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As an important measure to improve the supply of essential health services, the implementation of hierarchical medical system has encountered obstacles in different regions. Due to different referral standards in hospitals, temporal and geographical factors during treatment, it is difficult to promote the development of regional medical consortiums. Shanghai Pudong New Area People's Hospital, together with seven community health centers, established a Chuansha Medical Consortium, specifically for treating chronic kidney disease (CKD), using an accurate hierarchical management program for CKD supported by information technology, a hierarchical diagnosis and treatment system designed based on CKD management programs recommended by relevant guidelines, a CKD knowledge base in which medical information and referral criteria are incorporated, and a joint management model integrating hospital and community care. Empirical evaluation indicated that the hierarchical diagnosis and treatment model based on a CKD knowledge base could greatly contributed to accurately identifying vulnerable and high-risk population of CKD, timely screening and assessing patients with early stage CKD, and improving the efficiency of health management and diagnosis and treatment.