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Disclosures: The authors report no relevant financial disclosures.
August 10, 2021
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Most at-risk patients not tested for kidney disease according to clinical guidelines

Disclosures: The authors report no relevant financial disclosures.
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A joint study conducted by the National Kidney Foundation and Labcorp revealed that 80.3% of patients who should have been tested for chronic kidney disease according to clinical practice guidelines did not receive appropriate testing.

The study, which determined risk based on the presence of diabetes and/or hypertension, was published in Diabetes Care.

At-risk patients not tested for kidney disease
Infographic content was derived from Alfego D, et al. Diabetes Care. 2021;doi:10.2337/dc21-0723.

"Kidneys don't get the attention they should," Joseph Vassalotti, MD, chief medical officer for the NKF and co-author on the study, said in a related press release. "Kidneys don't cough. Kidney disease is largely asymptomatic, so patients don't realize they have it. Since most people living with kidney disease are seen in a primary care setting, these professionals have an opportunity to improve kidney diagnosis that will in turn increase awareness and patient engagement and inform therapeutic interventions."

For the study, researchers first identified 28,295,982 patients who had any Laboratory Corporation of America Holdings testing ordered with diagnosis codes for diabetes and/or hypertension between 2013 and 2019 (16.2% of patients had diabetes, 63.8% had hypertension and 20.1% had both). They determined the percentage of patients who received guideline-concordant CKD assessment, which was defined as receiving both eGFR testing and urine albumin-to-creatinine ratio testing (as per guidelines from Kidney Disease: Improving Global Outcomes).

“The common eGFR test alone is insufficient for kidney disease detection,” Vassalotti said in the release. “Both the eGFR blood test for kidney function and the uACR urine test for albumin, a type of protein, should be performed at least annually for at-risk patients by primary care physicians and other clinicians who manage diabetes and hypertension, such as endocrinologists and cardiologists.”

Findings showed 80.3% did not receive guideline-concordant assessment during the study period. Full CKD assessment, which occurred in 19.7% of patients, was most common in patients with both diabetes and hypertension (41.4%) compared with those who had diabetes (28.7%) or hypertension (10.5%) alone.

A greater percentage of patients received partial testing, with 89.6% receiving eGFR testing only and 21% receiving uACR testing only.

A state-by-state comparison demonstrated state-level variations with annual testing rates ranging from 5% to 30%. Nationwide, researchers observed a “modest” increase in the testing rate each year between 2013 and 2018 (from 10.7% to 15.2%).

"This large retrospective analysis provides real-world evidence that rates of guideline-concordant CKD testing in at-risk patients remain low and did not improve much over the studied period," study co-author David Alfego, PhD, senior data scientist at LabCorp, said. “As the at-risk population grows because of increases in diabetes, hypertension and obesity, it is imperative to identify and treat early kidney disease.”