Abstract: TH-OR037

A Pilot Pragmatic Randomized Trial of CKD Screening to Improve Care Among Hypertensive Veterans

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 305 CKD: Clinical Trials and Tubulointerstitial Disorders

Authors

  • Peralta, Carmen A., University of California San Francisco/SFVAMC, San Francisco, California, United States
  • Frigaard, Martin J., Kidney Health Research Collaborative, Oakland, California, United States
  • Rubinsky, Anna, University of California, San Francisco, San Francisco, California, United States
  • Rolon, Leticia, UCSF Medical Center, San Francisco, California, United States
  • Lo, Lowell J., None, San Francisco, California, United States
  • Voora, Santhi, UC San Francisco, San Francisco, California, United States
  • Tuot, Delphine S., University of California, San Francisco, San Francisco, California, United States
  • Powe, Neil R., Priscilla Chan and Mark Zuckerberg San Francisco General Hospital & University of California SF, San Francisco, California, United States
  • Shlipak, Michael, San Francisco VA Medical Center, San Francisco, California, United States
Background

It is uncertain whether screening for chronic kidney disease (CKD) can improve care of persons at high risk for complications.

Methods

We conducted a 3-arm randomized controlled trial within an integrated primary care clinic at the San Francisco VA (SFVA). The electronic health record (EHR) was used to identify eligible participants (from administrative codes), deliver interventions and ascertain outcomes. Non-diabetic hypertensive veterans without known CKD who receive primary care at SFVA were enrolled and cluster-randomized (41 clusters by provider) to Usual Care (UC), CKD Screening with patient-provider Education (SE) or CKD Screen-Educate plus clinical Pharmacist management (SEP). CKD screening included creatinine, cystatin C and albuminuria and CKD was defined as eGFRcreat-cys <60 ml/min/1.73m2 or albumin to creatinine ratio ≥30mg/g. Consent was written for providers and opt-out by mail for veterans.

Results

We mailed 2,012 consent letters and 133 veterans opted out. After exclusions, we randomized 1,819 veterans. Of 1,142 veterans randomized to intervention, 525 were identified with an upcoming appointment and had CKD screening ordered, among whom 371 (71%) completed testing. The yield of new CKD cases was 73 (20%, 95% CI 16-24%). Overall, proportions of participants who initiated ACE/ARB by end of study were 4.3% for UC, 6.0% for SE and 6.3%, for SEP. Proportions who initiated diuretics were 3.6% (UC), 4.8% (SE) and 6.0% (SEP). Among participants with screen-detected CKD, proportions who initiated ACE/ARB were 14.6% (SE) and 12.5% (SEP), and proportions who initiated diuretics were 7.3% (SE) and 9.4% (SEP). Differences were not statistically significant (all p>0.2). No adverse events were reported by providers.

Conclusion

We successfully implemented an EHR-based pragmatic trial of CKD screening with high rates of participation, and a 20% yield of undetected CKD among those screened. A larger study is required to test whether CKD screening would impact process of care and clinical outcomes.

Funding

  • NIDDK Support