BACKGROUND: Chronic Kidney Disease (CKD) is a significant public health issue globally. Its progressive nature calls for innovative care models to mitigate disease progression and enhance patient outcomes. An interdisciplinary clinic model may offer comprehensive care tailored to the needs of CKD patients. The aim of this study is to evaluate the impact of an interdisciplinary CKD clinic on disease progression, healthcare utilization, and social determinants of health (SDOH). METHODS: We conducted a retrospective cohort study at the Mayo Clinic in Rochester, Minnesota. The study included 534 patients enrolled in the CKD clinic between March 5, 2021, and May 31, 2022, excluding those who opted out of research. The intervention involved a clinical registry and an interdisciplinary team delivering evidence-based care pathways, patient education, shared decision-making, and care coordination. The primary outcomes assessed were CKD progression and healthcare utilization, while secondary outcomes examined the impact of social determinants of health (SDOH). RESULTS: At entry, the median age was 73 (IQR 64-79), with 60% at Stage IV or lower. Clinic Implementation correlated with a 26% decrease in hospital admissions (incidence rate ratio [IRR] 0.74, 95% confidence interval [CI] 0.60-0.91, p=0.004) and a 30% reduction in emergency visits (IRR 0.70, 95 % CI 0.57-0.87, p=0.001). Nephrology consultations increased by 46% (IRR 1.46, CI 1.34-1.60, p<
0.001), reflecting enhanced specialized care. Lower exercise frequency and unemployment were linked to increased CKD progression and healthcare usage. CONCLUSION: An interdisciplinary CKD clinic supported by a registry can potentially reduce healthcare utilization among CKD patients, with SDOH playing a critical role in disease management.