Proposal to strengthen network-based care for patients with kidney disease through the implementation of HEARTS 2.0 in Chile

Chronic kidney disease represents a growing burden on health systems in the Region of the Americas, and is closely linked to hypertension, diabetes mellitus, and cardiovascular risk. This paper proposes an operational model to adapt the HEARTS 2.0 approach to network-based care for patients with kidney disease, with a view to improving early detection, cardiorenal protection, and management of the risk of disease progression in primary health care. The model is organized into three interdependent levels: primary care, functional integration through telenephrology, and specialized management in nephrology clinics and advanced renal care units. The proposed adaptation of the HEARTS drivers aims to structure processes for screening at-risk populations, stratifying the risk of progression to kidney failure, providing protocol-based treatment, ensuring continuity of care, and monitoring performance. The proposal aims to contribute to the shift from a dialysis-centered model to a preventive, integrated, risk-based strategy. Its implementation should be assessed through pilot studies to determine its feasibility, effectiveness, economic impact, and sustainability across distinct healthcare settings.