Few diabetes, hypertension patients get recommended testing for kidney disease
Only 21% of patients with diabetes, hypertension, or both underwent urine albumin-to-creatinine ratio testing in a year, despite guideline recommendations, a large recent study found.
Testing for chronic kidney disease (CKD) with estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR) was low among U.S. adults with diabetes and hypertension despite guideline recommendations, a study found.
Researchers used results for tests between 2013 and 2019 from a national commercial clinical lab company to assess the rate of guideline-concordant CKD assessment, defined as eGFR and uACR testing within the study year. Results were published Aug. 5 by Diabetes Care.
The study included 28,295,982 patients at risk of CKD: 16.2% had diabetes, 63.8% had hypertension, and 20.1% had both. Of these, 80.3% did not receive guideline-concordant assessment: 21.0% had uACR testing and 89.6% had eGFR. Testing for CKD was ordered at least once in 28.7% of patients with diabetes, 10.5% of patients with hypertension, and 41.4% of patients with both conditions. The rate of testing increased modestly nationwide from 2013 and 2018, from 10.7% to 15.2%.
The study authors noted that testing for CKD in patients with hypertension and diabetes remains low in routine clinical care, despite guideline recommendations. They compared their findings to testing for diseases like colorectal cancer, which has a 68.8% colonoscopy rate nationwide in at-risk individuals, despite being more invasive and costly.
Primary care physicians are key to early identification and management of CKD, the authors wrote, noting that family practitioners and internists ordered the majority of tests in the study. The at-risk population for CKD is increasing as rates of diabetes, hypertension, and obesity do, so it is imperative to identify and treat CKD early, they said. “The effectiveness of two simple, inexpensive tests for diagnosis that can be ordered by primary care offers benefits to population health and a contrast to other diseases, which may require more expensive and invasive tests for detection and risk stratification,” the authors wrote.
A September 2020 article in ACP Internist focused on the importance of screening for chronic kidney disease in patients with diabetes.