideline. This is a reference, not a prescribing tool.

SGLT2 inhibitors (gliflozins)
Cornerstone of CKD pharmacotherapy per KDIGO 2024

KDIGO 2024 recommends SGLT2i for adults with CKD (both diabetic and non-diabetic kidney disease) who have eGFR ≥20 mL/min/1.73 m², with initiation at the same threshold. Continue until dialysis or transplantation unless otherwise indicated.

Key evidence

  • DAPA-CKD, EMPA-KIDNEY trials — significant reductions in CKD progression and cardiovascular events
  • Benefit extends across diabetic and non-diabetic CKD populations

Practical notes

  • Expect a small, transient eGFR dip at initiation (usually <5 mL/min)
  • Monitor for euglycaemic DKA (rare), genital mycotic infections
  • Dose reduction of diuretics may be needed at initiation
RAAS inhibitors (ACEi / ARB)
Foundational therapy for CKD with albuminuria

ACE inhibitors or angiotensin receptor blockers are recommended for adults with CKD and albuminuria (particularly A2/A3), irrespective of diabetes status. Titrate to maximum tolerated dose.

Key considerations

  • Check potassium and eGFR 1–2 weeks after initiation or dose change
  • A 20–30% rise in creatinine at initiation may be acceptable; larger rises warrant investigation
  • Not combined with direct renin inhibitors; dual RAAS blockade generally avoided
Non-steroidal MRA (finerenone)
For CKD with type 2 diabetes and residual albuminuria

KDIGO 2024 suggests adding a non-steroidal mineralocorticoid receptor antagonist (finerenone) for adults with type 2 diabetes, eGFR ≥25 mL/min/1.73 m², and uACR ≥3 mg/mmol who are already on a maximally tolerated RAAS inhibitor. Monitor potassium.

Hyperkalaemia management
Enabling optimal RAAS/MRA therapy

Potassium binders (patiromer, sodium zirconium cyclosilicate) may enable continuation of evidence-based RAAS/MRA therapy in patients with mild-moderate hyperkalaemia. Dietary advice, diuretic adjustment, and review of contributing medications are first-line steps.

Lipid management
Statins for cardiovascular risk reduction

Statin therapy is recommended for adults ≥50 years with CKD not requiring dialysis. In younger adults, statins are recommended if additional CV risk factors are present. Dose adjustment per eGFR — consult local guidance.

Bone-mineral disorder (CKD-MBD)
Phosphate, calcium, vitamin D, PTH

Management of CKD-MBD becomes increasingly important from CKD stage 3b onwards. Interventions include phosphate binders, vitamin D analogues, and calcimimetics (dialysis patients). Refer to nephrology for advanced CKD-MBD management.

Educational reference only: Prescribing decisions remain with the treating clinician. Content based on KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Always consult local formulary and regional guidance.
Qualitative research tool

Structured field notes

Timestamped observational notes organised by observational focus. All notes are stored locally in your browser.

Reflexive memo

Research instrument

Participant questionnaire

Structured questionnaires for patients, GPs, and nephrologists. Instruments draw on validated scales where available; custom items developed for study-specific constructs.

Qualitative research · WP2 & WP4

Semi-structured interview guides

Topic guides for interviews with GPs, nephrologists, and patients. Each guide contains opening, main topics with probes, and closing prompts. Guides are iteratively refined as analysis progresses.

Session scheduler

Plan your sessions

Calendar for interviews, co-design workshops, and pilot TC sessions. All entries are stored locally in your browser — no calendar integration, no cloud sync.

Add session
Upcoming & past
Secondary outcome tracking

Spillover log

Record instances where learning from a tripartite consultation was later applied to other CKD patients who did not directly participate. This captures an important secondary outcome of cross-sectoral collaboration.

Print-ready documents

Print & PDF

Print-ready versions of key documents. Use your browser's print function (⌘/Ctrl + P) to generate a PDF.

Privacy-first architecture

Anonymisation hub

Generate pseudonyms, scan text for potential identifiers, and manage your local data. All processing happens in your browser.

Generate pseudonym
Format: KL-{ROLE}-{###}
Export & wipe
Export your pseudonym map (obfuscated, local keep) or wipe all platform data immediately.
Identifier scanner
Paste any text — the scanner will flag potential identifiers (CPR, phone numbers, emails, dates in common formats, named entities) so you can redact before saving.
Remember: The scanner uses pattern matching — it is not a substitute for human review. Always verify anonymisation manually before sharing any research output.